| > Spewing hate at the system or at practitioners is just fucking awful. It's as awful as it is unwarranted. > The system can’t afford to throw Dr. House and his team at every patient walking in off the street. Telling a patient they're inoperable or not a candidate for immunotherapy or are going to die in 6 months from their disease is immoral and yet very common. It's really not difficult to just say to someone "based on my experience and the protocols we have at this institution, this is what I believe to be the case for your situation but you may find others with a different perspective". There's a seriously depraved amount of egoism and elitism in the medical world, in particular among younger medical professionals. > They’re essentially sitting there all day making trolley-track-payoff decisions. Yes but that's precisely not their job in a non-emergency context. They're not philosophers, they're not Maimonides. Their job is to provide medical expertise, not make value judgements on behalf of patients or arrogate themselves to a level of expertise or knowledge they don't have. |
> Telling a patient they're inoperable or not a candidate for immunotherapy or are going to die in 6 months from their disease is immoral and yet very common. It's really not difficult to just say to someone "based on my experience and the protocols we have at this institution, this is what I believe to be the case for your situation but you may find others with a different perspective".
I am not sure exactly what he was told, but the article says 'Mr Dons was told the average survival time for someone in his condition was between seven and nine months', not that he was going to die in six months. This is a fair thing to share, and I believe aligns with NHS guidance on how to share this kind of prognosis.
The article goes on to say:
> NHS treatment would have involved urgent surgery followed by chemotherapy. But Mr Dons, who divides his time between the UK and Japan, was concerned that a cancer drug called Avastin, was not widely available in the UK.
So he wasn't told he was inoperable (in fact, he was offered surgery) or that he was going to die in 6 months or anything like that. He was offered treatment, but he chose not to take it because he'd heard of this Avastin wonder drug, which the NHS were not offering him. However, Avastin is far from a wonder drug and the jury is still out as to whether it actually prolongs life or improves quality of life at all.
> Yes but that's precisely not their job in a non-emergency context. They're not philosophers, they're not Maimonides. Their job is to provide medical expertise, not make value judgements on behalf of patients or arrogate themselves to a level of expertise or knowledge they don't have.
That's wrong I'm afraid (rhetoric aside). In the UK, it is definitely the case that they are making value judgements on behalf of patients (or more accurately it's not the individual practioner who is generally bound by value judgements made by other bodies). because we have a single payer healthcare system, which cannot simply waste resources on treatments which are expensive, and ultimately the decision rests on balancing cost, likelihood of treatment success, and expected QALYS if the treatment is successful. Adoptive cell transfer is still an expensive and experimental treatment, and is not generally available to adults in the UK, although it is available for children with leukemia. People cleverer than I am debate these topics and come to their conclusions. I am very glad that I do not have that job.
My main point though is that I think it's very damaging to suggest that a doctor is 'immoral' for sharing a prognosis and offering a treatment plan.