A Truism in the Practice of Medicine: THINK SIMPLE

Jerry went to a psychiatrist. "Doc," he said, "I've got trouble. Every time I
get into bed, I think there's somebody under it ... I'm going crazy!"

"Just put yourself in my hands for one year," said the shrink. "Come to me
three times a week, and I'll cure your fears."

"How much do you charge?"

"A hundred dollars per visit."

"I'll have to think about that," said Jerry.

Six months later the doctor met Jerry on the street . "Why didn't you ever
come to see me again?" asked the psychiatrist.

"For a hundred bucks a visit? A bartender cured me for $10."

"Is that so? How?"

"He told me to cut the legs off the bed! Ain't nobody under there now!!!"

There is a truism about the practice of medical diagnosis and treatment in that amusing story. There is often a simple explanation for a complex combination of symptoms with which the patient is presenting. It is the sign of a thinking physician to find that explanation. The medical workup for a disease also can be simplified. Just because techniques such as expensive CAT scans or MRIs, as examples, are available, ordering these may not substitute for appropriate testing with less expensive and less invasive approaches. Often, many various testing methods are used which are unnecessary because it is easier for the physician to write the orders for these tests than to take time to THINK. And the issue of thinking simple can be applied to medication and prescription writing. Is that more expensive drug (usually the newer drug) or drug which requires more patient attention to be compliant with the directions really necessary to prescribe or could a less expensive drug or one to be taken once a day be equally as effective or in the case of compliance issues (cost or dosing schedules) even more effective? Why is thinking simple important? The simple diagnosis is often the more common. The simple workup is often the less expensive and the least harmful for the patient, especially if invasive testing is being ordered. The prescription of treatment which is not being influenced by pharmaceutical company pressures to use their newer and more expensive drugs or procedures more to enhance the physician’s pocketbook, all will make medical care less a financial hardship and lead to better care for all patient groups. I don’t want anyone to think that the effective practice of medicine is always simple. It isn’t. But doctors must learn when they are diagnosing and treating their patients to STOP A MOMENT, TAKE A DEEP BREATH and just consider to THINK SIMPLE. ..Maurice.

Human Enhancement in the Healthy:A Role for Physicians?

Continuing with the topic of human enhancement, I had a topic on my now inactive "Bioethics Discussion Pages" on whether there was a role for physicians to prescribe or perform procedures for strictly cosmetic reasons: in order to improve the patient's appearance and performance in the absence of disease or deformities from birth or injury or illness? Here are my visitors responses 2000 to 2004, with the oldest at the bottom of the post. As I noted in the comments section to the last post, I am not in favor of such human enhancement by physicians and therefore I would not be in favor of human enhancement of brain or body with nanotechnology in which physicians would be involved. ..Maurice.




Is a Role of Physicians to Prescribe or Perform Procedures for Cosmetic Reasons in the Healthy?

There are questions raised whether everything physicians do or are requested to do are part of their role which society has given them through the ages. There have been questions, for example, whether physicians should participate in legal executions. Tylor Kase, in his posting below, raises the issue of prescription of anabolic drugs to improve performance.

The concern expressed by Tyler raises a more general issue and that is whether physicians are responsible to not only prevent and treat disease but also to make patients look and feel more attractive and powerful. Prescriptions for anabolic steroids as Tyler noted have potential hazards but also there are hazards related to, for example, cosmetic surgery.

On Friday February 11, 2000 Tyler Kase ( lil_g_ride@hotmail.com) wrote:

"My position on Anabolic steroids is that I don't think it should be used only by doctor's through the means of rehabilitating patients who have weak ligament, joints, and tendons. It shouldn't be used by any kind of athlete to help them to become better at sports and to make them more muscular. After doing a little research on this topic I learned some of the side effects that comes with these steroids such as hair loss, massive amounts of acne on the body, and men developing breast. I think everyone should be informed on these side effects. I'm sure people know what they are. I just don't understand why people still use the steroids. This is not a kinda of drug you want to abuse. People should think before they ruin their lives.

Thanks alot,

Tyler Kase"

Here is the question:
Do you think it is right for the role of a physician to include writing prescriptions or carrying out procedures in order to improve the patient's appearance and performance in the absence of disease or deformities from birth or injury or illness?


---- THE DISCUSSIONS ----
Date: Thu, May 6, 2004 12:11 PM From: khmaio@earthlink.net To: DoktorMo@aol.com

Do you think it is right for the role of a physician to include writing prescriptions or carrying out procedures in order to improve the patient's appearance and performance------------------------------( in the absence of disease or deformities from birth or injury or illness)?

The issue that comes to mind ( I would end the sentence above earlier) is administering drugs so that a person can appear competent to take part in a trial. The "cosmetic" reason, an appearance to present a false reality, is in direct conflict with ethics, a blurring of line betwen medical ethics and trial ethics.

The drugs are forced by law. Should they also be forced by medicine is the dilemma.
Harold A. Maio


Date: Wed, Apr 2, 2003 4:48 PM From: joquina@hotmail.com To: DoktorMo@aol.com
It all depends on what type of surgery it is.I do not see anything wrong for a woman who want larger breast if they are a size A or B cup.I do see something wrong for a small frame woman to want a size D cup. I do not see anything wrong with having a tummy tuck done for someone who lost a substantial amount of weight; but still have excess skin.I do believe that some of the cosmetic surgeries being performed today are not necessary. Society is so big on looks and the shape of their body; plastic surgeons see it as away to make money by doing these outrageous procedures.


Date: Mon, Nov 11, 2002 8:39 AM From: elizabethalecrone@hotmail.com To: DoktorMo@aol.com
DoktorMo@aol.com My name is Elizabeth LeCrone, I am a Philosophy major at the University of Oklahoma, a healthcare worker for over twenty years and the wife of a physician. My interest in the field of medical ethics has increased over the past ten years because of the changes in the healthcare delivery systems and the new technology introduced in the past decade. The responsibility of a physician is to treat each patient to the best of his ability, to inform patients of possible side effects of any procedure or medication and to also safe guard the mental health and welfare of his patient. When you deal with the physical enhancement of a person you deal not only with the physical appearance of that person but also their feelings about their own identity and self-perception. Our culture dictates that everyone should be young and thin and beautiful and those who do not meet that criteria often suffer. A physician who is a skilled reconstructive surgeon can take years off of a persons appearance. Unfortunately, there are many less than ethical doctors and dentists who have jumped on the bandwagon to do skin-peels, botox injections, colagen injections, etc. just because these are seemingly simple yet lucrative procedures. Sometimes they are not skilled or trained to give the results that should be expected. The sad commentary for our society is the fact that as humans we have become conditioned and compelled to be more than what nature made us to be. For a child who is ridiculed by a nose that is a little to big or ears that stick out too far, most often, time is the best cure. Any mother who would consent to allowing her sixteen year old daughter to have breast augmentation is sending a very wrong message to her daughter. Our society is so caught up with sex appeal, that every twelve year old girl wants to be Brittney Spears. The idea of reducing young girls to sexual objects before puberty is just wrong. All enhancing surgeries are not successful. Many times the expectations of the patient go far beyond the ability of the surgeon, no matter how skillful. Many times, the psychological need of the patient is what needs to be addressed, not their bodies. It is my opinion, that to constantly be searching for artificial means to satisfy our egos and failing to accept ourselves as human beings, we lose sight of the importance of our individuality. Women more than men have struggled with unrealistic role-models. The media and advertising depends on the fact that we will never be satisfied with who we are and how we look. I am more than my appearance. I have tried to instill in my daughters their own sense of identity and self-worth. Medical advances have made it possible for anyone to do procedures that are cosmetic in nature. There are dentists who have gotten into the botox business because it is lucrative. There are plenty of OB-Gyn physicians who have turned their practices away from the delivery of babies to tummy-tucks and breast augmentation. This is a sad commentary of modern medicine. There will always be those in the profession who look more to the money than to the welfare of their patients. A physician who truly has the well-being of his patient in mind will not be doing procedures on his patients that he is not board certified to perform and most good reconstructive surgeons will look at the psychological motivation and seek counseling for that patient prior to any radical changes. Plastic surgery becomes an obsession to many who can afford it. It is the health care provider who must look beyond the revenue generated from the procedure and help his patient make a wise and prudent choice before electing surgery. Until we change the perception of a society who values Jennifer Lopez and any professional sports personality over the great minds of our world we will deal with unscrupulous physicians who seek to make a buck off those who are so shallow that beauty can only be "skin deep".

Date: Sun, Apr 27, 2002 8:21 AM From: paralogik@optushome.com.au To: DoktorMo@aol.com
It seems that it would be inappropriate to legally preclude treatment for non-pathological and non-medical conditions (I am very thankful for having had braces as a kid). western societies are built upon ideals of personal choice and freedom, and preventing people from pursuing their own aesthetic projects does violate this. however, being unwilling to completely proscribe against cosmetic surgery/prescriptions does not mean that we should fail to critique them when the social structure that such practices arise within and sustain can be extremely damaging, both psychologically and physically. the first problem i would like to suggest with the 'individual choice and freedom' defense is this: that it seems distinctly naive to claim that the motivations of people to get breast enlargements or liposuction or face-lifts arise from purely autonomous motivations. such desires arise within a social context which valorises certain physically ideals and stigmatises others. this is problematic. furthermore, our focus on appearance as something to be assessed, corrected, worked upon and subjected to judgement can lead to a real shallow materialism in our dealings with others and interpersonal relations. in such a context, can the desire to have surgery to correct the deformity of small breasts really be considered autonomous? secondly, I am interested in the extent to which aesthetic modification, in that it can involve surgery, can lead to the medicalisation of certain traits previously considered normal, i.e. the pathologisation of more and more features which we generally just live with. for example, the American Society of Reconstructive and Plastic Surgeons stated in an official comment to the FDA that small breasts are not only a deformity but a disease, which leads to increased levels of depression associated with poor self-image. surely this begs the question of whether it is the disease of small breasts which leads to poor self esteem, or the social construction of small-breastedness as disease and pathology requiring corrective surgery?! maybe what is required is not medical intervention to correct those features we consider aesthetically unacceptable, but a less shallow way of dealing with issues of beauty and self-esteem. all this may seem tangential to the issue of whether cosmetic surgery should be permissible. i do not believe that it should be prohibited, but I think that we should be very critical of it, and particularly when it is linked in with a capitalist system in which people's sense of self is exploited and manipulated in order to make money for cosmetic surgeons.
Date: Mon, Feb 4, 2002 10:36 AM From: joe_palmer@att.net To: DoktorMo@aol.com

Yes, I think a valid and legitimate role is for the physician to assist in improvement of a patients appearance and/or wellbeing even in the absence of disease. So much of our psychic health comes from our actual image as well as the mental self image we have. If appearance were not important, the cosmetic industry would not exist. The ability to enhance one's appearance should be encouraged and promoted. Joel Palmer


Date: Tue, Aug 7, 2001 4:43 PM From: dmacdoug@usc.edu To: DoktorMo@aol.com
This question opens up a very large area of physicians roles. Traditionally the physician has held a certain role in society. But in modern society that role is and has been changing for many reasons one of which is the law. Under US law and those also of many other countries, over the last century or so, physicians have gained a legal status that they didn't formerly have. They have been given the almost exclusive legal right to prescribe drugs and to perform surgery. This changes the physicians ethical responsibilities somewhat, for under this legal franchise, it means that if the physician, for moral, ethical, financial or other reasons, refuses to perform these tasks, he is, in practice denying those who would like to have these things performed, the right to do so. It would seem as though, the physician would have to choose either to reliquish the exclusive right to perform these tasks, or alternatively, accept the responsibility to do so. It wouldn't seem as though he could ethically take the position that I only can do this and then refuse to do so. It would not be the physicians role to make this choice, unilaterally on behalf of society.

Donald MacDougall dmacdoug@usc.edu
Date: Thu, Jan 4, 2001 11:28 AM From: aj_16_16@hotmail.com To: DoktorMo@aol.com
I think if the people want to pay for the doctor to make them look better or something, that is their business. I also think if the procedure is not going to harm anyone else, then the doctor should follow through with the patients orders.


Date: Wed, Dec 6, 2000 4:05 PM From: slicks@home.com To: DoktorMo@aol.com
Hi, I firmly believe in reconstructive and cosmetic surgery! I work for one of the most well respected plastic surgeons. I have seen him work wonders for patients. There are to many people out there who obviously have to much time on their hands, to be so opinionated about such a thing. Everyone is an individual and it should be their personal choice. It's about what makes them feel good, not what everyone else thinks. Anyone doctor can call himself a plastic surgeon but believe me it is not learned it is a true talent.


Date: Sun, Nov 5, 2000 5:47 PM From: keileym@hotmail.com To: DoktorMo@aol.com
what about liposuction? what if a only slightly overweight person wants liposuction? should it be provided even if the risks outweigh the benefits?


