The use of authority and language

So I only had time to look at the platform of the Conservatives before the election happened. This seems fitting now though since they won the minority. Will be interesting to see what happens in the upcoming months as the new government is formed.

I just finished watching this weeks episode of Grey's Anatomy. I love this show, not just because its witty and well made, but because it always provokes me to think about bioethical issues in the clinical context.

This week Meredith accidentally intubated an elderly woman who was DNR (do not resuscitate) because the nurses were on strike and the chart was not in the patients room. Meredith was then faced with the difficult task of removing the tube in front of her family and friends.

It's interesting to consider the language Meredith used to describe her situation. She said to her friends that she had to kill her patient. The word "kill" carries with it negative connotations. However, I think that in this situation it could have easily been said that she was being allowed to die, and that would more accurately describe the circumstances and shed a more positive light on things, like that the woman's wishes were being carried out. It may seem like a small thing, what word the doctor uses to describe something, but words portray opinions implicitly. It's interesting to think about.

Speaking of doctor's opinions, Izzie shared her opinion with a young pregnant girl that adoption should be an option she considers. She said there is more than one way to be a good mother. I feel that what she was saying was true, but she had no place at all to approach her patient like that. Izzie is in a place of authority and trust in relation to her patient, and her giving personal testimony oversteps her place. Just my opinion, I'm surprised they did not deal with that more in the show.

A final interesting thing that happened involved a woman with flesh-eating disease facing the possibility of leg amputation. The woman was young and a marathon runner, so her husband asked that they attempt to remove the damaged tissue and try to keep her leg. Cristina believed this was foolish and tried to overrule her attending. I think the attending was right here, to attempt to save the leg to try to maintain the woman's quality of life if possible. It makes me think of the combat sort of language often used in medicine, the feeling that its do anything possible to fight disease. With this sort of mentality, quality of life after the battle is up often falls between the cracks. Interesting stuff.

Take note: VOTE!

So election day quickly approacheth. I hope everyone is planning to vote if you are eligible to. Not voting is just a way of saying you are fine with letting everyone determine who should be running your country. I understand people's disillusionment with politics these days because sometimes it seems like people will just say anything to get your vote, but this whole election is about keeping our politicians accountable. So educate yourself and choose the party whose platform you can swallow. (And PLEASE don't fall into the sometimes attractive idea of strategic voting. Here's a good article showing the ineffectiveness of the strategic vote.)

So anyways, in the theme of bioethics, I thought I would outline some of the promises the leaders are making for health care in Canada. Today I'm going to look at the Conservatives and the main focus of their health care promises: wait times.

The Conservative party is making this promise:

We will cut medical wait times by establishing a Wait Times Guarantee by the end of 2006 -- setting wait time reduction targets to ensure that all Canadians are treated within medically acceptable time limits (source)

In a more detailed article about this Wait Times Guarantee, it says:

Canadian patients should not face unnecessary waits for medically necessary services. Canadians deserve a government that fulfills its health care promises and delivers timely access to quality health care services regardless of ability to pay. (source)

They talk about how the Liberals have said they would set benchmarks for what is an acceptable amount of time to wait for such treatments as heart surgery, diagnostic imaging, joint replacement, and so on. And if the Liberals are re-elected, they'll have until 2007 to do something about these benchmarks. The Conservatives promise to do something about it now. How do they plan on doing this?

We will also work to increase the supply of health care professionals in Canada by cooperating with the provinces and territories to expand educational programs for doctors, nurses, and other health professionals. (source)

This all sounds great. People should definitely not have to sit on wait lists if they are in chronic pain or have conditions that time-sensitive in how quickly they are treated. As the article points out by citing the Chaoulli case in Quebec, it's a question of our human rights and rights as Canadian citizens. But you must ask yourself, where will the resources come from to lower wait times? Having more health care professionals will definitely be key, but what about beds? Treatments? Expensive machines? And won't we have to wait for years for wait times to go down if we have to wait for all these new doctors to be trained? Will the Conservatives take away from other services to reach this Wait Times Guarantee? I myself find it curious that they are making this guarantee, but also promising to lower taxes. Basic logic is telling me this would be difficult to do...

So yeah that is the fundamental promise the Conservatives are making in regard to health care. A final question to ask yourself is if this seems like the most important issue facing the Canadian health care system today?

It isn't to myself, I am most concerned about privitization of health care funding. I will deal with that on another day.

What is this beast I'm dealing with?

I decided before I begin dealing with bioethical issues, I should outline what I think bioethics is all about. Bioethics is also known as medical ethics. From that it is pretty obvious that bioethics asks what is right and wrong and what we ought to do in dealing with issues in medicine.

As a discipline, bioethics emerged in the 1970's to deal with the paternalism prevalent in medicine. It questioned that science and health care profession really knew what was best for us, and started putting the focus on autonomy of the patient.

Bioethics asks questions about issues arising in the clinical setting. For example, how important is informed choice and consent from the patient? And how can we be sure that the patient understands the information he or she is told? How much information is mandatory for the health care professional to provide? If the patient is not given the full range of treatment options, are they really exercising true choice? You get the picture. These sort of questions are sort of below the surface, but are important to ask.

Bioethics also deals with ethical questions surrounding emerging medical technologies. Check out the comic above: some extraordinary technologies, like in vitro fertilization, are becoming very commonplace in our twenty-first century society. Are we dealing with all the ethical issues surrounding these technologies adequately before we go ahead with them?

Interwoven in all these questions are sociopolitical and socioeconomic issues like access to expensive treatments, privitization of health care, and who decides what medical technologies should be pursued. I'm going to pick up on these sorts of issues next time when I talk about bioethics and the Canadian election.

(*** all this information is off the top of my brain by the way... I have to give credit to the U of T profs)

Getting Aquainted

Hello! My name is Becca and I am an undergraduate student at the University of Toronto studying bioethics, aka medical ethics. I am starting this blog because on I notice on a daily basis issues in bioethics being addressed, and I often spend a considerable amount of time pondering what my stance is on those issues. I am by no means an expert on bioethics, but being in my fourth year of my degree I have encountered many aspects and situations related to bioethics.

In this blog I will discuss bioethical issues I encounter in news items, television shows, and my classes. I plan on outlining the issue as clearly as I can, and then giving my point of view. I hope my blog will attract some attention and that people will feel free and interested in commenting on what they think about the issues at hand.

Come back soon to see my first post discussing a bioethical issue!