TILIR #14: Hard questions

Today was our first weekly Thursday lecture of the academic year. It's a 4 hour block of "protected" time, where we theoretically shouldn't need to worry about any clinical duties and can give our full attention to learning. What this really means is people should stop calling you at noon (when the lecture time starts), but then you catch up with your work as fast as you can before grabbing lunch and heading downstairs to the conference room. 

At the beginning of the year we split up for the first hour, with the interns getting a series of lectures about hospital/residency basics and the senior residents doing practice board exam questions. Then we meet back up and have three traditional lectures. The topics are usually coordinated, such that there is a rough theme, e.g. eyes, kidneys, vaccines, etc. 

Today's topics were ethics and safety. Medical ethics is always difficult, but pediatrics brings in a few new levels of complexity. For instance, part of the discussion today was about informed consent and refusing care. Can a 17 year old refuse a blood transfusion? Probably. Can parents of a 2 year old refuse giving her chemotherapy for a very curable cancer? Nope, definitely not. But what about a 10 year old who doesn't want any more chemo after their cancer comes back? Or a 17 year old that doesn't want to treat their HIV? Are you willing to tie them down to force medication in them?

TIL: Baby Doe rules are dumb because, unsurprisingly, politicians are awful at writing medical ethics rules. These are ethical rules written under the Reagan administration in response to a controversial case of withdrawal of care for a newborn with significant congenital anomalies. Under the rules, withholding treatment from any newborn is only permissible if the child is irreversibly comatose, if treatment would only prolong its death, or if treatment would be inhumane.

Any of these conditions seem reasonable on the surface, but pretty quickly you can see that this standard doesn't hold water. For example, nearly any treatment is only prolonging death; that's basically what medicine is. And what is defined as inhumane? To whom?