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palmd's profile
PalMD
PalMD
PalMD
@palmd

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PalMD

@palmd

Internist, dad, husband, and sometimes-writer. He/him.

Great Lakes
Joined November 2008

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    PalMD‏ @palmd 20 Dec 2018

    Ugh. I guess it's time for medical ethics 101....tl:dr doctors cant shove things up a patient's ass just because the state tells them to. But there are reasons for this besides the obvious...

    3:44 AM - 20 Dec 2018
    • 6 Retweets
    • 22 Likes
    • giveemwatts Dillon Hounshell Goran Gachevski Kara Paolisso JByrne Steven Tiger David Gorski, MD, PhD Pete DeBalli, MD Fred "just call me Fred" Chu
    3 replies 6 retweets 22 likes
      1. New conversation
      2. PalMD‏ @palmd 20 Dec 2018

        Ethics obv change over time and culture and represent a huge field of philosophy, but there is currently a 4 point framework of medical ethics used by the medical community:

        1 reply 0 retweets 1 like
        Show this thread
      3. PalMD‏ @palmd 20 Dec 2018

        These principles are 1) beneficence 2)non-maleficence 3) patient autonomy 4)justice/human rights. All of these can be analyzed at the individual and societal level.

        1 reply 1 retweet 4 likes
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      4. PalMD‏ @palmd 20 Dec 2018

        In the current case, that of a syracuse hosp doing a flex sig on a police detainee against his will, here's the poop:

        1 reply 0 retweets 1 like
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      5. PalMD‏ @palmd 20 Dec 2018

        1) beneficence: did the doctor act in the best interest of the patient? Who defines this? This is generally taken to mean tho that the goal of care is to help the patient. Not the family, not the hospital, not the state. The patient.

        1 reply 0 retweets 4 likes
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      6. PalMD‏ @palmd 20 Dec 2018

        2) non-maleficence: primum non nocere, first do no harm. The default for docs is don't hurt people. Not only shouldn't you hurt people, you should protect your patient from harm. The doctor here failed. Miserably. But see #4

        2 replies 0 retweets 3 likes
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      7. PalMD‏ @palmd 20 Dec 2018

        3) autonomy: as opposed to paternalism, autonomy recognizes the right of every individual to decided what is or is not done to them by doctors. Any violation of autonomy better be preceded by a damn good ethics consult.

        1 reply 0 retweets 3 likes
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      8. PalMD‏ @palmd 20 Dec 2018

        4) Justice: doctors must think of what is just and right for their patients and for society as a whole. Now in this case perhaps the state intimidated the doctor into violating this patients rectum. Perhaps this mitigates his guilt...

        1 reply 0 retweets 3 likes
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      9. PalMD‏ @palmd 20 Dec 2018

        ...not everyone can be a hero. Was the doctor here on a limited visa and worried he could be deported? That doesn't justify the rape of the patient, but it does help explain it.

        1 reply 0 retweets 3 likes
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      10. PalMD‏ @palmd 20 Dec 2018

        When doctors become tools of the state, we have lost our profession completely and probably forever. Authoritarian societies have always used doctors as tools, and it always takes years to regain a shred of trust.

        1 reply 7 retweets 20 likes
        Show this thread
      11. End of conversation
      1. Steven Tiger‏ @SteveTiger999 20 Dec 2018
        Replying to @palmd

        Nice summary of the framework for medical ethics.

        0 replies 0 retweets 0 likes
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