Date: Tue, May 16, 2000 10:32 AM From: af485@lafn.org To: DoktorMo@aol.com
Phisicians should definitely provide cosmetic care to patients, but always under the auspices of "primum non nocere". We are responsible not only to the patient's physical but also his psychic health. When a person's body image is defective, it is the physician's responsibility to help alleviate the psychic pain. Help might be in the form of counseling, psychotherapy, medications or plastic surgery or a combination of these. Of course whatever course is chosen, the same mandates apply as in any other treatment. Is the patient's request rational in view of what is requested? Does the physician agree that the treatment the patient wishes is the best in his opinion also? (If not, explanation of his reasoning against the treatment and, if the patient still wishes referral, this should be done by recommending the best physician for th the requested course of treatment). Does the benefit of the treatment significantly exceed the risk? This point is far more essential in cosmetic therapy than in the treatment of illness or disability. The physician might include a mental risk profile with a necessity scale from 1 to 10: 10) being a disabling or disfiguring congenital defect, 1) a recommendation by a family member or friend(?) that the patient's appearance might be improved by plastic surgery.Hans


Date: Wed, Mar 29, 2000 7:37 AM From: SBERKOWI@AspenMed.org To: DoktorMo@aol.com
Braces, acne, contacts - these are all types of treatements that are recommended to improve appearance and are generally accepted. Braces may often be recommended to simply straighten one's teeth without any space problem. Acne could be considered a normal developmental state, yet we treat it to improve appearance and prevent disfigurement. Contacts are often requested by patients so that they can get rid of their glasses and/or to improve their appearance. I site these examples to show that a universal ban on helping patients for cosmetic reasons is not appropriate, while a thoughtful approach to the use of any treatment that is primarily designed to improve appearance, such as growth hormone treatment for "normal" short stature (non-GH deficiency) or steroids to increase mass, is indicated. As with all treatments, balancing the potential benefits of the treatment against the risks of both the treatment itself as well as non-treatment of the "condition" is a worthwhile way to proceed. - Sheldon Berkowitz, MD

Human Enhancement Through Nanotechnology: Is it Right?

From Nano-Ethics comes this very interesting paper that looks at the arguments for nanotechnological human enhancement and presents the authors’ caution on the subject.

Many of you will wonder: what is “human enhancement through nanotechnology"? Well, I have copied below the section of the paper which tells us what it is and what it isn’t.. This should whet your appetite to click on the link above and read the entire paper. I think I’ll be posting on the ethics of human enhancement and nanotechnology in the future. But maybe, especially after reading the entire paper (it's not too lengthy), you might want to comment here. ..Maurice.



March 27, 2006 - RESEARCH PAPER

[This paper may be reprinted under a GNU Free Documentation License. Also see Center for Responsible Nanotechnology for other papers in this collection.]


Published in Nanotechnology Perceptions (2006), Vol. 2, Issue 1: 47-52:


Nanoethics and Human Enhancement:
A Critical Evaluation of Recent Arguments

By Patrick Lin and Fritz Allhoff


2.0 Context

Before we proceed, we should lay out a few actual and possible scenarios in order to be clear on what we mean by “human enhancement.” In addition to steroid use to become stronger and plastic surgery to become more attractive, people today also use drugs to boost creativity, attentiveness, perception, and more. In the future, nanotechnology might give us implants that enable us to see in the dark, or in currently non-visible spectrums such as infrared. As artificial intelligence advances, nano-computers might be imbedded into our bodies in order to help process more information faster, even to the point where man and machine become indistinguishable.

These scenarios admittedly sound like science fiction, but with nanotechnology, we move much closer to turning them into reality. Atomically-precise manufacturing techniques continue to become more refined and will be able to build cellular-level sensors and other tools that can be integrated into our bodies. Indeed, designs have already been worked out for such innovations as a “respirocyte” – an artificial red blood cell that holds a reservoir of oxygen.[2] A respirocyte would come in handy for, say, a heart attack victim to continue breathing for an extra hour until medical treatment is available, despite a lack of blood circulation to the lungs or anywhere else. But in an otherwise-healthy athlete, a respirocyte could boost performance by delivering extra oxygen to the muscles, as if the person were breathing from a pure oxygen tank.

What we do not mean by “human enhancement” is the mere use of tools, such as a hammer or Microsoft Word, to aid human activities, or “natural” improvements of diet and exercise – though, as we shall discuss later, agreeing on a definition may not be a simple matter. Further, we must distinguish the concept from therapeutic applications, such as using steroids to treat any number of medical conditions, which we take to be unobjectionable for the purposes of this paper.

Also, our discussion here can benefit from quickly noting some of the intuitions on both sides of the debate. The anti-enhancement camp may point to steroids in sports as an argument for regulating technology: that it corrupts the notion of fair competition. Also, some say, by condoning enhancement we are setting the wrong example for our children, encouraging risky behavior in bodies that are still developing. “Human dignity” is also a recurring theme for this side, believing that such enhancements pervert the notion of what it means to be human (with all our flaws).

On the pro-enhancement side, it seems obvious that the desire for self-improvement is morally laudable. Attempts to improve ourselves through, for example, education, hard work, and so on are uncontroversially good; why should technology-based enhancements be viewed any differently? In addition to virtue-based defenses of technological enhancement, we might also appeal to individual autonomy to defend the practice: so long as rational, autonomous individuals freely choose to participate in these projects, intervention against them is morally problematic.

In More Than Human, it is interesting to see that the debate is framed as a conservative (anti-enhancement) versus liberal (pro-enhancement) issue.[3] This proposed dichotomy is undoubtedly influenced by the creation and work of the U.S. President’s Council on Bioethics. Led by Leon Kass, M.D., PhD, the council released a report, Beyond Therapy, in 2004 that endorsed an anti-enhancement position; this report has become the prime target for both liberals and pro-enhancement groups. However, it would be a mistake to think that the issue necessarily follows political lines, since there may be good reason for a liberal to be anti-enhancement, as well as for a conservative to support it.

Aiding and Abetting a Suicide?

OK..as a segue from my last posting and as a followup on a topic I have mentioned on this blog previously, here is a real case with which I had experience.
A lady in her 30s, in jail for a prostitution charge, hung herself in the jail cell. She was brought to the hospital still alive but with severe brain damage due to the prolonged lack of oxygen to the brain before she was found (anoxic encephalopathy). The patient, of course, was comatose and couldn’t communicate and was kept alive by breathing by means of the ventilator and blood pressure sustained by IV medications. When the family arrived at the hospital the neurologist told them that the prognosis was grim and if the patient survived at all she would be severely handicapped. The family decided to have the physicians stop the life support and allow her to die. The hospital, however, was concerned that by turning off the life support, the act might be interpreted as aiding and abetting a suicide, an action which was against the hospital’s religious directives. So.. if you were the ethicist called in for consultation, what would you have advised the hospital? ..Maurice.

Ethical Dilemma: Attempt Suicide Refuses Rescue

Ethical dilemmas are fascinating and a challenge because one has to come up with a decision, usually regarding two contrasting approaches, both of which have ethical merit. The challenge is great in medicine when life vs death rests on the final decision.

From my now inactive “Bioethics Discussion Pages”, I have reproduced below such a dilemma as presented to my visitors during the period from 1997 through 2004 (the oldest responses are present at the end of the posting). I hope my current blog readers find the responses interesting and hopefully some will add their own comments. ..Maurice.

Attempted Suicide Patient Requesting to Die and Refusing Rescue

The case is that of a 35 year old white single female who was found on her bed stuporous and moaning by her father and mother with whom she lives. There was a note in the room written by her explaining that she had carefully considered her life and what was happening to her and that she wanted to die. There was evidence in the bathroom that she had most likely taken three bottles of different pills including barbiturates. The family immediately called the paramedics and the patient was taken to the nearby hospital emergency room. The physician there was presented with the note and the bottles and since the patient was not fully unconscious began to insert a nasogastric tube to aspirate the contents of the stomach. As he was attempting to get the tube down, the patient became briefly more responsive and cried out that she didn't want the tube, she didn't want any treatment and that she wanted to be left alone and allowed to die. She moaned that she had left a note which said she wanted to die and she meant it. The family arrived in the next few minutes and informed the physician that she had not seemed depressed to them and she had never seen a psychiatrist but the medications were prescribed by her general physician. When told about what she had requested of the physician, the family urged that the doctor continue treatment. The physician realized that if she had consumed the pills in the bottles she would most likely not survive without medical treatment and yet it seemed clear that she did not want any treatment. What should he do next?
The issue is whether the doctor must follow the request of the patient and stop treatment and allow her to die. Does the principle of patient autonomy apply here? Can the physician perform a treatment against the consent of the patient? What is the responsibility of the ER physician in this matter? Must the physician be required to participate in completing a yet uncompleted suicide attempt?




Date: Sun, Mar 28, 2004 1:46 AM From: snoopy4meows@peoplepc.com To: DoktorMo@aol.com
Talking as a person who has been to the ER numerous times for overdosing, I can identify with this woman. Unless you have a terminal illness and are very old, I don't think anybody wants to die. I have said I wanted to die and even thought it, but if I really wanted to do it, I would know how to do it right. Anybody who says they want to die, is a bloody fool. She is not in her right mind. I am sorry to say that, but that is from one overdoser to another. The doctor is in the ER for one reason, to treat patients and save lives. He should do his job.

Date: Tue, Jan 20, 2004 8:34 PM From: Seth_Fam@msn.com To: DoktorMo@aol.com
First do no harm is the oath doctors have to abide to. I am confident that the doctor in the ER knows that oath and that he did what was necessary to save the woman's life ether she wants it or not. Obviously she is unable to make decisions for her self regardless of what the note says. I read in an article, about aggressive behavior that every act of violence against others or oneself is a cry for help. This woman committed an extreme act of violence on her self, she needs all the help she can get.

Date: Fri, Mar 1, 2002 11:18 AM From: lurane@webtv.net To: DoktorMo@aol.com
Regarding the 35 year old woman who tried to commit suicide and wound up in the ER First of all doctors take an oath to do no harm. There should be hestitation to give her medical care immediately. Our laws dictate that the patient should of had a durable power of attorney for medical care if she was unable to make her own decisions. Or living will. Why didnt the nurses, hospital or doctors contact the doctors who gave her the medications and treated her prior to this event and get their diagnosis? Even if it had to wait until she had received emergency care. Were there any signs of suicidal thoughts with her doctors beforehand? Did they send her for more specialized care? The issue that a lawsuit could remedy the problem is horrible. A lawsuit would do nothing for the woman except make her life more miserable and the lawsuit against the doctors would just make them more likely to not want to work with those kind of situations. Why cant anyone see that proper health care for her in the first place would of been the best plan? Today doctors dont even recognize their own patients, they rely on the patients to diagnosis themselves, they hardly ever have all of the medical records, if a patient doesnt have insurance needed tests are never done and everyone is in such a hurry no matter what the patient has even a basic non emergency patient gets the short end of the stick. And doctors talking to each other about the same patient? HA! Nurses HA! I feel sorry for the woman. Nobody helped her before she got to this point. I feel sorry for the doctor in the ER. He didnt choose suicide for her. And what makes anyone think if you want to kill yourself you know how to do it? It isnt like you get to try it a couple of times to figure it out. In life we can die for the simplest of causes and sometimes even the most extreme causes we still live. I doubt if any 35 year old woman would know the exact dose and combination of medications that would cause her death. Medicine is supposed to heal the patient. The system that is in use today is only reactive and uninformed for alot of people. I say put yourself in the shoes of that young woman. I would of helped her find proper care and a program to pay for it. You can say it was too late for that by the time she made it to the ER and this time yes, but why not repair the system so these things are decreased. Is anyone going to tell her while she is there about her legal rights and how to bypass her parents medical decisions for her? No one ever talks about this until you are in that in between place. And if she had that paperwork in her medical record already did anyone think to call her doctor and check? Those things called Living Wills. Everyone can say it is not my fault, but i say if we know this happens what are we doing to fix it? It is a disgrace to read the nurses who say she should of done it right the first time. They are probably working two shifts for very little pay and have a patient load they cannot bear and it is that way non stop. The system needs that fixed too. And since when have doctors needed to be lawyers? It makes me want to rollover and shout.
lurane

Date: Mon, Sep 24 2001 4:28 AM From: robynann@gateway.net To: DoktorMo@aol.com
Does the principle of patient autonomy apply here? No the patient is currently incompetent and we do not know if the not was written before or after taking the meds. Also, what was the patient's mental status at the time of writing the note this not an advance directive or DNR and even if it was the patient is not terminal.
Can the physician perform a treatment against the consent of the patient? Yes, because the patient is unable to give consent and the situation is life threatening. Once the patient awakens she can extubate herself if she wants but she better be prepared on being re-intubated.
What is the responsibility of the ER physician in this matter? Follow the standards of practice and resuscitate the patient. If he does any thing else he will find himself in court and will lose.
Must the physician be required to participate in completing a yet uncompleted suicide attempt? No. If your are going to end your life do it right. She should have taken the meds so she would not be found until she was cold and dead.
I am a critical care nurse and we get these patients after the ER saves them and half the time they are psych patients or seeking attention for help. I feel sorry for these persons, 1: because they feel their life is so bad they must end it and 2: because the were unable to carry out their wishes. I have told my colleagues that if they save me after a failed suicide attempt I will never forgive them. Anyway like I said earlier if your going to do it do it right!
Jason D. Nichols, RN, Broken Arrow, OK. 74011, robynann@gateway.net

Date: Wed, Sep 5, 2001 2:35 PM From: tmeecern@aol.com To: DoktorMo@aol.com
I believe that if a person really wants to die that they will do what they know will kill them. They would not attempt suicide in a home, where they could be found, and also I don't believe they would leave a note. As far as the ER Physcian is concerned, I believe he should do everything he could for the patient, because the patient was under the influence of mind alternating drugs. Most attempted suicides are like someone else said, "A cry for help". Men succeed much better that women!

Date: Sat, Mar 24, 2001 1:55 PM From: cwganz@gte.net To: DoktorMo@aol.com
What a delimma for the ER physician and the family of this patient. The ER physician, I believe, would be actively assisting in the suicide of this patient if he fails to intervene with all possible life saving measures. This is not a patient who has suffered with a long, terminal illness whose resuscitated will prolong an inevitable death. This young woman, if her life is preserved, may go on to make a full recovery and be productive to society. Such a situation begs the question, "does the sacredness of life override any justification to terminate it, no matter how painful, difficult and hopeless that life may be?"

