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Chemistry of Ethical Hope!

Chemistry of Ethical Hope!

Chemistry of Ethical Hope!

(OP)
I was reading a medical article on terminal case histories. The medical profession is divided about divulging the facts to the patient. Arguments for and against are presented and then comes the term" Chemistry of Ethical Hope".

 I was all along believing that to hope is ethical .Now comes this term . Providing spiritual and moral succour to the ailing is beyond the realm of the medical fraternity.

I would like to know if other members have also come across the term Ethical Hope in any other context.

Meanwhile a "Happy Christmas to ALL"!!

RE: Chemistry of Ethical Hope!

I would be interested in learning about the arguments for and against divulging all the facts.

==> Providing spiritual and moral succour to the ailing is beyond the realm of the medical fraternity.
I'm not sure that I accept that premise.  It is a tough line to draw, but holistic medicine is making small inroads in the traditional medical community.  The hard part is separating legitmate forms of alternate medicine from the many frauds under that guise.

For me personally, I want to know all the facts.

Good Luck
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As a circle of light increases so does the circumference of darkness around it. - Albert Einstein

RE: Chemistry of Ethical Hope!

(OP)
Cajun,I am giving one of the links from NYT others are from the local media in India.

Holistic medicine or alternate medicine practice is quite acceptable in India and no eyebrows are raised.

Recent times medical tourism to India is becoming popular. Excellent medical attention is available at minimal costs and also immediately. However, this is out of reach for the middle class Indian.

RE: Chemistry of Ethical Hope!

That's a good article; thanks for the link.

Good Luck
--------------
As a circle of light increases so does the circumference of darkness around it. - Albert Einstein

RE: Chemistry of Ethical Hope!

My mother died in 1995. She had a failing liver and faulty heart valve.  She spent the last 4 months bed-ridden, then the last 2 weeks in the hospital.  The doctors said she wasn't strong enough for a liver transplant until she was strong enough for a valve replacement.  I think the staff revived her three times.  After that, I wanted to sign a do not resuscitate order and the lead doctor pulled my dad and me into his office to explain that by signing that order I was taking my mother's last chance at life, even if it was only 5%.

I told the doctor he could low crawl across a four-line highway and probably have a greater than 5% chance of making it across alive.  I'd be on the other side waiting for him to give him the order so he could rip it up.  He didn't take me up on that offer.

I doubt anyone would see the ethical hope in that situation.  I would rather doctors give unbiased descriptions of procedures, treatments and options, and describe the dangers and real chances of success to the patients and families.  This would let the families make well informed decisions. Alternate medicine (like ayurvedic medicine) has its place and should be included in the list of options (but they are hardly know in the West).

False hope does nothing but increase stress, pain and suffering, and depletes the wallet.

"I think there is a world market for maybe five computers."
Thomas Watson, chairman of IBM, 1943.
Have you read FAQ731-376 to make the best use of Eng-Tips Forums?

RE: Chemistry of Ethical Hope!

Definitely lots of sides to this topic.  My wife is a physician who treats a population where this is an ongoing issue.  I know she's a big proponent of quality of life, but certainly not at the expense of the possibility for recovery.  It's a fine line she walks and I'm thankful there are people who are willing to do it.

I'll try to pass on her thoughts when she's had a chance to take a look at the article.

RE: Chemistry of Ethical Hope!

My father died of lung cancer on 7th December last year, not yet a month ago. He had liver and circulatory problems, plus a broken arm, and he was too weak for a transplant. We asked that he would not be resucitated because it would have been very traumatic for him. If there had been any hope of it achieving anything but delaying the inevitable then we would not have made the request. He slipped away with his family at his bedside.

The palliative care doctor who worked to try to make my father's last few weeks as comfortable as possible was very open and honest with us, although he was a little more guarded in what he said to my father. We had asked for the truth from the medical staff but we felt that while my father had a target to aim for, however hard it was to reach it, that he would not give up fighting and so we asked that he be shielded from the worst of the news. We talked of 'when he improved a little' and 'when he was strong enough to come home'. The staff went along with this and with each little bit of positive news his day was a little brighter - minor triumphs like having his plaster cast removed took on enormous significance. I am grateful beyond words to the staff who cared for him. They do a job which is beyond what I could do.

