The Ethics of Erasing a Bad Memory

Here is the Hippocratic Oath:

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

No professional code can address a situation like this.

Aha, indeed the hippocratic oath is not specific to the particular drug used. But then again, I never said that it was, I mentioned it to draw a demonstration of how it is there to make medicine objective, and show how it compares with the ethics surrounding that drug. I do indeed know someone who is studying to be an anesthesiologist, and in fact, they are trained never to use that drug without consent of the patient. They are required, before getting their medical license, to include that among their code of ethics, hippocratic oath is more general doesn't apply to any specific treatment, but rather how general procedures are to be done.

So while it can be argued that he didn't disobey the hippocratic oath, it can not be argued that he did not act unethically, that did not neglect his training, and that he did not violate procedures which he agreed to before taking the job. Because in fact, he did.

BTW - I'm not sure what about the last clause says that it is just a guideline.

...I see both sides of the argument, but...

I still belive that the doc did the right thing. he just "erased" a terrible thing that never should have happenned. Plus, it was only a few minutes.

Ok, Just to make my point clear, I absolutely side with the doc on this issue, BUT!!! When it comes to the manipulation, deletion and replacement of memores (I.E. As seen in Trace Memory) Then I'm totally against it. It's not for us to toy with people's minds.

It's just that sometimes, to prevent tragedies, we need to break the rules. >_> I know this can be abused to hell and back, but...In some rare instances, it holds true.

You are still trying to pretend like ethics are an exact science. Their application is more of an art. I do not subscribe to the Kantian school and I do not believe there is such a thing as a universal maxim.

They call these situations dilemmas for a reason. A dilemma is a problem where ethics provides a conflicting view of the correct action; either choice requires violating some supposedly sacred rule.

A classic example involves a group of tourists being led through a cave by a tour guide. This particular cave exists below sea level, but when the tide is low its entrance is revealed. As the time for the tide to come in approaches, the tour returns to the entrance. However, a small cave-in has occurred and the entrance is much smaller than when they entered. The tour guide attempts to exit the cave, but gets stuck.

The tide will start flooding the cave in 30 minutes. There is dynamite in the tour guide's backpack (which the tourists can still access), but using it to open the entrance means killing the tour guide. However, if the entrance is not reopened, all of the tourists and the tour guide will drown.

Here, we have a conflict with the proposed maxim "It is always wrong to kill a person". You may not believe it, but there are those who would not kill the tour guide, preferring to die knowing they did not kill a man. However, one could argue that in this case inaction makes the person responsible for the death of every person.

We need not bring death into the picture to create a dilemma, though. Suppose a poor man has been laid off from his job and is unable to feed his family. He attempts to steal some food from a grocery store and is caught. Do we agree that he should go to jail, or do we feel like his actions were excusable given the circumstances? Strict believers in the law would argue that he clearly broke the law and punishment must be rendered. Others might have sympathy and point out his alternative was to watch his family starve. Do we throw him in jail and leave his family to their own devices?

The key point to keep in mind is the meaning of the phrase "justice is blind" has two sides. There's the happy friendly meaning that indicates that no matter your walk of life you have the right to a fair trial when accused of a crime. Then there is the ugly side that indicates justice cares not about context, but reduces all issues to a true/false, "Was the law broken?".

That which is just is not always right.

Aegix Drakan wrote: I know this can be abused to hell and back,

And that's exactly what I'm afraid of. It wouldn't worry me so much if there wasn't potential for abuse. In this case, I would still say it was wrong since we can't know if that's what she would have wanted, but it wouldn't be so bad if not for potential abuse. I do agree at least, that it would be nice if we could break the rules and always be right about when we do it.

AtmaWeapon wrote:You are still trying to pretend like ethics are an exact science. Their application is more of an art. I do not subscribe to the Kantian school and I do not believe there is such a thing as a universal maxim.

In some cases it certainly can be. When you swear in your code of ethics to heal anyone and everyone, simply because they need healing, that sounds pretty exact to me. There are indeed cases where they are more arbitrary(engineering for example), but medicine is not such a case.

AtmaWeapon wrote:They call these situations dilemmas for a reason. A dilemma is a problem where ethics provides a conflicting view of the correct action; either choice requires violating some supposedly sacred rule.