Date: Sun, Aug 6, 2000 12:16 PM From: Julian@greenwoodwinn.freeserve.co.uk To: DoktorMo@aol.com
As presented the facts appear to be:
1. The patient took 3 bottles of pills 2. She left a note that appears to be coherent in its format and content 3. There is no history of psychiatric illness 4. The patient clearly stated to the doctor that she wished to die
The questions are: Does patient autonomy still persist in these circumstances ?
I would suggest that they do. The patient seems to have very clear objectives and taken the trouble to prepare for the suicide, not least by obtaining 3 bottles of barbituates. This alone indicates a high level of premeditation.
With no history of psychiatric illness there seems to be no grounds for questioning the validity of the patients attempt at suicide.
Should the doctor treat the patient against her will ?
No. Clearly the patient wishes to die. She says so, verbally and in written form. In addition, the 'emergency waiver' cited as a reason for undertaking treatment without consent in the ER appears to be void in this case. The patient is coherent enough to state her objective and to request that the doctor does not intervene. She is refusing consent to treatment.
What is the responsibility of the doctor ?
To treat a patient until or unless the patient demands that treatment stops. Treatment may be undertaken with the consent of family members until or unless the patient is able to make that decision.
In this case, the doctor appears to have undertaken the role fully and completely. But the patient is now demanding that the treatment stop. The responsibility of the doctor is to comply with the wishes of his patient. And there is evidence that the request serious and genuine. There appears to be an element of premeditation (having three bottles of Barbituates) and a note.
Should the doctor participate in the suicide by withholding treatment ?
A far more difficult question to answer but let's try.
Participation suggests that the doctor is DOING something to aid the suicide. By withholding treatment I believe that the doctor is letting the patient's actions run their 'natural' course. The patient has taken the ACTIONS and engineered the circumstances, time, method and explanation of her suicide.
If the parents had not come home the suicide would have been completed and successful.
Participation can be passive, providing a means or a method. Perhaps a question that needs to be explored is 'should a patient with no psychiatric history that we know of have been prescribed Barbituates on at least one but possibly three occasions ?' The actions of the general practitioner require closer examination than that of the ER doctor.
However, in short, I believe the doctor will be doing nothing wrong by withholding treatment, especially as the patient has made that request verbally and (de facto) in writing. In complying with the patients wishes the doctor is providing the highest standard of care and allowing full patient autonomy.
Julian Winn RN MCIM DipM

Date: Wed, May 31, 2000 3:22 AM From: tris@mailcity.com To: DoktorMo@aol.com
I believe, there is a simple answer to this situation. If you have ever suffered from any form of depression, whether short-term or long-term, then you should understand how this patient felt. She took pills, and wrote a note explicitly saying, "I do not want to live"! As the doctor insisted on curing her, she reassured him that she did not want to live. What should the doctor do?. . . He should respect her decision for autonomy and don't cure her.
Many will say, "She is just suffering from depression and if he cures her, she can get help and then she would be thankful". Most people who suffer from depression attempt to get help and sometimes it doesn't work. Unless a person walks around dreary everyday then they are not depressed. Look around you, alot of people suffer from depression and if they choose to end their suffering, then let them.

Date: Mon, May 8, 2000 10:47 PM From: musicbernard@yahoo.com To: DoktorMo@aol.com
about the question of suicide in the ER:
Having worked on both the ambulance and in the ER for years, I can say confidently that almost 100% of the people who *REALLY* want to die, actually do. In other words, all the "calls" that never make it to the ER (successful suicides.... OD's, hangings, GSW's, etc.).
Obviously you can't stand around and let someone die, even if they want it. To do medicine is to preserve life. Now I *realize* there are instances in which "death is prolonged" rather than "life preserved." These cases are most commonly seen in the preservation of brain-dead people. (This is just an example). But in the case of a suicide, look at it this way: If you "betray" the patient by "saving" him, he can always "do it right" the next time, if he is so hell-bent upon dying. In other words, what he needs is help, not death.
Bernard Jain, musicbernard@yahoo.com, Applying to med. school.

Date: Tue, Apr 25, 2000 11:28 AM From: schindlt@mercyhealth.com To: DoktorMo@aol.com
I am intrigued by your case study. I was surfing the Web to see if there was materials on dealing with suicidal patients in the ER when I happened upon your Web site. The situation that has been brought to my attention in very similar to the case you present--but with some very interesting differences. In the situation brought to my attention, the patient is a woman in her 50's. Rather than being found after taking an overdose, she herself called 911. When brought into the ER she was clutching a document which directed the physicians to do nothing and to let her die. The document--written by her two years previously--was signed by two witnesses and notarized. The patient had been in the ER a number of times previously beacuse of suicide attempts. When her family arrived, they verified that she did not want anything done; and they indicated that they were in agreement. The situation left the care providers in a difficult position. They wanted to respect her decision about no treatment. And, from her previous trips to the ER, her decision not only about no treatment but about suicide seemed to be very clear. At the same time, the care providers felt obligated by their profession to respond to her. The institution where this occurred is now in the process of writing a policy--or at least some guidelines--should another similar circumstance arise.
I would be interested in getting copies of any such policies or guidelines that others have developed. Please e-mail them to me at schindlt@mercyhealth.com

Date: Thu, Mar 9, 2000 11:40 AM From: CCCOLIB@inetmail.att.net To: DoktorMo@aol.com
In re the patient who attempted suicide who tries to refuse treatment:
Suicide tends to be an impulsive act. Poisoning suicides also tend to have a component of the "gesture" in them. The individual acts impulsively and dramatically because it seems like a good idea at the time. These impulses also pass. As this patient may still be in the throes of this impulse, I am unwilling to let her do it.
I also believe that though autonomy is a good, it is not an absolute good. I think the principles of benificence and paternalism have their place in medicine, and the ED is one of them. While patient autonomy cannot be ignored, it is of lesser importance in the ED than in the office. Also, having stipulated that this patient has no underlying medical problems, if she recovers, is treated, and still wishes to commit suicide, she can certainly do so later. As a pathologist I know that suicide is absurdly easy if one is determined, even in an instutional environment, so we're not denying her that option later.
Finally, I think it is unfair to the medical personel to force them into an act of ommission in this setting. As I said, if one is truly determined one can slip oneself under a bus or hang oneself even while bedridden.

Date: Sat, Dec 25, 1999 5:30 PM From: dimbulbz@earthlink.net To: DoktorMo@aol.com
Hello, I am in a quandry simularly to this in the long term care facility I work in. Two major factors intersect here: one, as a social worker, harm to self and others would make it necessary to intervene. Secondly, the lack of medical issues, and primarily mood/depression signs and symtoms makes me question very seriously the persons ability to reasonably make the decsion she was choosing. Personally, if someone is 95, facing terminal diagnosis and has requested a natural death to occur, I would respect that. A teenager, with depression, hopelessness, and an obvious call for help, would most likely recieve the same response. Legally, "Patient wish supersedes directives or powers of attorney." Where was she a patient? Has she been deemed competent? Past behavior, choices? How is she able to cope
I am using my families e-mail address below. My name is Laurinda. Please feel free to mail them if you think this warrents further discussion. Thank you very much. [Moderator's Note: Also write to this website] L.J. Plank, MSG, LSW Ethics Chair Dimbulbz@earthlink.net

Date: Tue, Oct 26, 1999 4:22 AM From: cianyl@earthlink.net To: DoktorMo@aol.com
In our society, we assume people want to live. In some situations, death may be a rationally defensible option when weighed against the alternative state of living, such as when a person suffers from chronic and severe pain from which no modern therapies can provide relief. We must also assume, however, that persons experiencing such pain may be so influenced by there condition that they may not have ratioanlly considered other options and/or they don't have the emotional or mental strength to seek help on their own. Therefore, in situations like the one presented where there is evidence that the woman has not sought help nor has been provided help from her family, all the potential options available to her other that suicide have not been explored. This suicide is obviously a option of last repsort, she should be treated against her will so she may be recover and seek and/or be provided help.
Wow, was that a cold analysis, don't you think? Our intuitions want to say, "hey, look, shes really depressed, treat her now and get her some help." But in our day and age, we must ratioanlly defend those assumptions made by our gut feelings because others WILL question their validity. Plus, its a good spiritual exercise in that by challenging our intuitions it forces us to articulate those everday values by which we live. Thats my two cents I suppose, thanks for reading.
Sincerely, Todd Ludwig, M.A.

Date: Mon, Oct 18, 1999 1:16 PM From: photi@webtv.net To: DoktorMo@aol.com
I am a firm believer in RATIONAL suicide. I would place the woman under "observation" for a DEFINITE period of time, treat her with GOOD anti-depressants and psychotherapy, and even if she still wanted to kill herself, I would release her ----- after urging her to continue therapy (shows compassion, etc.). I WOULD NOT HOSPITALIZE HER UNDER ANY CIRCUMSTANCES!

Date: Thu, Sep 30, 1999 5:02 PM From: Hlfenton1@aol.com To: DoktorMo@aol.com
Even though she left a note wishing to end her life, and there had been no depression noted, I think someting is still missing psychiatrically. The physician should treat and reffer for psychiatric counseling to find the true meaning of "why" this was done. It would be interesting to find out after 1 year treatment if the young woman felt the same way.

Date: Sat, Jun 5, 1999 12:59 PM From: default@binghamton.edu To: DoktorMo@aol.com
The doctor most definitely has to complete treatment. Doesn't a doctor promise in the Hippocratic Oath , "to please no one will I prescribe a deadly drug nor give advice that may cause his death". It is the doctor's duty to complete treatment, they were trained to save lives, not watch them slip away.

Date: Sun, May 16, 1999 9:18 PM From: af485@lafn.org To: DoktorMo@aol.com
In this case, it would seem to me that the ER doctor's ethical position is clear. He must treat her, against her wishes. There are limits to patient autonomy, religious, moral nd legal. Suicide is prohibited by all religions I know of (with the possible exception of Shinto, which permitted harakiri under certain circumstances in the past). The state has an interest in the existence of its subjects and most jurisdictions in the worlr consider suicide a crime (even though suicide attempts are almost never punished). As was recently decided in one court in the trial of "Dr. Death", assisting in suicide is considered illegal. Morally, you must consider the person; we are told this woman was never depressed in the past (to her parents; knowledge) and appeared to function normallly until the date of her sttempt. This was therefore a sudden, rash decision and she might have changed her opinion one day or week or a month later, if she were rescued. Furthermore, a physician's duty is to save lives and to prevent an avoidable death.
Hans G. Engel, M.D.

Date: Wed, Apr 28, 1999 8:20 AM From: mtview1@gte.net To: DoktorMo@aol.com
She made her wishes known - she is an adult and has stated her wishes very clearly. Her wishes should be followed - not those of her parents.

