Medicine, ethics and law: What are doctors supposed to do?

[xjx388]

Not taking the bait xjx. You just want to argue the same thing you did in the other thread: Your ethics supersede anyone you don't agree with.

You weren't exactly winning over converts in the Trump has dangerous narcissism. You're not going to win this one using the same failed foot stamping arguments here.

That’s a spurious statement. I have never argued that my ethics supersede anything. The ethics of the medical community are at issue here.

The ethics you have espoused here specifically about chloroquine are at odds with the majority of the medical community. This AMA statement succinctly rebuts you as do the various statements and emergency rules issued by the state Boards of medicine and pharmacy.


/Aside And speaking of The Donald, I would be remiss if I didn’t point out how you guys seem to agree on that particular issue.

 

[xjx388]

I notice I didn't reply to this. That was because I think my answer was implicit in my subsequent posts, but just in case:

Each of us decides for ourselves what we consider ethical. As a society we come together and each inputs their own views to determine social judgements, including laws. This process is imperfect and certainly doesn't result in a consensus.

An individual clinician makes their own judgement about their own actions, as well all do. Society may judge them differently, and there may be consequences to that.

No issue with that; it seems we pretty much agree. An individual’s actions are only ethically right or wrong when judged against the ethics of the larger society. Since we all live in a society, there’s a social contract there that effective says: we agree to abdicate certain of our ethical decisions to the society and if we don’t, we agree to pay the price society imposes. Medical decisions are among those “certain of our ethical decisions.”

 

[Venom]

Why did my doctor feel compelled to prescribe antibiotics for general minor upper respiratory symptoms?

Maybe because my parents expected something, taking me to the hospital. Maybe I expected too much out of a visit for a cold. I mean my mother has worked in hospitals damn near her entire adult life, but she still thinks it's justifiable to pop amoxicillin for colds and fever.

 

[Roboramma]

No issue with that; it seems we pretty much agree. An individual’s actions are only ethically right or wrong when judged against the ethics of the larger society. Since we all live in a society, there’s a social contract there that effective says: we agree to abdicate certain of our ethical decisions to the society and if we don’t, we agree to pay the price society imposes. Medical decisions are among those “certain of our ethical decisions.”

I think you misunderstand me.

I don't think "An individual’s actions are only ethically right or wrong when judged against the ethics of the larger society." I actually think that an individual's actions are right or wrong, period. But neither the individual or society at large has a magic ball with which to gaze in and determine whether or not their actions are ethical. We only have our reason and our senses. So we do our best.

Sometimes society will be wrong. Sometimes individuals will be. It's probably more often that individuals are wrong, simply because of how societies function. So as an individual it makes sense to start with a Bayesean prior that says 90% of the time that my ethics are in conflict with society, I'll be the one who is in the wrong. But a 90% prior can still end up with a 10%, or 1%, or 0.01% probability in a specific case when judged against further evidence. So while I think one's judgement in general should favor social norms, that's not an absolute.

However, society as a whole still has to form ethical judgements about people's actions, including those who take action in opposition to its norms. And while it should do so with mechanisms that allow for reflection and change, since it may actually be wrong, it's also still necessary for society to punish those who go against it's norms, even when they think they did so for good reasons.

Some of the time it will punish people who shouldn't have been punished. Hopefully that can be minimized, and those people can spur change: that's a sign of a well functioning society with good institutions. But you'll never get it to zero.

 

[xjx388]

Why did my doctor feel compelled to prescribe antibiotics for general minor upper respiratory symptoms?

Because the desire to please you/your parents outweighed the obligation to practice good medicine. IOW, inappropriate prescribing.

Maybe because my parents expected something, taking me to the hospital. Maybe I expected too much out of a visit for a cold. I mean my mother has worked in hospitals damn near her entire adult life, but she still thinks it's justifiable to pop amoxicillin for colds and fever.

That’s a very common thing even amongst people who should know better. A prescriber, OTOH, has an ethical obligation to do the right thing according to the best understanding available at the time.

 

[xjx388]

I think you misunderstand me.

I don't think "An individual’s actions are only ethically right or wrong when judged against the ethics of the larger society." I actually think that an individual's actions are right or wrong, period. But neither the individual or society at large has a magic ball with which to gaze in and determine whether or not their actions are ethical. We only have our reason and our senses. So we do our best.

Sometimes society will be wrong. Sometimes individuals will be. It's probably more often that individuals are wrong, simply because of how societies function. So as an individual it makes sense to start with a Bayesean prior that says 90% of the time that my ethics are in conflict with society, I'll be the one who is in the wrong. But a 90% prior can still end up with a 10%, or 1%, or 0.01% probability in a specific case when judged against further evidence. So while I think one's judgement in general should favor social norms, that's not an absolute.

However, society as a whole still has to form ethical judgements about people's actions, including those who take action in opposition to its norms. And while it should do so with mechanisms that allow for reflection and change, since it may actually be wrong, it's also still necessary for society to punish those who go against it's norms, even when they think they did so for good reasons.

