LisaRose said-
Yes, I understand about palliative patients, I am not talking about them.I am talking about patients who have some condition that is still being treated. If you have cancer, they may be still be giving you chemo, still treating you, even if your outlook is grim, I wouldn't think that would be considered palliative care. The patients may extend their life a few more months through a transfusion, but they may then die due to the underlying condition. The study is only considering costs and mortality during the hospital stay. They are not at all looking at longer term mortality of even a few months. If you look longer term, you may see more of the non JWs who eventually succumb to their illness. This would completely change the statistics.
We're talking about the same thing, since what you're talking about does involve the palliative care (AKA hospice) exclusion used in the study.
Even though it's most-commonly associated with the elderly, hospice can serve the needs of pediatric pts, and for the same exact reason: they've been diagnosed with a terminal medical condition and their physician feels their prognosis is poor, and end of life is near (usu. within 3 months). Of course in some cases, by refusing blood, JWs are hastening their own demise (esp for conditions such as untreated anemia) such that in severe cases they're virtually signing their own death certificate by refusing Tx. But by excluding those palliative care pts from the study, it's likely biasing towards those pts (patients) who are not as critical, and thus exaggerating or amplifying the cost effects of pts who are "hanging on" and thus driving up costs for their ongoing care due to needing more-expensive ongoing treatment, multiple visits to the ER/ICU, etc, rather than just dying within a short period (where, to be blunt, a quick death is the ultimate cost containment).
In other words, the pts who got sent to pallative care likely had comorbidities (i.e. other medical conditions which may have contributed to their symptom of severe anemia), where their deaths meant lower costs in the JW group, IF they had not been excluded (I'm guessing that the untreated cases of severe symptomatic anemia which had no other complicating diagnoses must pass away rather quickly anyway, and there'd be little point to sending them to hospice (although that's just a hunch, AKA an assumption.)
Marvin said-
For varied reasons you and I hold different views on how much the teens in Beliaev’s study (assuming there were teens in the group) would influence the number I concluded. That aside for a moment, I’m not sure your direct comparison of legality has the effect you think because in service areas like the USA though the law is different I’m not so sure the outcome is different. Let me explain what I mean. Doctors in the USA have a duty to provide appropriate care for all patients.
When an adult patient refuses appropriate care doctors are not allowed to overturn the decision unless the patient is incompetent or does not have a healthcare proxy completed when they were competent. When a doctor is confronted with refusal of treatment by a minor or parents/guardians of a minor a legal and ethical challenge arises over what is appropriate care for the patient when alternative treatment exists.
Thanks for the lesson on standard of care and patient's rights, Dr Schiller. Can I earn CME credit for that lecture?
The thing you seemingly don't understand is that the PATIENT ultimately has the final decision on their course of treatment, NOT the doctor: the provider MUST respect the patient's decision, EVEN IF the reason the patient provides is utterly absurd in their eyes, and EVEN IF the patient provides NO reason at all for their choice.
It's THE PATIENT'S body, and hence it's THEIR RIGHT to do with it as they see fit, AND FOR NO REASON, or for ANY REASON (within limits: if the provider has a clinical suspicions of their not being mentally competent, the onus is on them to seek out the professional opinion of a colleague in the mental health field to make that determination).
Hence a provider is minimally required to provide the pt with information on their treatment options (i.e. risks v benefits of the proposed courses of treatment), document the advice they gave (in order to defend themselves, in case they get sued for malpractice after being accused of failing to meet their standard of care), and follow the pts wishes, IF THEY CAN DO SO without compromising their profession's standard of care.
A doctor CAN refuse to provide care for any patient, if they feel the pt requests would violate their profession's standard of care; in that case, the doctor needs to make a referral to another provider (preferably a specialist who has experience) who IS willing and able to provide alternative treatment, and who agrees to accept caring for the patient. In any case, the doctor MUST avoid abandoning the patient, since it's a violation of professional standards to simply leave the pt in limbo, without any care.
In the end, a provider only has an obligation to explain the risks vs benefits of alternative treatment options in as fair and balanced a manner as possible, and the patient has to decide under their own power. Some providers will rely on their powers of persuasion and interpersonal communication skills to try and convince the pt of what they believe is option provides the better chance of obtaining a successful outcome, but it remains the patient's choice and they have to live (or die) with the results.
Unfortunately, many doctors let their egos get in the way, and end up getting frustrated or taking it as a personal affront when the patient refuses to do what THEY want them to do, like all the other patients. That's the doctor's problem, and often reflective of the old-skool "Doctor is God" thinking which is hopefully becoming a thing of the past.
I couldn't sleep at night unless I remembered the old saying, "You can lead a horse to water, but you can't make it drink." (well, if the horse were dehydrated, technically you could restrain it and start an IV infusion with Ringers to rehydrate, but.....)
In much the same way, we must appeal directly to the JW PATIENT, and explain WHY the choice to refuse a BT for themselves or to pressure their family is not wise, since at the end of the day, it remains THEIR choice. And if you think creating a number will have some dramatic impact, then go for it. Just consider that it's also likely to have a paradoxical response, eliciting the thinking of, "well, 50k OTHERS refused blood and died for it, so it MUST be the right choice". Or if they decide after seeing the hyperbolic claim of 50k deaths, and reject what is good advice (thinking that the GB's words of apostates being willing to lie is true). Their blood is partly on your head, if they are influenced by your metric.
With that, I'm out and back to lurking.
Adam
EDIT:
Marvin said-
None of the minors included in Beliaev’s study died for blood refusal.
Of course there weren't any: that's the entire point of them being considered "minors": they're under the age of consent in NZ.
However, that's an answer to the question I didn't ask. The real question is:
Were there any pts aged 16-18 y.o included in the JW group amongst the 21 deaths reported who died from refusing BT?
Adam