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  Your body might be a temple. Mine is an amusement park...

RE: Chemistry of Ethical Hope!

They say 'never say never;' that nothing is absolute.

Well, I have a never.  There is never a good day to bury your father!!

I am sorry for your loss.  Please accept my condolences.

rmw

RE: Chemistry of Ethical Hope!

ScottyUK, I feel for you. I lost my mom to a 4-month run of diagnosed lung cancer back in April (just passed through the 1-year anniversary of finding out). It was very hard to watch.

The best part of the whole process was the wonderful hospice nurse that helped us care for Mom all the way through. They were kindred spirits.

There was no hope of recovery save the miraculous but there was hope... hope of dignity, hope of comfort, hope in being cared for by your loving family, and the hope of being surrounded by loved ones during the passing.

The nurse shared the hopeless cases: Those going through what my mom was but doing it all by themselves. That is hopeless.

To the original question: I've never heard the term "ethical hope" in this context nor others.

It's hard to imagine how it might be considered ethical to withhold information and therefore impart irrational hope.

--------------------
Bring back the HP-15
www.hp15c.org
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RE: Chemistry of Ethical Hope!

Thank you for the thoughts guys. I appreciate it.

As far as 'Ethical Hope' is concerned, no I haven't heard that specific term. I think it may be ethical to withhold information from a patient if possesing that knowledge is likely to accelerate their decline by weakening their will to live, but I don't think it would be ethical to offer false hope to family where there is none: to do that would just make the blow harder when it eventually came. In my opinion the patient should know what is happening to them, but be spared the medical details of what will happen to them. It must be bad enough to know that you are dying without having to have the systemic collapse of your bodily functions explained in frightening detail.

----------------------------------
  Your body might be a temple. Mine is an amusement park...

RE: Chemistry of Ethical Hope!

Here's a related question - is it ethical to tell someone that you're giving them medication (for pain, perhaps), when what you're actually giving them is a placebo?  It's done for children all the time ("I'll give you the shot, then rub your arm with this magic pad to make the pain go away"), but is it okay to do it for adults?  ("I'm prescribing these pills which should dramatically improve your odds of surviving your terminal cancer.")  I suggest that when considering your answers you assume that the placebo is as "effective" at reducing the pain, or curing the condition in question, as other available medications.  
 
Is it ethical to do it for experimental purposes (give someone a placebo in place of medication for a serious illness, so that you can evaluate the efficacy of the real medication)?

RE: Chemistry of Ethical Hope!

The ethical issue with the placebo question is covered, I believe, with the patient's consent to be enrolled in a clinical trial.  This consent involves letting the patient know what variables are involved in the trial and that there is a possibility that a placebo will be administered.

RE: Chemistry of Ethical Hope!

Does the patient's consent make it ethical (in the case of the experiment)?  Maybe the patient is eschewing conventional treatment in the hopes of getting a new "wonder treatment," but is getting nothing instead?

The more interesting case, in my opinion, is someone who goes to the doctor with a complaint and comes home with a placebo (or someone who gets a placebo while in the hospital for something untreatable).  Placebos seem to be pretty effective for some conditions (take seasickness bracelets, for example).

RE: Chemistry of Ethical Hope!

First and foremost, take my comments for what they are - those of someone whose wife treats kids with cancer.

That being said, in the case of clinical trials in pediatric oncology, (again, secondhand knowledge on my part) the first case doesn't exist.  At a minimum, these kids get the current standard of care and never "nothing instead."  And yes, in my opinion, the patient's consent does make it ethical provided that they have been made aware that there is the possibility that they will end up in a randomized arm of a study.  This is what's known as informed consent.  In fact, some patients are reluctant to be enrolled in a clinical trial because they can't be guaranteed the treatment they want, be it the current standard or an experimental therapy.

RE: Chemistry of Ethical Hope!

(OP)
I am informed that ethical norms are very stringent in US. One of my friends was to be administered a medicine (trial one and not approved for release ) . He was advised to self administer or go to Brazil and stay for the period of trial. that is another story for later date. Unfortunately he expired in a New York hospital .

