The Quality of Life

[Corri]

When any medical professional gets to be licensed they are required toto be there for everyone and anyone and never do damage to the person unless it is needed to increase the quality of life... or extend it.

[Please note this is not the place to discuss human euthanasia]


Quality of life is something that is 100% subjective. Meaning that if somebody wants to alter their body in a way that usually humans try to avoid (BME) who are we to stop them? Is that not increasing their quality of life?
Let's take for example gender corrective surgery and hormone adjustment therapy. This is body modification to the utmost extreme. Completely changing almost the entire physiology of the human body to the opposite physical gender, or perhaps something in between. While this has become accepted as increasing the quality of life... what about other forms of body corrections?

Why is there still an aura about it?

We now know that the human mind develops different from others. Each human's life is uniquely their own; as such everyone has their own definition of quality in their body and life. Case in point lifetime ABs, or Nearly all the time ABs... such as myself being the latter. This is something that crosses my mind often, considering I have altered my body in ways that others don't like (tattoos, piercing, scarification, body hair removal). What makes any other form more or less extreme?
Yes that includes voluntary amputation, paralysis, limb reworking or splitting, implants, color changes... etc.
While many of us including myself don't think that one should damage themselves to cause disability in any retrospect... it is their body and their life... (lets cast aside Social Security and Disability assistance for a bit)

Should a doctor under a patients request actually be fined for preforming such operations?

Should we regard extreme body alterations the way we do gender correction ( A psychological trial, and one year living a simulation of the correction) if the person in question decides to go through with it?

There are more questions and elaborations one can place here... thats for you guys!

[bdb2004]

Interesting post, and I am going to post some initial thoughts, but I am sure I will have some more as others respond.

When any medical professional gets to be licensed they are required toto be there for everyone and anyone and never do damage to the person unless it is needed to increase the quality of life... or extend it.

First off I think it is important to point off some qualifications on that statement, there is an outstanding book on the history of Emergency Medicine in the US called Anyone, Anything, Anytime: A History of Emergency Medicine, this title captures what is required of an Emergency Physician, and what is accepted when they enter that career, the willingness to treat any patient for any reason at any time, however, that is not the case with other physicians, they have the ability to chose who they treat and what procedures the perform, for example, OB/Gyns are under no obligation to perform abortions if they choose not to, the same applies to other physicians. The second applies to never do damage, this is a more difficult statement to address and probably is slightly more subjective, however to avoid the complicated issues I will simply say that in medicine there are a number of times when not providing care is as important as providing care, and helping patients who chose not to receive care ease the pain and suffering at the end of life is an important aspect of our profession, especially as the population continues to age and DNR/DNI's and advanced directives become more common.

Ok, sorry for the tangent, but I felt it was important to address to continue the discussion. On to the main topic:
From my perspective there are a number of major differences between some of the initial procedures you mentioned, such as gender reassignment, and the more severe procedures such as limb reworking, paralysis, or amputation. While both cases can be argued to be correcting a mismatch between genetics and perception, in the former the physician is not creating a disability and instead is only altering the gender assignment of the patient, and most will agree that being male or female does not create a disability. The latter cases however create what is a permanent disability and those feelings should be addressed through means other than surgery. Furthermore, inducing a number of these conditions can create further medical problems that might lead to severe consequences up to and including death.

While it is our responsibilities as physicians to work with our patients to provide the best possible care, we also have a responsibility to our patients which exceeds simply blindly following their wishes. For example, if a patient presents with suicidal ideations, in many cases, we will obtain psychiatric help for them instead of simply allowing them to end their lives.

Ultimately, while it is unlikely that I will directly encounter this situation in my clinical practice, I do feel that there is a significant difference between gender reassignment and these other procedures, as there is also a difference between allowing a patient to die by not providing care (according to their wishes of course) and actively participating in a patient’s death by administering drugs. While this relationship is clearly not perfect, and I do not mean to equate death and any of the other procedures, it is the best I can come up with at 1 am, and maybe later on I will be able to further clarify.

Simply put, I think there is a difficult ethical question to be considered regarding what care is appropriate, however, gender reassignment falls solidly on one side, while the other procedures, I feel, fall clearly to the other.

[Lukie]

Originally Posted by Corri

Quality of life is something that is 100% subjective.

It is.
The problem with perspective is much like the problem with opinion - everyone just has to have one, yet no one can seem to agree.

Having quality of life doesn't necessarily mean undertaking ventures that make you happier, or improve your standing in society. It can also come in the form of communal factors, like where you live, what connections you have and the availability and access to resources, support, information, utilities, etc...

A doctor/surgeon not only has a moral obligation to be responsible for their patient, but a societal one as well... and one's own morals differ greatly from the next person's. This is why you see people who want elective surgery only having a handful of professionals to choose from, because not all surgeons who can do the operation would do the operation.

Whilst I do believe people have the right to change themselves, it becomes narcissistic if they don't consider the repercussions to those whom said changes would affect. Like a weighted scale, if you add something to one side, it's going to affect the other, and that's what undermines the subjectivity of quality of life. We need some definitive common ideals within our respective communities to keep things in balance.

I think elective / body-altering surgery is okay, provided people consult those whom the changes would affect first. Doctor's definitely shouldn't be fined for performing such surgery either... but hey, that's what we have waivers for anyway!

[Dawes]

Advanced directives.

In most medical situations, you'll hear about these. Advanced directives are a series of simple questions the answers to which a patient (or potential patient!) can use to help define how their quality of life can be managed. By legally claiming your advanced directives long before you're ever in a situation that requires you to be put under emergency medical care, you can have a lot more control over exactly how your treatment is given.

Advanced directives define if you should or should not be intubated for nutrition; they define whether or not they should attempt to resuscitate you if you code; they discuss whether or not you're an organ or tissue donor; they define whether or not you would ever want to live off of respirators or breathing machines or dialysis.

Using these advanced directives, doctors and caregivers are not just given an opportunity to try to assist you how you want, but they are required to abide by these predefined standards.

[NeiNei]

Our bodies, our choices. Just because somebody wants a limb amputated does necessarily mean that they have a mental issue. It simply means that they want their body to be altered to fit their self-image and make themselves have a better life. Same goes for other types of bodily modification.

I have to admit that I do want to have an amputation of my left leg, and, like Lukie said, I've considered the consequences of that. But overall, I think it would make me a much happier person. (I'd be more comfortable with my body, and I could walk more easily. It's win/win for me.)