Date: Fri, Feb 19, 1999 10:57 AM From: TWOCNTPLN@aol.com To: DoktorMo@aol.com
The case is that of a 35-year-old white single female who was found on her bed stuporous and moaning by her father and mother with whom she lives. There was a note in the room written by her explaining that she had carefully considered her life and what was happening to her and that she wanted to die. There was evidence in the bathroom that she had most likely taken three bottles of different pills including barbiturates. The family immediately called the paramedics and the patient was taken to the nearby hospital emergency room. The physician there was presented with the note and the bottles and since the patient was not fully unconscious began to insert a nasogastric tube to aspirate the contents of the stomach. As he was attempting to get the tube down, the patient became briefly more responsive and cried out that she didn't want the tube, she didn't want any treatment and that she wanted to be left alone and allowed to die. She moaned that she had left a note which said she wanted to die and she meant it. The family arrived in the next few minutes and informed the physician that she had not seemed depressed to them and she had never seen a psychiatrist but the medications were prescribed by her general physician. When told about what she had requested of the physician, the family urged that the doctor continue treatment. Given what pills were consumed, she will most likely not survive without medical treatment.
Ethical Issues
Should the physician follow the request of the patient and stop treatment and allow her to die, i.e. must the physician be required to participate in completing a yet uncompleted suicide attempt?
The Goals of Medicine
Promotion of Health
Treating the patient for overdue will promote patient's health. In fact, patient likely will die without treatment.
Prevention of Disease
Treating the patient will not prevent disease, but it will cause the dis-ease of patient's continued existence, given that she does not want to live. (It should be noted that from a medical standpoint, it would prevent dis-ease associated with death via overdose.
Relief of Symptoms/Pain/Suffering
Treating patient will relieve patient's pain and suffering only insofar as she has been made uncomfortable by her suicide attempt. Treating patient will, arguably, increase her pain and suffering insofar as patient believes that continuing her life will continue her pain and suffering.
Cure of Disease
Treatment of patient will cure disease (disease not being an illness, but impending death from overdose).
Improvement of Functional Status/ Maintenance of Functional Status
Treatment will greatly improve her functional status insofar as without treatment patient will die. Treatment will (or may) allow patient to return to life.
Prevention of Untimely Death
Treatment will prevent an untimely death. Although I will discuss issues regarding patient's preferences below, clearly, from her family's eyes, the death would be untimely. Likewise, I believe that society would generally feel that a 35-year old has likely not accomplished what she would have hoped for at this stage in life and, thus, the death is untimely. (I note that the fact that she is attempting suicide clearly indicates that she, too, feels that she did not accomplish her goals, or at least did not attain a certain level or she probably would not want to kill herself).
Education and Counseling of Patient
This is not really applicable. If treatment is forgone, there is certainly no time to educate the patient. If treatment is provided, patient will likely undergo some psychiatric counseling to determine why she wishes to end her life. Insofar as the issue of continuing treatment, however, there is no real place for education/counseling - they're only applicable to the outcomes (including education/counseling of the parents if treatment is not provided and patient dies.
Avoiding Harm to Patient
From a strictly medical perspective, treating the patient will avoid the greatest harm there is, death. From an ethical standpoint, that is, from a standpoint of patient preferences, quality of life, etc. continued life would be considered, at least from patient's perspective at this particular point in time, a harm to this patient.
The Principle of Proportionality is fairly clear. From a strictly medical perspective, the Goals of Medicine (as opposed to medical goals of the patient) are ultimately the goal of continued life in a physically healthy person. Thus the Principle of Proportionality would dictate that treatment be provided.
Patient Preferences
This provides an interesting matter. Here, we've got a patient who indicates very clearly (she has attempted suicide) that she prefers death to life. In addition to the act of suicide, she has written a note that states that she has carefully considered her life, and has chosen not to continue living. Finally, she regains some consciousness during her admission to the Emergency Room and states that she doesn't want treatment, that she left a note and that she wants to die. This evidence makes it clear that patient wants to die.
We must, however, ask ourselves whether or not she is competent in making her decision for forego life-sustaining treatment. Her parents have indicated that they did not believe that patient had been depressed. This point argues both ways. In one sense, the fact that she appeared to be lucid and without emotional distress can indicate that her state of mind was clear and that she was competent. However, the fact that her parents apparently failed to recognize that she is obviously depressed (I'm not aware of any happy people who attempt suicide) indicates either: 1) her parents have no real input as to patient's state of being or competence, since it is clear that they could not recognize emotional problems with patient; or 2) patient was competent in her daily life activities, but we cannot determine her competency in her private matters (since they were not revealed by patient to her family).
We also (and unfortunately we do not have any additional information here) do not know whether patient actually undertook a careful consideration of her life and whether her decision was competent that she believes death to be a better state of being. Her note states that she made careful consideration, but a simple statement that she did does not provide any information about her reasoning, analysis, etc. Perhaps her "careful consideration" was based upon a mistaken belief about her life or situation. Perhaps her "careful consideration" was based on a delusional psychotic episode, thus making an informed decision impossible. Thus, we have no real evidence of patient's ability to make a competent decision on this matter.
Quality of Life
Quality of Life issues include patient autonomy. If the treatment to save her life is commenced, patient's autonomy will be wholly ignored. Society does not have a problem with, and in fact supports, an individual's decision to terminate life-sustaining treatment. This is contingent upon our view of patient autonomy. We will see below that this situation differs from termination of life sustaining treatment in some ways, but the principal behind patient autonomy and patient's right to make medical decisions remains.
Quality of Life also includes the physician-patient relationship. Physician's paternalistic actions can irreparably harm this relationship, not only between patient and physician in this case, but also in all her future dealings with physicians.
Contextual Features
Family perspectives are clear. Patient's family want patient to live, and thus, support treatment.
Physician's perspectives are not stated herein, but it is presumed that health care providers would prefer to see that 35 year-old patients (who are otherwise physically healthy) capable of full recovery are treated. This is supported by the Goals of Medicine.
Public Policy perspectives are perhaps the most interesting. While it is true that public policy allows for the withdraw of life sustaining treatment, it is accepted that such withdraw is acceptable for patients in which death is imminent. Although patient's death is imminent, her approaching death is not the result of disease or accident beyond her control, but rather due to self-inflicted harm. Given that we cannot determine her mental capacity to have made this decision, we cannot allow patient to die. Suicide is often, according to psychiatrists/psychologists, a cry for help. Given this, public policy would seem to dictate that patient be treated. This will allow for patient to obtain necessary counseling to determine her reasons for suicide, and whether, in fact, she actually prefers life, but needs to deal with various issues in her life. It must be admitted that such treatment is an affront to patient's autonomy, but given the overpowering reasons stated above, patient's autonomy is worth sacrificing in these situations.
Financial perspectives are not relevant.
Cultural/religious beliefs can be, however we have no information regarding patient's religious beliefs. Some religions would consider suicide unacceptable and would also demand treatment be given.
Legal factors play a small role. Suicide is not illegal, however many states do not allow for physician-assisted suicide. In fact, only Oregon permits it. The legal question here is whether the physician would be assisting a suicide if he fails to provide treatment. I think it could be successfully argued that physician did not assist suicide, even if he let patient die. Physician did nothing to put patient in condition she is in (he did not supply drugs or any other medical intervention). There may, however, be an action for negligence or failure to treat if he does not treat patient, but these a different from assisting suicide.
On the continuum, the goals of medicine, principle of proportionality, quality of life and contextual features dictate that treatment be provided. Patient perspectives are not clear here since we cannot determine patient's state of mind or competence to refuse treatment in this matter. The decision to treat falls at absolute duty.
Daniel Seltzer, JD, Student, MA HealthCare Ethics, Rush University, Chicago, IL

Date: Wed, Dec 2, 1998 1:56 PM From: johnnyb84@hotmail.com To: DoktorMo@aol.com
As a practicing Emerg Doc, I don't practice with Socrates in mind very often, but I think there is not much of dilemma here. I treat her. If she gets lives, and wants to kill herself later, she will have the opportunity I'm sure. If she gets lives and and her depression is treated, she and her family may be thankful.
If I let her die, she will not have the opportunity to have her depression get better. If I let her die, (against the wishes of her family no less) I'm looking at many hours of talking with lawyers.
If I treat her, it is the unusual lawyer which would take the case ("so the doctor treated you and you didn't die and you want to sue him?")
Sorry for making it seem so simple, but to me it is. And yes I have treated people in this scenario several times in my career, and I have always treated them.

Date: Fri, Oct 30, 1998 5:32 PM From: ShArPeTuRn@aol.com To: DoktorMo@aol.com
I think that if someone is not in the right state of mind. Which usually when someone is sucidal they want to die. The doctor should do all he can to save the person, unless when the get out of the sucidal "room/stage" they will not be able to fuction like normal.
Sincerely, Penny

Date: Tue, Oct 27, 1998 4:33 PM From: XxU1N2C3xX@aol.com To: DoktorMo@aol.com
Suicide is more of a disease process rather then a rational decision. It is linked to low serotonin levels in the brain. The deficiency is caused by high levels of stress and psychological pain associated with chronic depression in some people and acute depression in others. In the case which is presented the family members of the 35 year lady said that Òshe did not look depressedÓ; but maybe she was and she just didnÕt show it. The patient wanted to die from what it said in the letter and even when the doctor tried to insert a nasogastric tube into the patient and the patient began to cry out that she did not want the tube and that she didnÕt want any treatment and that she wanted to be left alone and allowed to die. The physician cannot perform a treatment against the consent of the patient. The lady didnÕt want the tube and so the physician cannot give it to her. The patient has rights not to want something. The autonomy of the patient does not apply because, she can function independently with out the aid of the doctor but she governs her body herself and so she can tell the docter she does not want the tube and just wants to die. The ER physician is just like the other physician (doctor) they are not allowed do stuff without the consent of the patient and so they donÕt do anything. The physician is not required to participate in completing a uncompleted suicide if he or she does not wish to because the patient has taken his life in his own hand and can do what ever he or she wants to do and the 35 year old lady can do what she wishes because she is old enough to do so and the doctor can help if he wishes too. So the suicide patient can do what he or she wishes because they have the right to get help or not and the physician can not do anything. I think if the patient request to die then let the patient die.
From: Aarti Patel

Date: Wed, Sep 23, 1998 12:26 PM From: cmddml@sowega.net To: DoktorMo@aol.com
I generally believe individual has the right to accept or refuse treatment. Even when decision wile result in death. However, in this case, I believe the ER physician must press ahead with resesutation efforts for several reasons. First ,I have doubt the patient is competent to direct her own treatment following the ingestion of, presumably, a large quantify of barbiturates and other unknown drugs. I believe one must assume the other drugs are depressants and may cloud the patients judgment- at that moment.
If the patient had a long history of depression, therapy, etc. then one may feel justified in honoring her written note. In the absence of such evidence, treatment is permissible.
Charles M Davis, MD

Date: Sun, Jun 7, 1998 7:12 PM From: rramas@ix.netcom.com To: DoktorMo@aol.com
I am learning how to use the Internet and chanced on to this dilemma. the answer may be found in the Socratic dialogues Phaedo and Crito. In Phaedo Socrates argues that man's relationship to God is that of a slave or oxen to the master and just as the latter have no right to put themselves out of the way so man cannot. In Crito, he says that since he enjoyed the benefits of the state he must bear the burdens, so if life was worth living when it was painless then pain must be borne, too, because that is justice and justice precedes one's self interest and hence it is in the ER Dr's duty to engage in a Socratic dialogue with the patient after rescuing.

Date: Thu, Apr 30, 1998 1:08 PM From: N.DENHAM@newman.ac.uk To: DoktorMo@aol.com
The doctor should save this woman's life. After she has had counselling and when she realises that she has too much too loose, she may thank him for it. It's up to you though, can you really live with yourself if you assist her with her suicide??

Date: Sat, Feb 23, 1998 6:40 PM From: Tshcma@aol.com To: DoktorMo@aol.com
There is mounting research that suicide is a *disease process * rather than a rational decision. It has been linked to low serotonin levels in the brain. This chemical deficiency is caused by extraordinary levels of stress and psychological pain associated with chronic depression in some people and acute depression in others. Suicide Survivors (parents, spouses, siblings, children, etc. of someone who has completed suicide) and clinicians both report that the deceased often cited unbearable pain as the reason for wanting to die. Research on chronic intractable pain indicates that sufferers experience diminished self-esteem and a loss of control. This appears to occur with severe emotional pain ("psychache") as well. Suicidal individuals become trapped in a spiral of psychological stress which overcomes their physiological defenses. Suicidal individuals experience traumatic stress disorder where the trauma is confronting their wish to die. They want to die to *end their pain * not necessarily their lives. Their pain is temporary as is the transient chemical deficiency that makes them vulnerable. Their pain like all pain can be treated and ameliorated. Medications like Paxil, Zoloft, and other antidepressants can help, but take time to reach clinical levels. People no more want to die of suicide than they want to die of HIV or cancer. Applying the principle of autonomy to cases of suicidal individuals is inappropriate and unpardonable because of their temporary diminished capacity. Many completed suicides are the result according self-determination to individuals who are unable to act otherwise because of the nature of their condition. Doing so without meaningful intervention with their pain is unethical and negligent, and, in effect, assisted suicide.
Tony Salvatore

Date: Sun, Nov 23, 1997 6:02 PM From: MRock2915@aol.com To: DoktorMo@aol.com
The principle of patient autonomy does and doesnÕt apply here. It doesnÕt apply because the woman really isnÕt a patient, because she never wanted or agreed to treatment and that is the definition of a patient. It does apply because the woman, may not be fully competent at the hospital, but she was fully competent when she contemplated suicide and wrote the letter and decided to end her life. The woman made a fully competent choice and if no one found her before the pills took their effect, she wouldÕve gotten her wish and died. The doctor is obligated to follow the wishes of the patient, I think, because she is over eighteen and old enough to make her own decisions, and wrote the letter when she was competent. The doctor should allow her to die if that is what she wants.
The physician can only perform a treatment against the consent of a patient when the patient is under eighteen and/or has been incompetent their whole life. This woman is neither of these. She made her decision before she became unconscious and incompetent, so her wishes should be respected. The parents saying that she didnÕt seem depressed or anything shouldnÕt matter because they really donÕt know what was going on in their daughters life or how she was feeling. There are things that happened that her parents most likely didnÕt know about that made her depressed. The patient said in the note that she thought about everything and made her decision, it wasnÕt like it was some spur of the moment think.
I am really not sure what the responsibility of the ER physician is in this matter. The people in the ER are trained to rescue people who were in violent accidents and thing like that. The ER has been faced with overdoses on drugs before, but people who didnÕt overdose on purpose. The patient overdosed on purpose with hopes of ending her life. The ER physicians should just let her die. If the doctors try to and successfully save her and she really wanted to die, she will try again and their work would be for nothing.
The physician is not required to participate in any kind of suicide. A physician should be required to follow the wishes of the patient, because she made the decision to die. The doctor wouldnÕt be participating in her suicide, but just not treating a person who didnÕt want to be a patient in the first place.
I think that the woman should be able to die because that is what she wanted. She had many chances to stop what she was doing and live, but she did not want that. It is a uncomfortable situation because I can understand how parents wouldnÕt want to loose their child, and a doctor wouldnÕt want to loose a patient, but the woman chose to end her life. They should respect her wishes.

Date: Wed, Oct 8, 1997 3:33PM From: Babyblu953@aol.com To: DoktorMo@aol.com
I think if the 35 year old woman was in her right mind when she was saying in the emergency room that she wanted to die, then that's her choice, it's her body and she can do what she wants with it. But, if she is taking some pills that she has some kind of weird side effects to, then she wouldn't be in the right state of mind, and she'd have no idea of what she was talking about and should be further investigated. Also, taking to some consideration for her family, maybe they didn't see the hurt inside their relative, if there were any. There are a lot of issues involved in this decision, but it is right to go with what the 35 year old says if in the right state of mind, it's her body and she knows what she wants to do with it.