Some of the time it will punish people who shouldn't have been punished. Hopefully that can be minimized, and those people can spur change: that's a sign of a well functioning society with good institutions. But you'll never get it to zero.

On what basis do we judge whether or not society is right? I don’t think we can. It’s only when the zeitgeist of the society changes that ethics/law changes. To use a big example: I don’t think Rosa Parks changed society; society was changing already which allowed Rosa Parks to serve as a clear illustration of that change.

IOW, there is no true “revolution,” in ethics and law, it only looks that way.

 

[Roboramma]

On what basis do we judge whether or not society is right?

On whatever basis you make any sort of moral or ethical judgements. If your basis is simply "whatever society decides", you have to have some basis for considering that to be the right basis, and that in itself is a moral or ethical judgement.

Furthermore whatever process by which society makes it's judgements is also available to individuals: it is, in fact, the collective judgements of individuals that make up the judgements of society as a whole. If their judgements are made without basis, then society's must be as well.

 

[xjx388]

On whatever basis you make any sort of moral or ethical judgements. If your basis is simply "whatever society decides", you have to have some basis for considering that to be the right basis, and that in itself is a moral or ethical judgement.

Furthermore whatever process by which society makes it's judgements is also available to individuals: it is, in fact, the collective judgements of individuals that make up the judgements of society as a whole. If their judgements are made without basis, then society's must be as well.

I’m sure we could have an interesting debate on the origin of ethics. But this is more about what ethical code should an individual be accountable to. I think you’re right in that a society’s ethics is basically the ethics that most members agree upon; that changes as individuals change and enough of them agree to enact those changes.

We can’t have a society where every individual decides what ethical code (law is just an enforceable ethical code) to follow. That would be anarchy. The same holds true for a profession like medicine. Doctors and other medical professionals can’t practice based only on their own judgement of what’s right. In order to ensure safe and effective medical practice, there has to be laws, rules and standards.

A good example: I think doctors who use unproven treatments and diagnostic methods that are not part of the profession’s standards are acting unethically. They can’t simply say: “I disagree because reasons.” They should, instead carry out the science that convinces their peers that they are right or desist when the science proves them wrong.

 

[novaphile]

Why did my doctor feel compelled to prescribe antibiotics for general minor upper respiratory symptoms?
Maybe because my parents expected something, taking me to the hospital. Maybe I expected too much out of a visit for a cold. I mean my mother has worked in hospitals damn near her entire adult life, but she still thinks it's justifiable to pop amoxicillin for colds and fever.

I can point to two other possible reasons that are not necessarily in opposition to the above.

1. The Dr recognised the symptoms of a secondary bacterial infection.
2. Your mother produced evidence that you had a long history of inevitable bacterial secondary infections.
3. You had a primary bacterial infection and have mis-remembered.
4. The Dr wasn't competent by today's evidence-based medicine standards.

Re point 4. There is growing, perhaps even near-complete acceptance of evidence-based medicine, but from my own experience, and the experience of a friend who recently completed his practice degrees, it is not complete.

There are still pockets of woo being taught, even today, and of course, there will be some practitioners out there who still believe what they've always believed.

In my experience, as a child with a long history of secondary bacterial infections, even then, in the 1970's Dr's would only provide a prescription for anti-biotics with a warning to only get the prescription filled if the sputum changed colour, and the coughing etc. became much worse.

In recent years, I've twice had the experience of seeing the Dr for an URTI, and not needed the anti-biotics. (2 out of 5 is pretty good).

 

[Roboramma]

I’m sure we could have an interesting debate on the origin of ethics. But this is more about what ethical code should an individual be accountable to. I think you’re right in that a society’s ethics is basically the ethics that most members agree upon; that changes as individuals change and enough of them agree to enact those changes.

Yeah, I agree with this.

We can’t have a society where every individual decides what ethical code (law is just an enforceable ethical code) to follow. That would be anarchy.

I think not only can we have such a society, we necessarily do: people do make their own decisions about what ethical code to follow. Society tries to impact those decisions in a few ways: education/advocacy, introducing repercussions to actions outside of society's collective codes, repercussions which can be both social and legal in nature, and a sort of organic influence from discussions on both large and small scales.

The same holds true for a profession like medicine. Doctors and other medical professionals can’t practice based only on their own judgement of what’s right. In order to ensure safe and effective medical practice, there has to be laws, rules and standards.

We certainly agree about that. But that's just a statement about what society should do. As an individual, though, what should I do, knowing that I live within that evironment that society has created? I still think I should do what I think is best.

A good example: I think doctors who use unproven treatments and diagnostic methods that are not part of the profession’s standards are acting unethically.

Usually, they are. Or, to put it tautologically: when what they're doing is unethical, then it's unethical. And society tends to be right most of the time, but not always, about what's unethical.

They can’t simply say: “I disagree because reasons.” They should, instead carry out the science that convinces their peers that they are right or desist when the science proves them wrong.

When their reasons are valid, then they should follow them. Now, sometimes society's laws will be wrong, but the ethical thing will still be to follow them while trying to change the system. Maybe that is even true in the majority of cases. But it's not necessarily true in all cases. I think that's the only thing we disagree about, actually.