Blog > Thoughts > Sean's Thoughts > A Dilemma For Surgeons
A Dilemma For Surgeons
Written by Sean on Friday, March 19, 2010
Wikipedia defines Dilemma as: "a problem offering at least two solutions or possibilities, of which none are practically acceptable". Which would a surgeon pick for a patient: Death, or Surgery?
What would happen if I went to a surgeon, in a face to face appointment, and told her "if you don’t give me surgery for a spinal cord transection (or bilateral femoral and sciatic nerve transection), I will kill myself"?
Surgeon, considering a dilemma.
I would not intend it as blackmail, although I realise that it could be perceived that way. But today, I certainly feel that for me, death is preferable to continuing life without being paralysed.
One of the arguments we often hear is that surgery for BIID is not ethical. Yet many ethicists disagree. Another argument is that a doctor has to provide the best possible outcome for the patient, and when they compare life without an impairment to life with an impairment, they say that it is better to have no impairment. I would argue that point, but let’s say I accept that argument for a moment.
Let’s change the picture, just a little bit. Let’s say the comparison is in fact life with an impairment, or death. Which is better? I know what my usual reader would likely chose. But what of my hypothetical surgeon? Is he part of the 52% of people who would rather be dead than disabled? What a choice! Could they put themselves in my place, agree that their perception of disability might be different from mine, and that I chose disability? Can they ethically decide to refuse treatment on the basis of their belief? Ahh, yes, they can! They could refuse to conduct an abortion. But then they’d have to point the person to a doctor who *would* do the abortion.
Of course the problem is, NO ONE is doing BIID surgery, except one or two exceptions which are cost prohibitive for most people I know, myself included.
So back to my earlier question for that surgeon. Will you do the surgery, or will you let me kill myself? They’d likely refer me to the mental health services. Yes, the very same service who had one shrink tell me that I should look at Zen Buddhism, a social worker who told me that it’s not therapy that fails you, it’s you that fails therapy, and the Director who threatened to out me (which I haven’t blogged about). The very same service who admitted that if someone is on suicide "watch", most often they are left at home and someone rings them every few hours to check on them. The system fails there, in significant ways. But even if the system wasn’t failing, they still couldn’t help with the BIID!
Surgeon might argue I am making this decision at a time where I am not competent to make such a drastic decision, because I am too deep in depression. Except that it is something I’ve been considering regularly, at times of depression and at times of no depression. It is not a new thought for me.
A physician who has BIID said on a Yahoo! mailing list that:
[...] even I with my own BIID find a desire for a spinal paralysis hard to swallow. Understand, it is not that I have any intellectual problems with your form of BIID. How should I object to this when I have accepted my own BIID? But on an emotional level it does seem a harder thing for me to accept than someone’s decision to get a leg lopped off.
That really does give me a good indication that such an approach to a surgeon would lead me nowhere at all.
Perhaps I will drive the car off the cliff after all.
Tags: Death, Dilemma, Ethic, Mental Health, Suicide, Surgery
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17 Comments
Sean. I am really sorry to read that you find yourself in this situation.
I understand your very serious choice, paralysis or death. However, as someone who has dealt many times with people in depression, threatening suicide comes across as incredibly manipulative. I know you don’t mean it that way. Putting a surgeon in that position would be counter-productive. Suicide is not seen as a rational choice, therefore you’re not rational and not capable of making the decision to become paralysed.
You know all this, I know you do. And I know that to be considering this you must be extremely desperate.
___
Regarding those people who think they would rather be dead than disabled, it seems they have completely missed the point. There is so much ignorance when it comes to disability, and no one understands impending death unless they have been there or have seriously attempted suicide. I know from my own experience, being suicidal, that being suicidal and actually killing yourself are miles apart.
Most people have no real concept of death. They say all sorts of daft things, not really meaning what they say.
As well, most people have no real idea as to what disability is about. They can’t get past “I wouldn’t be able to walk!” to think of all the stuff they WOULD be able to do.
___
Regarding the physician’s conflicting emotional and sensible ideas… I understand. I have been reading this for a very long time, and my initial reaction was one of horror and disgust. But, as a biologist and aspiring medical bod, incredibly intrigued. Through reading, I have managed to understand your point of view, and thoroughly support all of you…
However, despite all of this, I commented once on a post of yours saying, “I sincerely hope you get what you need.” Fine. Absolutely fine. About ten minutes later it dawned on me that I’d just said, “I hope you suffer some horrific accident and become paralysed.”
I had a huge debate with my brain about whether that could possibly be right. My head prevailed, but if I was in a position of actually making that decision I don’t know if I could.
Sorry for the essay…
Sean… In my mind I am sitting opposite you right now, holding your hand, looking into your eyes, crying (which I am). There is no impulse to say anything at all. You already know all there is to say.
I just want you to stay.
4 On 19 March, 2010, Sean said:
@Howard, the only comment from you is the one asking about your other comment. That first one did not come through. If I had censored it, which I do only VERY rarely, I would have told you about it and why.
5 On 19 March, 2010, Sean said:
@Gravity, I hear what you’re saying. The thing is, I’m not actually in severe depression. I am depressed, yes, but no more than I usualy am – I’ve been living with ongoing depression since my mid-teens. So at the moment, my thoughts are about as clear as they get, not clouded at all by a deep and dark depression.
If putting the question to a surgeon is counter-productive, then, what would be productive? Tell me, because I’d really like to know. No other line of reasoning has seemed to work.