Date: Thu, Oct 2, 1997 3:00 PM From: cavcunit@ultratech.net To: DoktorMo@aol.com
I am not the doctor faced with this problem but surely he must continue treatment. It is my understanding that in most places assisting in a suicide is against the law. Refusal of treatment in most hospitals is accepted only after certain procedures are followed, one of which is assessment of capacity. Any 35 year old who truly wants to die would not choose a bedroom in her parent's house unless the parents were on an extended vacation and there was no chance of them walking in to stop the process. In my opinion it was a cry for help and, possibly, an attempt to punish her parents, for she must have known they would find her body. A true attempt would involve checking into a hotel mid-afternoon and let a member of the staff find her the next morning when it would be too late to do anything.
Elizabeth Sutton

Date: Tue, Jul 15, 1997 5:53 AM From: Nrse4morph@aol.com To: DoktorMo@aol.com
There is no dilemma here. In every contry that allows assisted suicide there is a process for implementing the wishes of the patient. It is not something that is allowed on a casual basis. I have a problem with the case as stated, although I do agree with an earlier comment, that she might not have in fact taken a lethal dose. With few exceptions, suicides who are truly serious about dying do not get found until they are either dead, or beyond rescue. This does not include those individuals who are, even temporarily, incompetent, and therefore unable to plan for their possible discovery. These individuals since they are not mentaly competent are not able to refuse rescue. If an individual wishes to commit suicide, an option I personaly find distastefull at this point in my life, then they should do so with a full awareness of the consquences of their actions to society, their family, and personaly. As with many other choices we make, it should not be done lightly As to the ER Doctor I'll hold her head still while you put it down.
Chuck Masters RN nrse4morph@aol.com

Date: Thu, Apr 10, 1997 3:33 AM From: jgregor@bitbucket.engr.sgi.com (John Gregor) To: DoktorMo@aol.com
Even if this scenario were to take place in a society where providing suicide-on-demand was legal, I believe that the ER physician would be compelled to make a best effort to save the patient. The largest concern that I have with stopping treatment is that the physician cannot be sure that the patient has consumed a lethal dose of medication. The patient may have only consumed enough to guarantee profound liver, kidney, or brain damage. The patient may also vomit before a lethal dose has been absorbed. Either could lead to the patient surviving, but in a very incapacitated state and exposes the physician to great liability. So, in reality, the question cannot be whether to treat or just stand by helplessly. If those are the only two options, the physician must intervene and treat the overdose. The question should be which active role the physician will take. If the physician were to decide that the patient was entitled to her wish to die, the physicial should administer a lethal IV dose of KCl, phenobarb, or other agent that guarantees a quick, painless death. I don't believe, however, that an ER physician can or should be placed in this position. He or she has too little information at hand. Without a psych consult the physician cannot judge whether or not the patient made an informed and rational choice. Certainly, the request from a barely conscious patient in the ER cannot be taken as consent. While I support the right to commit suicide, I think a proceedure must be established to eliminate the problems like in this example. There must be a psych consult. There must be a physician of record in charge of the case who prescribes and administers the lethal meds. There has to be some legal document stating the intention to die. There must be some sort of counsel/advocate/next-of-kin/etc. present who has been granted the legal authority to refuse treatment (or request treatment that hastens death) on the behalf of the patient. Etc. Without such a procedure in place, you wind up with a jumbled mess where family, EMS, and doctors are put in a situation where the only reasonable, legal action is to attempt to save the patient.
Thanks for an interesting question.
-John Gregor

Date: Wed, Apr 9, 1997 10:00 AM From: amb3234@edgar.k12.wi.us (AMBER BORCHARDT) To: DoktorMo@aol.com
This is a very difficult topic to discuss because there are so many different viewpoints. I believe that God put each one of us on this earth for a reason and when He thinks his plan has been carried out, HE will take the life He has given us. I think the decision should be made by each individual hospital whether or not to try to keep and attempted suicide patient alive or not.
Amber E. Borchardt

Date: Fri, Apr 4, 1997 4:13 PM From: gerlarch@mailhost.grolier.fr (GERALD LARCHE) To: DoktorMo@aol.com
It is a surprising but interesting problem. My opinion is that we should consider the general duty of society and of physicians; we may consider as a philosophical opinion that everyone is free to suicide; but this will cannot be considered as an objection against any rescue. Mutual aid is one of the greatest purposes of living in society. We may also consider as evident that despair is generally the cause of suicides. Somebody who is desperate should be considered as needing some help to live not to die. So, I think that letting the patient die should be considered as a criminal act.(In France it could be punished with a five-year prison sentence and a $ 100,000 fine). If you admit such a freedom, you should also consider all the laws that protect people against themselves or accidents as immoral because anybody should be free for instance to die in a car accident without driving-belt, or to be crushed by a car. Saving people is a duty. May I say that if I had respected her will, I should have let die 13 years ago the girl who became my wife and that obviously, she desired to die because of problems that she overcame. So there is a difference between free will and pathological desire and you can consider that suicide is a pathological desire. "The free man does not think at all to death, and his wisdom is a meditation not on death, but on life". SPINOZA Ethics, book 4, proposition 67; he also writes that when one suicides, one is defeated by external causes and because of one's powerlessness. So, if the will of suiciding people should be obeyed, we should consider that as a moral decline not as a proof of respect of autonomy.
Gerald Larche, teacher of philosophy, Paris. gerlarch@club-internet.fr

Date: Thu, Apr 3, 1997 8:52 AM From: rvisser@REX.RE.uokhsc.edu (rvisser) To: DoktorMo@aol.com
DoktorMo, I am a senior nursing student at the University of Oklahoma. I recently read your article concerning the ethical dilema faced by Doctor K., and feel very strongly that the physician should have done all that was within his power to save the life of this 35 yo female. It is my understanding that it is the duty of all health care members to do all that is within their scope of practice to prevent death. The exceptions to this include an advanced directive. There is a legal contract that must be signed by the patient and a witness if the patient desires to refuse life-saving procedures. If there is no evidence of this, the physician must do all that is within his/her power to save the patients life. It would be easier to say that because this woman wants to die, that we can all stand back and watch. The legality portion of this ethical dilemma leads me to the conclusion that the Doctor K. must perform the life-saving procedures.

Date: Thu, Mar 27, 1997 8:38 PM From: STA2560@edgar.k12.wi.us (SONNENTAG, STACY) To: DoktorMo@aol.com
This topic is just like Dr. K. he wanted to help people die the way they wanted to die. It is just like saying that if you are 80 years old and your husband/wife would like to die now because he/she doesn't want to die in pain, and they would like you to help them by doing something. So you the lawful other that you are decide to help your wife/husband out. Yet if the law would find out about you trying to kill your other they would arrest you for murder. Even though you were told to do what you did. Dr.'s are told to try and save everyone who comes to their attention. If they didn't they would be commiting murder. Even if a person that could have killed his family comes in with wounds, he still has to help him the best way he can. I believe that the doctor should have done everything he can to help the girl live. After that if she tries to kill herself again it won't be the doctors door that the police are knocking at because he tried to save her life. If he would have respected her wishes, he could be out of a job. I am only 16 years old, but this is my opinion. I don't agree with Elliot L. Goldman either. M.D or not!
Stacy Sonnentag, Student

Date: Tue, Mar 25, 1997 9:05 AM From: efought@fdldotnet.com (Eric S. Fought) To: DoktorMo@aol.com
This is a very interesting case because there is no visible illness that would justify a lack of support. The fine line comes into play when we discuss suicide and it's justification. Is it ever justified? If we believe that suicide is justified in cases of serious illness, (I don't) what about cases like this one. Soon people suffering from indigestion will request to die if they feel their life isn't worth living. A psychiatric consultation is needed in this case, following treatment. The role of the physician in this case is to protect the life of this patient who needs help.
Eric S. Fought

Date: Sat, Feb 15, 1997 10:41 AM From: eg0617@ix.netcom.com (ELLIOT L GOLDMAN, M.D.) To: DoktorMo@aol.com
Clearly a conundrum without approved guidelines. However, the physician should attempt to save the patient, then establish whether or not depression is responsible for her behavior. Psychiatric consultation would be helpful. If depression was not responsible, the principle of Patient Autonomy would apply thereafter. He would have to withold treatment if she returned the following day with another overdose!
Elliot L. Goldman, M.D. eg0617@ix.netcom.com

Can A Child Sue Physicians for "Wrongful Life"?

If a child is born handicapped due to a genetic defect that should have been detected by his mother's doctor, should the child be allowed to sue for damages, claiming "wrongful life", i.e., that the child would have been better off not being born at all?

I posed the question regarding about a child suing the doctor for a "wrongful life" on my now inactive Bioethics Discussion Pages. I got a large number of responses from my visitors between 1997 and 2004. They are displayed below with the oldest at the bottom of the posting.

I would like to hear the view of my current visitors including those who support the "right to life". ..Maurice.





"Should a child who was born handicapped due to a genetic defect that should have been detected by his mother's doctor, be allowed to sue for damages, claiming wrongful life, i.e., that he would have been better off not being born at all?"


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Date: Thu, Jul 1, 2004 6:56 {< From: Freak4unasti@aol.com To: DoktorMo@aol.com
hello, A healthy person cant judge a person who was born with a handicap or defect.(This is my opinon and not advice). Thank you


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Date: Sat, Jun 12, 2004 9:22 PM From: Lillibralove1@aol.com To: DoktorMo@aol.com
As I sit here looking for research for Wrongful Life for my Legal Research class I was disturbed by the issues that we as parent would even consider the thought to choose if our child should be or not be. My stomach has turned in knots for the Fact that if you choose to play you must take responsibility for whatever may happen after you play, (i.e.) Sex is not a toy that most people take it to be it is an act of love and if a child be conceived through the grace of god then through the grace of god shall you find the strength to care for the child that has been born onto thee. Further more the reason that I can say that you find the guidence you need to handle the challenging tasks of takeing care of a child or even a disabled child is I DO IT EVERY DAY AND I HAVE 1 DISSABELD CHILD AND 3 SMALLER CHILDREN. MY first born child at 18 years old and have had 10 years of doing what other people won't do because they don't want to. A child is a bleesing and should always be looked upon as such. And also one of the TEN COMANDMENTS says THOU SHALL NOT KILL......


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Date: Tue, Mar 25, 2003 6:22 PM From: hilburnjeff@hotmail.com To: DoktorMo@aol.com
Should a child that was born with a birth defect have the right to sue for damages claiming wrongful death? My answer in this case would be no. I realize that this is a very sensitive subject for some and I can sympathize with both sides of the spectrum. I think it is interesting that the common denominator for all the responses is that they are more happy having and loving their child even with defects than not wanting them at all. In my limited understanding of genetic testing, it is the parent’s responsibility to ask their doctor for these tests to be performed. I believe that it also is the parent’s job to be mindful of their own genetic history so that they may inform their physician of possible defects. Genetic testing is a relatively new science, and it is my understanding that there are often skewed results in this tests. I do not feel that this is the physician’s or parents’ fault. It is impossible at this stage for any doctor to ensure parents that their child will be 100% perfect. When two people decide to have children together, they are assuming the risks some possible birth defects. Does this mean they are liable to be sued by their progeny if they are born with a defect? I think not. My belief is that life is the greatest gift that can be given. Someone raised an interesting point that a child that was aborted is not able to sue for wrongful death, so how can a child born with a defect sue anyone for wrongful life?

Jeffrey W. Hilburn II


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Date: Tue, Mar 11, 2003 8:18 PM From: lconwayrrt@bigfoot.com To: DoktorMo@aol.com
Wrongful Life?

Most everyone on the list seems to be pretty much focused on their opinion or their belief about this topic. However, my understanding of the purpose of bioethics is to try to reach a reasoned - not emotional - decision about what options are best out of a selection of potentially all unpleasant choices. The "best" option is generally the one that most closely reflects the societal moral values and does the most good with the least harm. The discussion before us is not supposed to be about whether abortion is right or wrong, or whether the mother SHOULD have the right to abort an impaired child/fetus, or even whether the physician should counsel a couple or single mother to continue the pregnancy OR end the pregnancy. The issue is "Should a child who was born handicapped due to a genetic defect that should have been detected by his mother's doctor, be allowed to sue for damages, claiming wrongful life, i.e., that he would have been better off not being born at all?"

First, it seems to me that the child would not the be person to bring action if one were brought. At the time of the "offense," the child was a non-person with no rights, not even the right to be born if the mother chose otherwise. This is not a slap at the current abortion situation. It is a statement of fact, based upon the law of the land as interpreted by the Supreme Court of the land. Therefore, it would seem that since the child could not have acted on the knowledge of a genetic problem, the child has no standing to claim offense.

Second, genetic testing is not without risk. Acquiring the sample prior to birth carries risks, as another poster on this list noted. Poor outcome from the testing, the doctor is in court. Some alternatives exist, such as some high resolution ultrasound scans, but they cannot reveal all defects. Nor are they perfect. The fetal heart is extremely tiny, especially in the first and second trimesters, which is when the freedom to terminate a pregnancy is greatest. Detecting holes in a very small, beating organ when what you are actually seeing is "sonic shadows" is exceedingly difficult. The same is true of other fetal organs. Given the imprecision of some of these alternative tests, imagine the headlines and the size of the damage award if a healthy child were aborted on the basis of an incorrect test result!

Third, the word "should" in the question is a pivotal issue. "Should have been detected" according to whom? Is this according to widely accepted standards of care for similar circumstances, or is it the opinion of the suing attorney (who has a financial incentive to believe this is true)? Or "should" this have been detected because the mother or father want someone else to meet the cost of caring for a child that is not what they wanted? Or did the circumstance have no clear standard of what "should" have been done? Without a compelling understanding of the validity of the "should have been detected," the whole question is too nebulous to answer. Physicians are not psychic. They cannot divine the correct answer in every case.

