From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Post-hysterectomy Sex Abstracts (Re: Doctor-bashing)
Date: 18 Mar 1999 13:08:13 GMT

In <370560fc.390614789@news.erols.com> vl-hb001@erols.com (Terri)
writes:
>
>On Wed, 17 Mar 1999 16:56:22 -0700, clw@teleport.com wrote:
>
>>In article <37012839.376081027@news.erols.com>, vl-hb001@erols.com (Terri)
>>wrote:
>>
>>> >    The general rule??  What general rule?  The general rule in surgery
>>> >is cut it out if trying to save it is dangerous and you can live a
>>> >quality life without it.
>>>
>>> And who defines dangerous? or quality life?
>>
>>There is no "general Rule".  Everything in medicine is a benefit/risk
>>decision.  If one is already in a persons abdomen for a good reason and
>>you find something that is very probably going to cause a problem in the
>>future the usual scenario is to go out to the waiting room and discuss
>>it with the immediate next of kin.
>
>What a piece of crap. Are you really a doctor at all? This is true in
>the case of an unexpected life or death situation - and only then. The
>next of kin has no right to give consent at all in the case of a
>competent adult except in the case of an immediate life-threatening
>condition. And even then most doctors try to cover their rears with a
>consult and the signatures of two doctors. And try to load the consent
>with every possible complication so that they're covered for
>everything. Repeat - when you are dealing with a competent adult the
>next of kin CANNOT give consent He/she has no legal right. None.
>Zilch. Fuck all. Whatever term you like. The scenario you outline was
>true 30 years ago, but any surgeon operating on that basis now, is a
>lawsuit waiting to happen.


Comment:

   This is not my argument, but I cannot resist adding my two cents
worth.  First of all, in elective surgeries the competent patient signs
a document beforehand generally directing the surgeon as to what to do
in cases of unexpected findings-- what's okay to take out and what's
not.

   Second, the prudent surgeon will have had the patient sign a durable
power of attorney for health care document, so that family can be
consulted in cases where the patient cannot make an unexpected
difficult and unforseen decision, or cannot without undue danger.

   In unexpected surgeries, or with demented patients where no such
documents have been signed, the nearest relatives are indeed consulted,
and their wishes generally followed, so long as they aren't too
outrageous to the doctor.  Very occasionally a staff member might
disagree, and in such cases it is usually wise to have that person talk
to the family before doing things the legal and hard way.  And (if
time) this is where hospital ethics committees come in handy.  If there
is still disagreement, then the court is the only remedy.  Preferably
not in retrospect.  Courts do generally respect the wishes of closest
family members in such cases, though only case law and custom in most
places encourages this.



>> It's the patient who decides what's done not the doctor.
>> Then, if that person thinks that the
>>patient would approve, a consent to remove or repair the new problem is
>>signed and the surgeon proceeds to do what seems to be best for the
>>patient.

     Usually these things are decided beforehand.  If not, the doctor
is bound to do only emergency procedures that were not forseen.  Quite
right.


>Terri has worked in recovery rooms, critical care units , ER's, and
>psychiatric units.  I am a nurse whose job it  is to protect  the
>patient  when he/she is unable to protect himself/herself, such as
>when he/she is under anesthesia,  is brought into an ER  in a state
>where he/she cannot defend himself/herself or is mentally incompetent.
>I've crossed swords with many doctors like you. And have testified
>against such a person in court on one occasion. Don't mess with my
>patients' rights, Doctor.
>
>Terri


    Did you win?  The circumstances of the case would be most
interesting, as an illustration of your point of view.  Care to share?