As for you wishing for us to get what we need, paralysis is it. No need for a horrific accident ;)
6 On 19 March, 2010, Sean said:
@Chloe, thank you.
Black mailing doctor,going over a cliff and chloes skiing for a sci.dont you thinj this dangerous.the are safer not painless but less painful way to get an sci.i have some ideas if you want to hear.i mean you or chloe could get killed or get sci like c2 quad.go with something sure of causing l2 l1 or t12 type of injury
Sean… I know you know all of what I said… They were just my thoughts.
I wish I had something to say that WOULD be productive.
I am so sorry you find yourself in this position.
9 On 19 March, 2010, Sean said:
@Howard, as I specifically pointed out, the query of “death or surgery” is not intended as blackmail, and would not be phrased in such a way that blackmail would be construed. Please use the contact form to share your ideas with me. Because I’ve been thinking about this issue for nearly 30 years without coming up with an answer. And I’m not unintelligent, even if I say so myself…
@Gravity, that’s just the thing, isn’t it? Nobody seems to have anything productive to suggest. Hence the incredible frustration. All we hear is “don’t do this”, but never “do this”. Not upset with you, just pointing out that’s what we always hear.
Im sorry if i souned condacending.thats why i didnt say any obvious sci tips.i did kinda think you had thought of it all.very few people know the dangers of paintball guns.they can cause major soft tissue injurys,worth researching.sorry if i ofended you.
11 On 19 March, 2010, Phil said:
Dear Sean,
it is not rare in life that there is no help, no productive words, no “solution”. Life just has to be taken as it is at times.
Let’s try to make the best out of it NOW and not think too much about what could and should be in the future.
We already do what we can. Take part in research, support each other, inform therapists and doctors and the public, look for surgeons…
You already do everything you can. Don’t search too much.
Otherwise you put yourself in the treadmill.
It is hard, but there is no solution for you and me right now. But for so many people in the world there is no solution right now. We are not alone in suffering.
Best wishes and lots of compassion
Phil
12 On 19 March, 2010, Sean said:
@howard “soft tissue injury” is quite different from spinal cord injury. There’s about 5cm (2″) of soft tissue (muscles) before reaching the spine, which wraps around and protects the spinal cord. I doubt any paintball gun could ever come near to touching the spine…
@Phil, you’re right, there are many people in the world for whom there is no solution. We aren’t alone in suffering.
I am already doing everything I can. And that is so far from sufficient, it’s not even funny. I *can* hang on and continue struggling. It is not a LIFE. It is mere surviving. And frankly, I’m tired of surviving. I’ve been surviving for more than 20 years. I guess I just don’t really *want* to continue hanging on. I’m tired.
At point blank range maybe.im not sugesting simple soft tissue would cause a complete sci. Pb guns can do profoundly more than just that.i would say 40% chance it could work.i googled pb gun injurys
15 On 19 March, 2010, Sean said:
@Howard, are you seriously suggesting that a paintball gun pellet, even at point blank range, could get through a 5cm layer of muscles, and impact the spinal cord sufficiently as to cause *any* level of paralysis???
and 40% chance is nowhere near sufficient enough
@Howard: yes, paintball waivers say that you could be paralyzed playing but I don’t think they mean from the gun. While paintball guns, I agree are dangerous. Most injuries from playing occur a collision or fall on the course.
@Sean: Hugs…
I recently read an article in Wired (http://www.wired.com/magazine/2009/10/mf_optigenetics/all/1) which sounded promising as a possibility for safely aquired SCI. They’re currently using it to control brain activity by triggering/inhibiting neurons in the brain, but why not nerons in the spinal cord. Unfortunately it’s highly experimental and only in lab rats at the moment. But maybe there’s hope. It’s a simple “procedure” and someone could be rigged up to “turn off” motor or sensory neurons at a specific site in their body via a tiny embedded led light emitter. The benefit to this is that it would not necessarily be any permenant damage so quite possibly a stong case for it being ethically ok with the docs could be made. Check it out and see what you think.
17 On 19 December, 2010, David K. said:
Indeed quite a dilemma for surgeons. But on more ways than one.
However, it seems that most if not all choose the ineffective route, and by extension the most harmful route. Their choice, ironically is based on what they believe to be the least harmful route.
And if it’s not, or at least what they qualify it with is that there’s been no (formal) study proving that it would actually resolve the problems.
Equally, there is also no study proving that any other routes would solve the issues.
And it seems like there is no one actually willing to perform those often cited, but as of yet, non-existent studies and their results.
I’ve even been,to say the least, quite dismayed at that prospect. But, I can’t help but wonder if they haven’t been offered to be the ones to perform said studies.
I’ve also considered getting the necessary qualifications to be able to fully and inclusively perform those studies myself. But after looking into things, it would require at least 12 years of education, and that is only for the physical aspect (i.e. actually being able to perform the surgeries).
Unfortunately, I came to the conclusion that, first, I’d probably wouldn’t be able to put forth the confidence and effort required to attain that goal, without first getting my needed impairment. Second, with looking into the studies required, also came the often graphic images of said surgeries, that I wouldn’t have the stomach for it. I do realize, that the stomach for it can be an acquired thing for some. Finally, I don’t think I would be able to put forth that much effort into something that I don’t particularly want to do for a living, although the average wage is quite attractive.
Although, I am fairly close to be driven to actually attempt it, which is no guarantee of success, nor do I or would have the financial means.
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1 On 19 March, 2010, Howard said:
I sent response to surgion delema 2 hours ago .did it not go through or was it censured