Society, as a whole, is not best served by rendering all physicians afraid to do any testing, make any recommendations, or perform ALL potential testing on the off chance of an unsuspected disorder. Clearly, on a strictly Utilitarianism basis, an occasional birth of a baby with undetected defects is far outweighed by a medical reality in which physicians perform the most appropriate tests - and no more - thus spreading the resources of health care most effectively, improving the lives of millions, instead of spending thousands upon thousands of limited health care dollars (lira, francs, pesos, etc.) to exhaust every last possible legal risk for each and every pregnancy. The current climate of litigation in the United States has already brought health care to its knees over just such unreasonable expectations and legal actions. Pregnant women in many areas of the country must travel vast distances to find a physician WILLING to provide prenatal care and deliver the baby, just because of the high risk of being sued for doing - or failing to do - "something" that someone else thinks they "should have done."

Punish true negligence or malpractice or stupidity. However, unplanned outcomes occur even in the best of situations, with the best of care and the most reasoned decision making. If a physician makes a true, sincere, well-founded set of choices which are in keeping with the standard of care, and the patient survives ANYWAY, but doesn't like it, that is not malpractice. Punishing a physician in this situation produces the most harm to the most people by crippling the health care system. Such a decision, while perhaps emotionally and financially gratifying, cannot be viewed as ethical, in my opinion.

No. A child as described in the question should not be allowed to sue for "wrongful life" in the absence of definitive, standards based neglect or malpractice.

Larry Conway, Registered Respiratory Therapist (RRT) Saltillo, Mississippi, Internet student at Kansas University Medical Center


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Date: Fri, Feb 28, 2003 9:18 PM From: Denptrp@aol.com To: DoktorMo@aol.com
I do not know if my point makes sense or not, but in the future, where testing for genetic abnormalities prenatally for virtually all hereditary-linked diseases (including heart disease and cancer) will be available, would we consider someone who gets cancer or heart disease a result of wrongful birth or life? would we need to make a choice to let someone live even if they are likely to get cancer or heart disease (for example) in the future and suffer disability? disability at any age produces suffering, and disabling diseases can lead to death. but I can't imagine suing my parents' prenatal doctor for not detecting my high risk of getting stroke or heart disease (if the test should become available), if I am suffering from it. can you?


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Date: Fri, Jan 31, 2003 7:47 PM From: Kng3bn@aol.com To: DoktorMo@aol.com
On answering this question I think of myself. I was born with Hemophilia and it has changed my lifestyle to what I would consider a "normal life". The doctor is obligated to inform the parents of any genetic defaults, it's his job. This is why doctors are consulted during pregnancy because all parents want a healthy child. The other fact is that parents should keep in mind that they should be knowledgable in their own family genetics as to prepare. My children have an extremely slim chance of being Hemophiliacs; yet, my daughter has 90% chance of being a carrier. Her children if Males would be positive or her female child would continue to pass on this genetic trait. I do not agree in a child sueing his parents for being handicaped. As adults it is their responsibility to assist their child whom is at a disadvantage so he can grow up with a mature perspective and acceptance of how he must live his life.


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Date: Tue, Sep 24, 2002 4:51 AM From: ChigwellCh1ck@aol.com To: DoktorMo@aol.com
Hello, Having looked through a few discussions on your site, I see that most people are decent, thank goodness! :o)

On this subject of 'Wrongful Life' I should like to add my comment as follows please:-

Having discovered a genetic disease within my family, namely 'Huntingtons Disease', after the birth of my two sons, I was very angry with my mother. Had she told me of this, I would have delayed starting a family until I could have undergone thorough tests to ensure I would not be a carrier - in this case I would have had to have the disease myself in order to pass it to any offspring, since this is a 'dominant' gene. However, I have to say that I have my two sons, and I am extremely glad that they are with me. Incidentally, neither is at risk because having undergone tests, I do not carry the defective gene.

Since then, I had a break from childbirth of 15 years. I gave birth to a healthy little boy in 1998, and a healthy little girl in 1999. During the last pregnancy, there was a question that my little girl could have 'Downs Syndrome', so I was offered an amniocentesis. After thoroughly researching the procedure, I opted for a detailed scan at the University College Hospital in London instead. We were worried about the affect of the amniocentesis, both because of the incidence of abortion and the possibility of disfigurement in the womb if the baby happened to move. Our reasons was clear to us, even without much discussion - we were both happy to give birth to a Downs Syndrome baby who had no other significant health problems, such as liver/kidney/heart defects which would affect the child's quality of life. We did not want to give life to a child who would suffer extreme ill health and therefore have little or no pleasure in such a life. Often Downs Syndrome children are extremely happy, and contribute so much to the lives of others that they cannot be denied! We were willing to act on our gut reactions to the situation, and follow our hearts.

The scan told us that is was extremely unlikely that our daughter was a 'Downs' baby. She has very long legs for a start. But, most important to us, she had no defects of major organs that could be discerned by the scan. This meant that whether she was physically and mentally pleasing to others or not, she could be happy within a loving family such as ours.

I believe that situations need to be looked at individually. We were prepared to take responsibility, both for the birth of a Down's Syndrome child and the child's subsequent life, or for aborting a child who would be chronically ill with no or little quality of life.

I am anti-abortion in its usual context because I strongly feel that parental responsibility is supremely important, right from the moment of conception. However, I feel that human ethics can and should be brought to bear in a situation where it would be cruelty to bring life to a child who cannot have any pleasure in it. I feel that the decisions should be made by the parents, where the parents are able, and otherwise by court decision with the advice of the medical practitioner's involved. In this case, medical practitioners should not be held responsible unless they have obviously acted in an unlawful or cruel manner. Jackie Sherlock


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Date: Fri, Sep 6, 2002 3:12 AM From: n.long@centralservices.co.uk To: DoktorMo@aol.com
I came across the website while looking up bioethics. I think this question is one of the most difficult anyone can face.

In the case of some genetic defects such as those suffered by the child of Lori Nagle the obvious thing to do seems to be to spare the child from those 5 days of pain and yourself from the lifetime of pain that will follow the loss of a child. If you choose to abort such an ill baby you can at least console yourself that the child never suffered.

Having read all the responses posted here I can see that many feel that people are likely to sue because they didn't have their "Perfect Child". I think that these people are missing the point. The point is that these people were not given the information that would have allowed them to make such a difficult decision. It is not about having a "perfect child" it is about the fear a parent must feel when their child is seriously ill, and the emotional toll that caring for such a child would take. I am a mother myself and know how hard it is to raise perfectly healthy children, I can't imagine the heartache I would go through if my children had been born with Down's Syndrome or Autism. Not because of how it would affect my life (although that is something that everyone must consider) but because I would be worrying how my child would manage when I wasn't there, how they would make it in this uncaring world. I would worry that I'm not financially or emotionally equipped to provide the extra care that a disabled child would require. In these cases, the argument that every child is a gift from God and we should be grateful for every child born does not stand up. If I can't provide the proper care and support for a child who needs it then surely it is less damaging not to bring the child into the world in the first place. If I were to have the baby and then give it up for a adoption, would this be less cruel than aborting it? Letting my child go through life thinking that I didn't love it because of something it couldn't change? When in fact I would have given it up because I didn't feel that I could provide the amount of care it would need. Just thinking about it makes me sad.

It is a very tricky problem which I don't think people will ever agree on, but I feel that people should be given all the information available on the health of their unborn child so they can make an informed decision based on their own beliefs and circumstances. For a doctor to miss something that would normally show up in routine tests is negligent. For a doctor to deliberately withhold this information is outrageous.


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Date: Sat, Aug 31, 2002 12:39 PM From: mbertoll@yahoo.com To: DoktorMo@aol.com
Why is the child, who thinks that he should not have been born at all, not suing his own parents? That is where the defect originated. Perhaps the doctor could have done genetic testing and known about the problems in the fetal stage, but the parents could have requested genetic testing and known about the possibility of problems before conception. The doctor did not cause the problems and tests are not always accurate anyhow. Also, it seems an injustice to allow a child to sue for wrongful life when there is no recourse for a child who is aborted to sue for wrongful death.

Michael Bertolli


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Date: Thu, Aug 1, 2002 8:52 AM From: pixxystix@pa.net To: DoktorMo@aol.com
I just stumbled upon this website because I was looking for a way to do what some of these people find "Horrible". I want to sue my DR because my baby who was born July 12th died July 17th due to the simple fact that the person giving me my ultrasounds at 5 months and 6 months didnt see that his heart was on the wrong side of his chest and backwards and had 3 major holes in it How can something like this be missed? They are trained to look for these things and they had 2 chances to find it. My son was born with Trisomy 18, it is a fatal disease. He was 4 weeks early and was born not breathing. Had we known BEFORE we gave birth, we would of decided to not bring him back to life. But instead, I had to suffer the pain of delivering him thinking I was having a normal healty baby boy, then to get a slap in the face like this, also, we had to sit in the Neo Natal Unit for 5 days, day in and day out, watching out baby lay there hooked up to all those machines, I couldnt hold my baby, I couldnt feed my baby. All I could do was touch his hand !! And I am not sure you are familiar with this disease or not but, almost all babies born with this die within the first week of life, some make it for a month or so. But my point is this.. Since most of these babies die so early, they can never tell you if they are in pain, so who am I to prolong that if they are? I would give ANYTHING to have my baby with me right now, and its only been a few weeks. But I know he is better where he is at right now. I just wish I could of known before I had him so those 5 days I did have with him werent filled with saddness or questions of WHY??? They could of been strickly filled with LOVE !!!! As for suing for millions of dollars, I dont want the money, All the money in the world wont bring back my baby Austin. What we want is to find out WHY it wasnt picked up so we could of made the decision WE thought would of been the right one. And also to make all testings mandatory during pregnancy. They test you for Gestational Diabetes at every visit without asking you if you want it, so why cant they do these tests also? We just want to save someone else from having to go through this, and everyone out there who says this is not right, Until you have to sit there in the NICU with your newborn knowing he will never make it home, THEN YOU CAN TALK TO ME !!

Lori Nagle


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Date: Wed, Mar 27, 2002 3:26 PM From: jch0066@unt.edu To: DoktorMo@aol.com
Well, what can we expect in a country that legally allows parents to decide if their child lives or dies up to birth? What next? Like Hitler we can kill these children at birth to prevent these lawsuits. Or a child that develops a disability after birth..well, let's just kill them, too.

The thought that any parent can go to court and argue that they were denied the ability to kill their child is disgusting. And on top of that, they want money. How incomprehensibly sick! I refuse to argue about the quality of life of a disabled person. That's not my call. I myself am not disabled, but I will argue that it's not my choice to take that person's life away. Talking about how precious disabled children are is irrelevant. A Child is A Child. A human and human. This is saying that a disabled child is not as valuable as a 'normal' child. Who is anyone to decide how good my life is?

Am I the only one scared to go to sleep in this country? One more thing:

These parents that sue because they wish there children weren't born...? They get to keep the child they would have killed? That's injustice. Deborah Campano sued her doctor because her son was born with Down Syndrome. She won. She has money and she has a child. These parents that emotionally scar their children publicly and God knows how else should give those 'burdens' those 'monsters' away to human beings with a conscience who will give them the love they're entitled to as human beings.


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Date: Sat, Jul 28, 2001 4:14 AM From: lakusta@telus.net To: DoktorMo@aol.com
Who is going to pay for this girls plastic surgeory ? If her mother would have had the option she would have died to save this from happening !!! Herself having lived through 28 facial surgeries prior to the age of 15 when she finnally said she had enough & has endured a life of abuse & descrimination because of a birth defect!!! Is it really fair to say the doctor should have spend an extra minute at one of the 20+ prenatal appointments to figure out that this baby was breached throughout the pregnancy causing complications leading up to a facial defect??? How about the altrasound that was denied because the doctor said everything seems to be alright & we only allow them when there could be problems. The baby was breached at that point & I the father being gulable, not educated in fetal position thought the head was the butt, am suffering or wanting to blame somebody. Who is going to pay for the plastic surgeory because where we live in British Columbia, Canada this will be elective by the time she has grown big enough to have it done??? I am really POed that with an ultrasound this could have been not necessary!!! Does anybody Know any Good Lawyers & if so send me a brief note please. Yours Trully.

lakusta@telus.net


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Date: Wed, Jun 13, 2001 10:33 AM From: Diane.Orr@UTSouthwestern.edu To: DoktorMo@aol.com
I think that anyone (mother or father) who would even consider suing a doctor because of some genetic defect is "Insane"!! What would that parent have done previous to being able to have the genetic testing done? Besides, a handicapped child is a "Gift From God" (in my opinion). The child was supposedly created from love and should be given nothing but love - It's NOT HIS FAULT. Sometimes these children can live a long and meaningful life. Just because there is some type of "genetic defect" does not mean that that child won't be smart or be able to make a place in the world for himself. Suing the doctor won't change the genetics of the child and make him/her perfect, will it?

In my case, my son was born normal and due to a bad vaccination (at 4.5mos old) is now mentally 8-18 months old in a 20 year old body. I thank God every day that he is alive. He has been a blessing and I have learned much from him. I could have sued, but at what cost? What would it have accomplished? Would it have brought my "normal" child back? Bottom Line: HE IS MY SON, given to me by God. I love and cherish him and always will. By the way, his 7 year old brother thinks he is really neat.


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Date: Mon, May 28, 2001 4:38 PM From: gmward@pcbank.net To: DoktorMo@aol.com
I was researching a homework assignment for Healthcare Law on the issue of Wrongful Birth and Wrongful Life when I came upon this site. I felt compelled to write, if not for myself, then to defend the mothers, fathers and guardians of the children that are born so severely defected, both mentally and physically. If the doctor had any prior knowledge that these birth defects were present, he or she had every right to inform the parents of this possibility. Then and only then can the parents make an informed decision as to whether or not to abort. This should in no way be a judgment call against the parents, as to whether or not they love their children; or whether the defected child has no right to live. It is for the love of their children that they would not want to see them going through endless days and nights of pain. And what about their lives, who is there to help these poor parents? Are this so higher than God moral human beings who are casting the first stone against these parents going to be there morning, noon and night? Are they sitting in the emergency a million different nights watching a helpless child suffer? Yes, children and parents alike should have the legal right to seek damages against the negligent physicians that could have prevented this. No, it is not going to make the child better, but it will help with the expenses of raising and caring for a child with multiple disabilities. Until someone walks in the shoes of these parents they should hold on to there stones and through them somewhere for a better cause.