But in this case, a conflict of ethics is not actually present. It is indeed true that the intercom thing should not have happened, however that does not give doctors the right to violate their ethics further. I do agree that conflicts of ethics do in fact exist, but I'm afraid I can't see eye to eye on this being one of them.

AtmaWeapon wrote:A classic example involves a group of tourists being led through a cave by a tour guide. This particular cave exists below sea level, but when the tide is low its entrance is revealed. As the time for the tide to come in approaches, the tour returns to the entrance. However, a small cave-in has occurred and the entrance is much smaller than when they entered. The tour guide attempts to exit the cave, but gets stuck.

The tide will start flooding the cave in 30 minutes. There is dynamite in the tour guide's backpack (which the tourists can still access), but using it to open the entrance means killing the tour guide. However, if the entrance is not reopened, all of the tourists and the tour guide will drown.

Here, we have a conflict with the proposed maxim "It is always wrong to kill a person". You may not believe it, but there are those who would not kill the tour guide, preferring to die knowing they did not kill a man. However, one could argue that in this case inaction makes the person responsible for the death of every person.

And indeed, that would be an example of an ethical conflict. It is much different however, from treating a human being like a machine, and simply erasing a mistake you made on it. In the case of what we are discussing, it was a panicked person, she was the only victim, and after the first ethic had been breached, there was indeed potential to correct the situation in a way other than what was done. Also there may have been a good reason for her to wanna live through it, since surviving a battle with death can be exhilarating(being near-missed by a car for example).

In the case you spoke of above, someone dies no matter what, and there is no way to correct either mistake. In the case of what happened with what we're talking about, it was indeed possible to make the correction without another ethics breach. While it could be argued that we don't know if they'd have been able to keep listening long enough to hear them out, we don't know if she'd have preferred to live the memory and tough it, having had the experience of recovering from cancer, as opposed to just forgetting it.

AtmaWeapon wrote:We need not bring death into the picture to create a dilemma, though. Suppose a poor man has been laid off from his job and is unable to feed his family. He attempts to steal some food from a grocery store and is caught. Do we agree that he should go to jail, or do we feel like his actions were excusable given the circumstances? Strict believers in the law would argue that he clearly broke the law and punishment must be rendered. Others might have sympathy and point out his alternative was to watch his family starve. Do we throw him in jail and leave his family to their own devices?

The key point to keep in mind is the meaning of the phrase "justice is blind" has two sides. There's the happy friendly meaning that indicates that no matter your walk of life you have the right to a fair trial when accused of a crime. Then there is the ugly side that indicates justice cares not about context, but reduces all issues to a true/false, "Was the law broken?".

That which is just is not always right.

I agree here, but 2 things:

1. The idea that we will always do things right is just that, an idea. It is far from fact. Objectivity may not always result in the right decision being made, but it's a damn sight better than what subjectivity would bring.

2. Law is similar in this aspect to medicine. But it is also in many ways different. Which is one reason why we have trials, and sentencing. Because sentencing and crimes are indeed handled case by case(no pun intended), and the law also has plenty of gray areas. So the way laws are enforced can be and in fact is at least a little more subjective than the practice of medicine, because law is a bit more arbitrary than whether or not a person is injured.

I hate to be nitpicky litte guy but this comment kinda struck a chord with me...

Anarchy_Balsac wrote:When you swear in your code of ethics to heal anyone and everyone, simply because they need healing, that sounds pretty exact to me.

...>_> One could argue that "deleting" that traumatic memory was a form of "healing"

Aegix Drakan wrote:

...>_> One could argue that "deleting" that traumatic memory was a form of "healing"

No it is not. Sure people can play semantics and stuff, but I'm not going to suddenly start believing that concrete facts are in fact, not concrete because someone wants to argue semantics about what concrete, or in this case, healing means. You can argue it to be mental healing, but that is not something which a doctor has discretion over, that is something which a psychologist has discretion over.

I joinded this discussion a little late, but here is my opinion. I think that what the docter did was wrong. It was wrong for him to erase her whole memory of the incedent. It was wong for him to go against her will not to be put to sleep. And lastly, it was wrong of him to never tell her the incedent. He never told her, and I can garenty (I know that's spelled worng) you that that incedent is going to haunt him for the rest of his life.