RE: Chemistry of Ethical Hope!

Look at New Scientist's list of big puzzles. The placebo effect is number one. Particularly the one where they inject saline instead of morphine, and get pain relief, but then inject some morphine inhibitor, and the pain relief 'caused' by the saline goes away. Very confusing.

Incidentally the protocol seems to be that if there is conclusive statistical proof during a trial that the placebo effect is not working then the trial terminates and they all get the effective course of treatment.



Cheers

Greg Locock

Please see FAQ731-376 for tips on how to make the best use of Eng-Tips.

RE: Chemistry of Ethical Hope!

(OP)
I wish to highlight the recent issue of coal mine disaster. The immediate and anxiously waiting families were given a hope that 12 people have survived. But this proved to be false later.

Was it right for such hope to be given at the time of disaster? Who takes the responsibility for spreading such bad information? I see none.

RE: Chemistry of Ethical Hope!

It's interesting how ethics in the medical field change.  When doing some research on open heart surgery, I came across an article that told an interesting story about a surgery that was conducted in the 1950's to treat chest pain associated with heart disease.  The results from this "miracle" surgery were so amazing that some medical experts grew skeptical.  They conducted a study that demonstrated that the placebo effect works with surgery too.  Half the patients were given the real surgery, while half the patients had their chests cracked and were sewn back up without the surgery.  Both groups faired about the same in the short term, and those that had the fake surgery faired better in the long term.  An amazing study, and equally amazing that it passed the medical ethical standards of the day!

By the way, the point of the article was that some experts suspect the same thing about today's open heart surgery.  A scary thought!

RE: Chemistry of Ethical Hope!


Let me start this with I don't mean to be cruel - just factual. I lost both parents - one suddenly and the other after a prolonged hospital stay.

What amazes me is how most families will make the trip to the Vet so the beloved family dog or cat doesn't suffer, but will endlessly beg the medical staff to do everything to prolong the life of a human, mainly because they don't want to deal with the grief of the loss.

Two terms come to mind here - Dignity and Quality of Life.
We were told by our parents that they did NOT want to be machine sustained. They had lived full lives and preferred to pass with Dignity than postpone the inevitable.

My stepfather had just survived his SEVENTH heart attack (70's, non smoker, very active and healthy) and was to be discharged from the hospital in 3 days. He looked at my mother and told her "I think I've had enough fun" and 20 minutes later he was gone. He had a DNR order, otherwise they would have 'coded' him and tried to revive him. This way he left in peace. Now THAT was class and dignity.

My dad survived his 2nd stroke and other health issues. He stayed around long enough to get out of ICU and to see EVERYONE - including those of us who were 1000 miles away - and then passed quietly in the night.  He had lost his speech ability and he knew that the quality of life he would face was far less than he was accustomed to. He had always told me that he had done more in his life than most people could even imagine, so he had no regrets when it came time to pass on. Words to live by.

My Mom - well, she just dropped dead at work one morning sitting at her desk with a cup of coffee and a muffin. Not very classy but she did get the last laugh on her boss. This goes along with the "When it's your time..." concept.

We all grieve differently but as a family we had agreed on not wanting to end it attached to a machine, waiting for the plug to be pulled, just to be around longer.

So the question becomes this: If you care enough about a injured or older pet to end their suffering, why can't that same courtesy be extended to other loved ones? I'm not talking Kevorkian steps, but just to be allowed to leave with dignity? Is the temporary postponement of grief worth making another family member suffer the pain and humiliation of continued medical 'practices'? Will this person have a better quality of life afterwards?

My sympathy goes out to each of you who has lost a loved one. The pain diminishes but never really leaves. I guess that is what Love is about.

"If A equals success, then the formula is: A = X + Y + Z, X is work. Y is play. Z is keep your mouth shut."
-- by Albert Einstein

RE: Chemistry of Ethical Hope!


Quote:

The more interesting case, in my opinion, is someone who goes to the doctor with a complaint and comes home with a placebo.

Would this include when someone goes in with a cold, and then the doctor sends them home with antibiotics when they complain about paying for a doctors visit and then feeling cheated if they don't get drugs?  I have read this trend has contributed to drug resistant bacteria.

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