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Date: Tue, Feb 20, 2001 12:28 AM From: Credo463@aol.com To: DoktorMo@aol.com
I would like to make a distinction here. From what I have read... it sounds like many of the posts are confusing the idea of "wrongful life" and the morality of abortion. I am not an advocate of abortion. However, in the state where I live, abortion is legal up to 24 weeks. The discussion here is not whether or not it is right to terminate a pregnancy. I already know that is my legal right to make that choice, reguardless of what anyone else thinks or has to say about it. The discussion concerning "wrongful life" deals with the issue that it is already the legal right of the mother to decide to terminate a pregnancy. Prenatal care is intended to monitor the health of the mother and the unborn child. If a doctor fails to inform the parents of results of a prenatal test that reveals abnormalities, it directly interferes with the parent's legal right to decide to terminate that pregnancy. This is medical malpractice. The term itself, "wrongful life" seems to distort this fact. I have a son who is severely physically and mentally damaged. I resent the comments reguarding parent's who don't love their children "because they aren't perfect". The term "handicapped" covers a range from down syndrome to cerebral palsey, to ADD, to autism, to a person missing their little finger. Where do we come to a conclusion reguarding the quality of life of a person? I'm the first to say, we can't. I do love my son. However, if given the opportunity, I certainly would have spared him every bit of pain his little body has endured. It seems to be a natural reaction for a parent to want to prevent the pain of their child. It isn't lack of love, or wishing that child simply had not been born. Even though that is what it might seem, it is much deeper and complex than that. I don't think a person who has not experienced it, could have full perspective on the issue. My son's brain was so severely damaged... all that remained was the brain stem. I don't claim to begin to "rate" the quality of someone else's life. I only know that the abortion law states that it's my right to decide to continue or end my pregnancy.


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Date: Wed, Feb 14, 2001 1:32 PM From: greengizmo@webtv.net To: DoktorMo@aol.com
Every person has a right to life even though the child is born with a birth defect that could've and or should've been detected through an amniocentesis or other types of bloodwork does not mean even though most people would like to sue over the issue of wrongful life that the child in later years could not have a normal life with a little extra love and support from his or her family and friends or otherwise they would be able to make it just fine.

Sincerely, Kelli Renee Musgrave


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Date: Mon, Feb 5, 2001 9:57 AM From: dvaug@email.msn.com To: DoktorMo@aol.com
As to the last posting: I must answer. You have no right to say that I do not love my child just because I wish she didnt have to endure the multiple operations and treatments she goes through . I would give my own life to let her have a "normal" life. How can this person say she knows anything about what my family has endured? Just because she has cousins that are disabled? At the end of the day, you still go home to your own house and leave the diabilities at someone elses home. Being close to a disability is not the same as a disability in your home. I have never wished my child dead!


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Date: Fri, Oct 27, 2000 6:59 AM From: bwieszek@cnu.edu To: DoktorMo@aol.com
If you mean a child independently bringing up a lawsuit, that is another matter entirely. However, if you mean the parents bringing the lawsuit or suing on behalf of the child, that seems to be utterly heartless. What a cruel thing to tell your child that you wish that he or she had never been born! In all these cases, the mother or father claim to love their child. But I have to say I doubt that they do love their child. My aunt and uncle have two disabled children- one slightly autistic and one downs syndrome. They are not perfect-but then again who is? We all love them and never once have wished them dead. If parents feel that their child is wrongfully born-maybe they should let them be adopted by parents who do love them. They obviously do not.


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Date: Fri, Oct 6, 2000 5:29 PM From: dvaug@email.msn.com To: DoktorMo@aol.com
My comment to this question is really a short story. When I was pregnant, the drs told us our baby had many rare abnormalities and we needed to consider ending the pregnancy. We did the unthinkable! We chose to end the pregnancy. After we notified the dr, he wanted to repeat some tests because so few babies had ever had these abnormalities before. Matter of fact, no one had ever seen these anomalies so early in pregnancy. Needless to say, all of a sudden, there was nothing wrong with our child anymore. We had our precious baby and she was born with all the problems he had said there was in the beginning. Now what do we do? He is even using all of our ultrasound and MRI films in the teaching hospital. The hospital has even sued us to pay for the bills that I refuse to pay. So, those of you who say that it is soooo wrong to sue the dr for wrongful life, in my opinion, are wrong. If there was another way to term it, I would. Fact remains, I had to quit my job to take care of my child and she will require life-long physical and emotional help. All I ever asked the hospital for, was to help provide for her care. The doctor will not even speak to us. Not by letter or phone. So, now what? He saw the problems then took it back. He has written papers in the American Medical Journal about diagnosing these problems and has gained recognition in the medical community, at our expense!


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Date: Thu, Sep 21, 2000 4:04 PM From: Nekkedchickens@aol.com To: DoktorMo@aol.com
If our court systems were to set a precedence by awarding damages to people suing under such a ridiculous claim as "Wrongful Life," where would it stop? Not all cases would be as cut and dry as the mother suing her obstetrician for failing to inform her of her neonate suffering from something as horrible as hydrocephalus. All too soon our courts would be filled to the brim with people seeking money because they were born with one arm, a cleft palate, or Down's Syndrome. Who are we, as fallible human beings, to claim we have the answer to whether or not a person is better off not being born? There are those who live a healthy 30 years of life, only to be involved in a debilitating accident, that take their own life rather than having to suffer the rest of it confined to a wheel chair. And then there are those among us who simply overcome. We look at ourselves and our handicaps every day, and it does not deter us from living. As a 24 year old woman who has never taken a step without some form of prosthesis, I can tell you that I am certainly NOT better off dead. And for JDtaylor, who stated his belief that "when genetic mutations are found existent in a fetus, abortion should be an option," I have this to say: We are human beings, JD. We are not puppies to be culled from a litter to further a breed standard. When two people set out to start a family, they should understand the risks involved. Maybe the child you conceive will never walk on their own, maybe they will never offer a glance of recognition to you, but never forget that they are your child. Having a family is nothing like fishing. It's reprehensible for a person to take the attitude that you can just keep "tossin' em back" until you get the kind you want. Physical perfection is no guarantee of happiness in life. There didn't seem to be anything physically wrong with the shooters at Columbine High School.


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Date: Fri, Aug 4, 2000 3:18 PM From: Calithump@aol.com To: DoktorMo@aol.com
I was reviewing web sites for a college library when I was referred to the bio-ethics site by a professor. I was mesmerized by the thoughtful, complex discussions, and couldn't resist commenting on the "wrongful life" discussion. Having been the mother of teenagers, I must say that I heard "I would have been better off if I'd never been born" more than once. Also, having been treated for clinical depression, I've felt that way myself once or twice. I cannot imagine what it would be like to be born with severe, debilitating, painful disabilities--wishing for nonexistence is one logical outcome. But since birth conditions arise from a number of sources (genetic makeup, medical malpractice, lack of responsible parenting, drugs, and probably just quirky nature), I have to think that the culpability for the defect depends upon its source. Furthermore, the child always has the right to sue, but the final arbiter (judge, jury, ombudsman)decides the merits of the case. The final decision would take many factors into consideration. But death is not an option.


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Date: Mon, Jun 19, 2000 7:12 PM From: Credo463@aol.com To: DoktorMo@aol.com
The reason why I am writing, is because I have read through the responses to this question, and feel that some of them portray a misunderstanding to the initial question. Also, as a mother who has personal experience with this topic, maybe I can offer another perspective. The day my son was born was the most shocking, painful day I could ever imagine. I thought I had received good prenatal care throughout my pregnancy. My husband and I knew to expect a baby boy, and we looked forward to our new family. The term "handicapped" is a label. One that a large variety of people can be placed in to. My son was born with a condition called hydrocephalus. Throughout my entire pregnancy, his brain was being smashed. When he was born, his head was full of fluid, instead of brain tissue. His diagnosis was that he would live out however long his life might be, as a "vegetable". Now, I am not an advocate of abortion. Nor do I claim to know when to say that another person's life is not worth living. I do know the pain I have watched my son endure. I know that he is far from being "just handicapped". (not that I am diminishing anybody... that is not my intention) I do know... that given the choice, had I known the kind of damage that was happening to my son... I would have terminated my pregnancy. I can't deny that is somewhat selfish thinking. I only know that I would have saved him his pain, given the choice that I feel was morally, and legally, mine.


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Date: Fri, Mar 24, 2000 1:28 PM From: mkbledsoe@hotmail.com To: DoktorMo@aol.com
My feelings are that everyone should have a chance to live even if they are born with the misfortune of a handicap. The fact that they have a disability does not make them less of a person than anyone else. They still have the power to enjoy life and look past their drawbacks in order to accomplish personal goals. Just because a person is disabled does not mean that they would be better off not being born. In fact, many handicapped people probably do not think that at all. They look past their disability and strive to do the best they can. I do not think that they should be allowed to sue for damages because even if their handicap was detected, I do not feel that it is the doctor's or anyone else's right to decide that they would be better off dead. It is only the person's decision who has the disability, and they obviously cannot make that decision until later in life. If they are truly unhappy and feel that they would be better off dead later on in life then they can take care of it themselves. This sounds cruel, but at least it would be their decision and not the act of murder decided by someone else.


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Date: Tue, Mar 21, 2000 11:13 PM From: cinefacta@hotmail.com To: DoktorMo@aol.com
Suing for wrongful life is as silly as suing Mc Donald's for falling off a toilet seat. If a child were to bring a lawsuit against his mother's doctor for wrongful life, this would imply that there is not much wrong with the child's intellectual capability. Furthermore, whether the doctor genuinely did not dectect the genetic defect, or whether the doctor did detect the defect and witheld the information from the parents, the ultimate decision to bring the child to term would have been the decision of the parents, not the child. The child should perhaps have the right to sue his *parents* for damages, provided they were armed with proper information about the genetic flaw and its implications, yet chose life for the child anyway, but it's a frivolous claim at best, and as well founded as being able to sue one's doctors for not altering the outcome of one's sex, had one preferred to be born the opposite gender, or born from a parent who had AIDS.


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Date: Tue, Mar 21, 2000 4:33 PM From: jkbyrd13@hotmail.com To: DoktorMo@aol.com
I agree with Carmen Jaeger's response. I don't see how suing a doctor for money could make up for such a horrible life that you feel that you should never have been born. I certainly feel for those who are less fortunate because of such a genetic defect or any other birth defect, but where would the line be drawn? What would constitute a defect so terrible that a person should not have been born? To me this sounds like another way to extort money from someone doing his or her job to the best of his abilities.

Furthermore, I agree with the response that said that we have no guarantees in life. My personal belief is that abortion is morally objectionable and prohibited in the Hippocratic Oath, but as the law is now it is legal. To me the term "Wrongful Life" is a contradiction; God wanted this child to be born. This seems to be more a question of ethics than blame.

Ken Byrd


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Date: Sun, Mar 19, 2000 8:16 PM From: Jdtaylor20@aol.com To: DoktorMo@aol.com
Whether one feels it is for the better or not, advances in genetics will gradually provide physicians with more and more knowledge of what birth defects a family may encounter with their newborn. I personally feel that these advances cannot be viewed in anything but a positive light. Ideally, I would like to see these genetic mutations corrected through methods of prenatal gene therapy. I think this will become a reality as more research is done on how to perform gene therapy. At the present, however, I believe families should have the right to have tests done to detect genetic disorders. If they are found, abortion should be an option. I realize that the Hippocritic Oath prohibits abortion, but the knowledge we now have of genetic mutations was nonexistent at the time of its writing. Yet, the physician should not be at fault if birth defects are discovered after the child is born. Medicine is, by no means, an exact science, and physicians cannot be held accountable, or sued, for all problems that occur.

-Jonathan Taylor, Univ. of South Carolina


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Date: Sun, Mar 19, 4:47 PM From: amhames@hotmail.com To: DoktorMo@aol.com
This question is absolutely absurd and I am sorry that we live in a day and time that the courts have come to this. Is there a "wrongful life"? Of course not. The being in charge of granting life can do NO wrong. We should learn to be content with what we are given that we cannot change and to try to improve the things we can. Maybe some would be better off without ever being born. They would not be born into a society that makes issues and questions as shallow as this! On the defense of someone who has been "wrongfully" born into something in which life would be the worse choice between it and death, how would they ever know life was the most unfavorable choice unless they were given the chance to live it?