...>_> One could argue that "deleting" that traumatic memory was a form of "healing"

Anarchy_Balsac wrote:

*Include everything Anarchy_Balsac has said in this thread thus far*

To be honest man, it seems like you're more concerned about this whole thing than the lady who died from the cancer. And are you preparing for a debate class, or running for a political office? It seems that way with all of your logical arguments. Somehow though, I doubt that is the case, considering the hours you've spent arguing the same case in every other post of yours.

Anyway, my take on the matter is that the "put-you-to-sleep"* dude did the right thing at that moment in time. I would be concerned about the lady freaking out while being in the OR, and possibly hurting herself by freaking out, ie. running out of the room half dressed with fresh stitches on her neck.

I do think, however, that it is wrong to withhold the information from the patient indefinately. At some point the doctor should've sat her down and told her exactly what was going on with her body. That's it from me, so everyone continue to beat a dead horse if you like. 🙄

*I don't feel like looking up, or attempting to spell anastesiolgist(sp?) at 4:37 am in the morning.

I still think the docter should not have gon against the lady's wishes. I am just like her, I never wish to be put to sleep and I certainly don't want my memory erased. So I can easily syphathise with her. The docter should DEFINITLY at least told her what happened afterwards.

Rijuhn wrote:To be honest man, it seems like you're more concerned about this whole thing than the lady who died from the cancer.

So? What's wrong with having valid concerns about where crossing the line may lead? And if you read, yes I am also concerned with the patient herself. I stated several times that she may have indeed wanted her memory, we just don't know.

Rijuhn wrote:And are you preparing for a debate class, or running for a political office? It seems that way with all of your logical arguments. Somehow though, I doubt that is the case, considering the hours you've spent arguing the same case in every other post of yours.

That is a text book ad hominem attack and it is irrelevant.

Rijuhn wrote:Anyway, my take on the matter is that the "put-you-to-sleep"* dude did the right thing at that moment in time. I would be concerned about the lady freaking out while being in the OR, and possibly hurting herself by freaking out, ie. running out of the room half dressed with fresh stitches on her neck.

She was sedated, she would not have been able to do so, while she freaked out a bit more than it seems a sedated person should be able to, the fact remains that she would not have been able to just get the hell up and go running out of the room like that. Also, he's an anesthesiologist, if she did indeed show signs of being ready to do something drastic which could hurt herself(which is rediculus because she'd have to be pretty damned stupid to get up and run out while she is also fully aware that her body is sliced open, or even loosely stiched) he could have used, well, anesthesia, which would not have erased her memory, but he didn't.

She wasn't sedated, she was under local anesthetic.

Your case just developed a crack. You suggest he could have chosen a drug that sedated her but did not erase the memory. Her clear wish was to not be placed unconscious. It is my opinion that if he violated her wishes so far as to knock her out, it is only humane to erase her memory of the event as well.

Atmaweapon wrote:She wasn't sedated, she was under local anesthetic.

Okay, I'll admit I don't know the difference, but what is it?

AtmaWeapon wrote:

Your case just developed a crack. You suggest he could have chosen a drug that sedated her but did not erase the memory. Her clear wish was to not be placed unconscious. It is my opinion that if he violated her wishes so far as to knock her out, it is only humane to erase her memory of the event as well.

I will admit that it was a poor choice of words on my part. What I meant was this:

It is my understanding(and correct me if I am wrong) that doctors may sedate patients without consent, including by using knockout drugs, when they start to pose a danger to themselves and/or others. This does not however, mean that they can erase memories, it is entirely different.

Also, violation of one right definitely does not okay violation of another. Tranquilizing someone for their and/or other's safety is not the same as violating their memories, nor should it be treated as such.

Sedated means you're out cold and won't know squat (I'm not sure if you're on breathing help, etc).

Local anesthetic means you're basically still conscious but are kinda on the edge between being awake and not awake.

Prrkitty wrote:Sedated means you're out cold and won't know squat (I'm not sure if you're on breathing help, etc).

