this post was submitted on 30 Jul 2024

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Trolley problem Pt. 2: A cancer hospital, limited funds, patients of various ages and conditions. Should there be a universal answer? (sh.itjust.works)

submitted 1 month ago* (last edited 1 month ago) by [email protected] to c/[email protected]

9 comments fedilink hide all child comments

I'd assume we want everyone to survive and carry on with their lives equally. Yet, if we can't, there's a choice of distributing our doctors' time and equipments towards some of patients rather than others.

Policies deciding that choice in general, if implemented, naturally smell like death. That'd organically lead to some marks for a cut-off, the obvious one is the age - like excluding 70+ patients from active treatment and supporting them as they are instead, while prefering younger folks, because they have more projected lifespan ahead of them (AND MORE VALUE TO THE REGIIIIME!). Then, there is a game of chances for recovery. Then there are biases against lung, stomack or skin cancer patients who neglected their bodies themselves etc etc etc. And we don't even touch the problem of these policies being sexist, racist or otherwise based on unscientific grounds.

But if not over-generalized policies that can mark some categories as not-worthy patients, we'd then assume the power to decide is in the hands of individual doctors who do have the problems in the last paragraph, but with individual power to decide as well as individual responsibility for that (but they can ask patients themselves if they want it?).

My question is: should we even seek a universal answer to that dillema? What is the beacon to navigate us here, balancing general policies and individual responsibilities? How'd we personally judge a party who'd make such decision (+ if we are their patient and we don't want to die)?

I've tried my best not to suggest any answer and not to instigate any sort of an infight, but if it's not ok, please delete it.

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[–] [email protected] 5 points 1 month ago

I believe it's called medical triage, and it's a real problem. Usually, in first world countries it's more between top notch care (Immunotherapy, Hadrontherapy), regular care, and pain management.

For cancer, it would be taken by specialised hospital on a multi disciplinary team based on what they can do, and the expected life quality/expectancy afterwards (a 75 year old having to wear a diaper sucks, but the same at 30 is worse)

Note also that the way, they do it in the US based on who can pay what is even worse. Your life isn't more important if you can put your winter apartment in Aspen for rent this winter to pay for your treatment.

Triage is also a classic one in Emergency. If you watch the Netflix documentary about Paris 2015 shootings, they interviewed one of the doctor who was doing field triage. One of these ninja are cutting onion moments

[–] [email protected] 8 points 1 month ago

My question is: should we even seek a universal answer to that dillema?

The answer is No. We should let the doctors decide, and they already do it, as a group, country-wide. They have set policies, and they teach and explain the rules to new doctors.

[–] [email protected] 15 points 1 month ago (1 children)

We already have an answer to this, it's literally how hospitals work in every Universal healthcare country. It's generally decided on using a base of the factors you mentioned, plus a few more (like the resources available in the region). Doctors also generally get a say as a group at the hospital, they all take ethics classes at school for a reason.

[–] [email protected] 12 points 1 month ago* (last edited 1 month ago) (1 children)

To add further to this idea of managing death, the government does this all the time for other industries too.

For example they balance speed limits for cars (deaths vs utility for transportation)

They set maximum allowed concentrations of harmful chemicals in food and water (100% vs Good enough)

The list goes on and on.

[–] [email protected] 4 points 1 month ago (1 children)

For example they balance speed limits for cars (deaths vs utility for transportation)

In North America they do a shit job of this particular balancing act

[–] [email protected] 1 points 1 month ago (1 children)

Do they? What would you prefer to see?

[–] [email protected] 1 points 1 month ago (1 children)

Much slower speed limits as well as physical traffic calming measures to limit how fast people are comfortable going on streets in cities. Currently the way it's handled is mostly by trying to optimize for car throughput. There is no consideration to the safety of pedestrians or cyclists, nor really of the risk to drivers at higher speeds in a collision. North American cities are so drunk on car-centric approaches to urban planning that they can't comprehend how to build cities that are actually conducive to human life anymore.

[–] [email protected] 2 points 1 month ago (1 children)

And how much would lower speed limits cost the economy?

How many dollars per human life saved would you like?

[–] [email protected] 2 points 1 month ago* (last edited 1 month ago)

Lol

Sure it would save lives, but millions would be late!

-Homer Simpson