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Date: Sat, Mar 18, 2000 9:23 AM From: MayDay913@aol.com To: DoktorMo@aol.com
Introducing cases as such into our legal system opens the courts up for serious struggle. Every patient who visits a doctor expects to be made aware of the important things going on inside their bodies. The point of going to a doctor is to check-up on health, etc. In legal terms, I would have to say that people should be allowed to sue for damages in such a case. There are definitely defects, etc. that are evident in the many tests that are run on an expectant mother. HOWEVER, allowing this to be so is also giving and encouraging the doctors to give abortion as an alternative. That, in my opinion, is what we do not want to happen. In the days when abortion was much less common, before there was constantly talk about abortive techniques, etc. in the media, it seemed to the naive citizen that families were simply dealing with the defects to the best of their abilities, loving the child just the same. Lately, as in within the last fifty years or so, there is more talk about dealing with the defected child, as in insurance concerns and the quality of life. Some people are probably thinking at this point that I am denying how the child feels, and how difficult life can be for them- but I'm not. I simply strongly believe that once we bring in the situation where humans are playing God, and deciding who and what should enter this earth, then we've got problems. The balance of human power is stretched, never to return to stable grounds. I, as most patients would I assume, would expect to be told of any disturbances in my pregnancy that are evident in checkups because I expect my doctor to inform me of all she knows. However, if my doctor does not catch the defect, and therefore is not aware of it herself, then there is possibly some grounds for legal action. Doctors/Surgeons/Radiologists, etc. are trained to acknowledge things that we as "common people" are not aware of, and we are therefore able to hold them accountable for realizing the defect.


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Date: Wed, Feb 23, 2000 7:10 PM From: cjaeger@itctel.com To: DoktorMo@aol.com
Doktor Mo, I am from Deuel High School and I have just posted a WebQuest website about wrongful birth. I feel that wrongful birth lawsuits are wrong. Upon filling a lawsuit about wrongful birth, I feel, is just like saying you don't want your child. I know many people who can't get pregnant and would be happy with any child they can get. Sure the children are dependent on their parents, but they are your children. You should love them and take care of them just like you would do with any child. I don't think there is any need for wrongful birth lawsuits and I don't think it should be the doctor's fault. It is up to you whether or not you want to test if your child in the womb has any physical conditions, but that should be discussed with your doctor. Wrongful lawsuits need to be kept out of the already busy court rooms, because I think wrongful birth lawsuits are a waste of time. Sincerely,

Carmen Jaeger

P.S. If you want to contact me, e-mail me at c_critters@yahoo.com. Thank you.


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Date: Mon, May 24, 1999 7:23 PM From: jacob@ncis.net To: DoktorMo@aol.com
Supposedly in the 1980 case 'Curlander v. Bio-Science Laboratories' a California appellate court ruled that a child with a genetic defect could bring a "wrongful life" suit against her parents for not undergoing prenatal screening and aborting her.


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Date: Wed, Mar 3, 1999 10:56 AM From: Lbruckman@namic.org To: DoktorMo@aol.com
What if a baby is born extremely premature and is kept alive -- parents being told "everything will be okay" but in fact, the child has severe brain injuries? Doctor called, baby hypoxic for hours, doctor doesn't come because he expects the baby to die, but baby doesn't die. Parents told "everything will be okay."

Guess what? Everything is not okay.


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Date: Sat, Feb 13, 1999 6:48 PM From: mailbox@ecis.com To: DoktorMo@aol.com
Hello I was responding to your page. What if the doctor knows you were infected with a virus while pregnant? What is the standard of care for this?

What if at 20.5 weeks of pregnancy the doctor writes the ventricles are at uppper limits of normal but doesn't tell you (parents) or re-test??

This is exactly what happened to me. My son was born severly disabled. He is 7 now doesn't walk, talk develomentally 7 months old. He is legally blind, feeding tube, seizures, chronic constipation, central apnea (on monitor) etc. etc.

My husband and I told the doctor we wanted to know if anything was wrong ( at the best he could tell) he told us everything was fine. We feel that the doctor withheld very important information that my husband and I needed to discuss. How could the doctor get away with that? Shouldn't they tell you?

Thanks, Michele


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Date: Wed, May 20, 1998 12:34 PM From: bethkeen@nstar.net To: DoktorMo@aol.com
I ran across this site while searching for information on "wrongful life/birth" cases and felt I had to respond. Since abortionists believe that life does not begin at conception but at birth, how can these same people want to defend the right of the fetus (remember, not a real person) to be born or not? The same applies to the mother... how can you defend her right to protect something that is not yet someone?! Is it just me or does that seem a bit contradictory? In reference to the doctor's liability, perhaps running the standard tests and informing the parents are issues. However, the doctor should not be required to offer abortion as an option. When it comes to accountability, he is ultimately accountable to God. You can try to leave Him out of this, but He will always be here. When man's knowledge is not balanced with God's wisdom, the result is confusion. Such is "wrongful life". I believe God is the author of life, therefore life can't be wrong. Isn't it sad that our society has developed the thought process, "I deserve the best, and if I don't get it, it's somebody else's fault"? Let's face it, folks. We don't DESERVE anything! Life is NOT fair and there are no guarantees! Who's going to guarantee you and I (normal people with no birth defects) that in the next minute we won't become victims of some crippling disease? Will there always be someone else to blame and to sue for damages? Will someone else always be responsible for "depriving us a real opportunity to avoid suffering"? What's next? If "avoiding suffering" and quality of life are the issues, what's the difference if we 86 someone before or after birth? I'm not an attorney (that's probably obvious), but if I was...

Anyway, here's your feedback.

Beth


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Date: Wed, Apr 22, 1998 1:19 PM From: mlo@acpub.duke.edu To: DoktorMo@aol.com
There are too many lawsuits in this country already, and a large number of ludicrous lawsuits are actually won. The option to sue any medical professional in this case should not be outlawed, but the child doesn't need to be encouraged to sue, either. If it is proven that medical/genetic tests available were not performed, and the child is still in the care of his or her parents, then the parents should have the option to file suit, but if the parents were informed of the possibility or probabibility of genetic defect or disease, and they chose to have the child, they really don't have a case.


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Date: Sat, Apr 11, 1998 4:50 PM From: sbimhoof@deltanet.com To: DoktorMo@aol.com
Doktor,

I am a first year law student, and am currently writing a appelate brief on this exact issue. The whole issue seems to turn on whether the infant has sustained an injury at the hands of a negligent docter. Well, how do we want to define injury? Clearly there is no injury in just being born. In fact, the child never had a right to be born in the first place. However, if a health care provider negligently takes away the expectant mother's right to protect her infants interests, that is an actionable injury. In other words, "but for" the docter's negligent conduct, the mother would have protected the childs interest by having an abortion. Typically, at least in the jurisdictions that allow "wrongful life", the infant need show through evidence that she would have in fact been aborted had the mother been properly informed by the docter. The childs complain is not that she is born defectinve, but that the doctor's conduct deprived her the existant and real opportuinty to avois sufering and be aborted.

One more thing, most states have "wrongful birth" acts. This is essentially the parents version of wrongful birth. In those statutes, the child is always defined as being a legally existant person. This not a moral or metaphysical stance, it is only importnat for the purposes of establishing the legal elemnts needed to find negligence. Under negligence, the first thing to do is determine if the doctor owed a duty. This is clear, as she will be held to a reasonable professional standard of care. This duty is obviosly owed to the expectant mother. Also, as people typically get amnio tests to determine the genetic integrity of the unborn child, it is extremmly foreseeable that a improperly conducted test will gravely effect the childs opportuinty to avoid suffering from the ailment. In other words, wrongful birth acts tend to provide the legal basis to establish negligence, and can be extened to cover the childs "wrongful birth" cause. After all, it would be illogical to allow the parents to recover and not allow the DIRECT victem of the doctor's negligence to be redressed for her injuries.

In closing, for legal purposes, it is not prudent to reduce the infants injury into a philosophical debate about existance vs. nonexistance. That was rendered academic when the doctor screwed up the test. What is important is that if we wish to promote the social benefits of prenatal care, genetic counseling, etc..we also extend the legal protection to cover those classes of individuals (Parents and the unborn), to the same standard that all members of society are protected by.

Thanks, I enjoyed reading your posts, it has helped me work through my position. Any feedback would be great.

Steven


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Date: Thu, Mar 19, 1998 7:42 AM From: hdwhitt@ehc.edu To: DoktorMo@aol.com
Who is to decide what really is wrongful life? How could someone want to take the life of their unborn child just because the child will not be born in perfect health? Some people aren't even able to have children, and if they could, they would be overwelmed with joy to have a baby whether he or she was in perfect health - no birth defects - or not. If a child is born with down syndrome, that child has a right to live a "normal" and happy life. Abortion is wrong, so why would killing a fetus with down syndrome be right? Sure the child may have difficulties in life, but who doesn't. Children with disabilities are beautiful people who have a lot of joy to offer to their parent's lives, so why would we want to kill them? Killing a fetus is just like killing a person. Murder is wrong. Children are a blessing from God, and we should not destroy His beautiful gift to us!!!


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Date: Fri, Dec 19, 1997 12:31 PM From: peckn@okway.okstate.edu To: DoktorMo@aol.com
I believe that the mother and/or child should at least be able to sue for the negligence of the doctor (I'm not an attorney but this seems reasonable to me). I don't think we can touch the issue of whether or not he would have been better off not being born. If he is so handicapped that he cannot articulate what he feels/how he thinks, how can we know if he is satisfied with his life? And, the only other person "qualified" to make that decision, would be the mother (or father, if he was involved) as she is the one who has to bear the "burden" (I use that term very loosely, i.e., be responsible) of caring for the child, paying expenses, etc. What is life worth? Is anything required of a person to "deserve being born?" I don't know. I think that's an individual decision. But, the doctor should be liable for his mistake, especially if it was something that could have been corrected in utero (you'd really have a good case for negligence then!).

This is my first visit and response on these discussion boards. Thanks for hosting it...I'm finding it very interesting.

Natalie Peck


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Date: Thu, Oct 16, 1997 4:16 AM From: af485@lafn.org (hans g engel) To: DoktorMo@aol.com
In these days, when the world's greatest problem is overpopulation, permitting the birth of an infant known to be seriously defective is probably counter to optimal public policy and cruel to the prospective parents. There may be a few parents who are willing to provide the endless love and dedication required to raise a severely handicapped child, but if the parents would have chosen not to sacrifice much of their own lives to care for such an infant knowing the outcome of their pregnancy and had no personal religious objections to abortions, they should be able to sue a physician who (a) fails to run the tests required to determine such an outcome, (b) misinterprets the test results, (c) negligently fails to inform the parents of the test results at the proper time or (d) fails to inform them because of his/her personal religious or moral beliefs.


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Date: Wed, Oct 8, 1997 From: jettas@mindspring.com To: DoktorMo@aol.com
This is perhaps the premire example of a paradoxical ethical dilemma. A few yars ago, an Israeli woman consulted her doctor as to the safety of conceiving the child she was carrying. The fetus was at risk for a very serious genetic defect. The doctor gave the woman false assurances that the child would indeed be born healthy. The child was subsequently born with the serious genetic defect that rendered him psychologicaly and physically abnormal to a supposedly horrifying degree.

The mother, on behalf of herself and her child, sued the doctor for damages. The district court recognized the mother's standing, but not the child's. The doctor appealed to the Supreme Court of Israel against the first decision, and the mother appealed against the second decision. The courts unanimously overruled the doctor's appeal, and in a majority decision, accepted the child's appeal.

Torts, or harms, are universially defined as some sort of worsening in the condition of an already existing person. Damages are usually sought for the difference between a person's condition before a certain harm was done vs. after the harm. But in wrongful life cases, the only comparison (maybe) to the condition of a person before a harm was done is nonexistence. Is there a value that can be attachted to nonexistence to serve as a comparison to being harmed? Can we even understand nonexistence?

It is not simply a matter of not having or not utilizing the proper epistemic tools. Rather, it is simply that there is nothing to understand. Not only is nonexistence a "state" that can not be given value, it is a "state" that cannot even be attributed to a subject of any kind. Death at least has this attribute - it has happened to somebody. If the plaitiff in the Israeli case had not been conceived, would the boy be better off? It is hard to answer affirmatively.

So, it seems that, to answer the exact question - would the child have been better off not being born - the answer would have to be: no. However, the other question that is alluded to is: can a child sue for damages if being born with defects is worse than being born without a certain defect? In the above case, the child is either born with a serious defect, or not born at all. The only comparison to the child's wronged life is nonexistence. The real queston is not whether a person has a right to be born, but does a person have a right to be born healthy?

In this scenario, a child now has a comparison to a healthy life and can(?) sue for compensation on these grounds. Some judges have used this tactic in some wrongful life cases even where the only actual alternative to being born with a defect was nonexistence. A healthy life, not nonexistence, is the alternative to the child's condition.

In actual wrongful life cases, birth in handicap is absolutely necessary - the alternative is not to be born - but being born is not the complaint. Being born handicapped is the real complaint. Intuitively, we feel that a wrong was certainly done, and judges are usually ready to lay responsibility on the doctor(s) involved. However, this is a double-edged sword as we can easily get caught in the slippery-slope. That is, judges are also aware of the potential abuses of such claims. Can a child, suing for a right to a healthy life, claim illegitimacy as a "defect"? Or being born underweight; with a low I.Q.; or into a polluted and crime-ridden world?

Some hard quesitons will be: how do you define "harm" or an injury vs. simply a denial of certain "better" conditions for the future life of the child? As medical and scientific technologies advance - i.e., cloning - will children be suing for having been born "y" instead of "x"?

In closing, it seems that wrongful life cases are blocked by two conditions: on the one hand, there is a valuelessness of nonexistence, and on the other, is the fact that its value (if it does have value) cannot be attached to an individual person - there simply isn't a person to attach the value to. Anyway, sorry for being so long winded, but it's hard to limit a response to just a short paragraph. If you agree or disagree or just have some ideas, PLEASE mail me at: jettas@mindspring.com

Thanks for reading this response! Michael R. Miller, University of Alabama at Birmingham.


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Date: Wed, Oct 8, 1997 3:22 PM From: Babyblu953@aol.com To: DoktorMo@aol.com
I think that even though the mother and father of this child weren't aware of the handicapp that their unborn child had had, that no matter what they should love the child regardless, and saying that a human being isn't worth being born is kind of sick.


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