Local anesthetic means you're basically still conscious but are kinda on the edge between being awake and not awake.

Gotcha, I think the latter is what I meant when I said that. Well live and learn.

Local anesthetic means that they numbed her arm and performed the procedure. She was completely concious in the operating room, even having a conversation with the doctor while waiting for the test results to come back.

The only 'fact' in this thread is that none of us were there.

The article, which was written by the doctor, notes that he had finished stitching her up when the results came back. She became hysterical when she heard the results of the lab work over the intercom. It doesn't say whether or not she was posing a danger to herself or just how hysterical she really was.

From some of your comments, I doubt many of you have ever seen the inside of an operating room, or ever met an anesthesiologist for that matter. He was standing by her side ready to push an already preselected medicine into her IV that would slip her into an amnesiac sleep in the event that anything disrupted the patient.

'Milk of Amnesia', which could be anything since it doesn't specificy what exactly he dosed her with in the article, works so effectively that it will immediately knock your ass out. The side effect is short term memory loss, which is pretty common among any strong anesthesia or sedative.

If she was extremely hysterical and posed a danger to herself, then the anesthesiologist acted appropriately. If she wasn't, which I doubt very much considering she was just told she had bad cancer, then they should have talked to her and attempted to calm her down.

This isn't even really an issue worth debating since we can't know what really happened. We only have the author of the article's guilt ridden confession of the incident.

Regardless of the situation, the comments that the doctor made afterwards were unprofessional and made it seem like he and the anesthesiologist were selfishly acting to save their asses at her expense.

If she was strong enough to undergo the entire procedure of slicing a piece of bone off with only local anesthetic, then I would think they would have been able to calm her down. She clearly expressed a desire to not be put under anesthesia from the beginning, so they should have respected that if she wasn't putting herself in physical harm. If they didn't, then they were just bad doctors.

Guess what kids?

There are a lot of them in the world that don't give a shit about you or follow a strict code of ethics. I've met doctors that probably couldn't even spell the word morality, let alone express it.

Breaker I agree with you until the last part of your post, because you contradict yourself.

We weren't there, we don't know the situation, we can't assume we know what happened.
I assume she was hysterical because of the situation.
I assume, based on this information, they could have calmed her down.
_______________________________________________________________
Bad doctors.

Hypotheses 2 and 3 are mutually exclusive. Both contradict hypothesis 1.

Breaker wrote:

Guess what kids?

There are a lot of them in the world that don't give a shit about you or follow a strict code of ethics. I've met doctors that probably couldn't even spell the word morality, let alone express it.

Yes, and they need to lose their medical licenses. And plenty of them do. In extreme cases they even go to jail, which I agree that sometimes they should, depending on the nature of their bad decisions.

As for milk of amnesia, it's called propofol. And frankly, erasing someone's memory is not okay just because they are getting hysterical and posing a danger to themselves and/or others, that's where you give them knockout drugs. And after seeing this, if I am ever in a situation where there's an anesthesiologist involved, I will demand a drug test after the procedure to make sure no propofol is used. If there is, I'll sue for malpractice.

You do bring up an effective point though. We don't know how hysterical she was or what the doctors actual motives for using propofol were. I've been arguing extremely conservatively about this, only arguing the best case scenario, but truth be told, I'm not at all convinced that he necessarily had good intentions. It's entirely possible that his reason was to cover everyone's ass for the major fuck up that happened over the intercom. And the fact she wasn't even told she had cancer after the fact, and recurring cancer at that, and she died because she was unaware of this and did not go back to the doctor as a result, guess what? We're looking at a possible manslaughter case.

It isn't necessarily, but just to cast some light on it, the worst case scenario is every bit as worth mentioning as the best case.

She was told she had cancer several weeks after the incident in the operating room. The delay was so that they could confirm the diagnosis.

Breaker wrote:She was told she had cancer several weeks after the incident in the operating room. The delay was so that they could confirm the diagnosis.

I must have missed that detail. I would have to question why she did not go back to the doctor if she was indeed told that not only was it cancer, but recurring cancer.

Anarchy_Balsac wrote:I must have missed that detail. I would have to question why she did not go back to the doctor if she was indeed told that not only was it cancer, but recurring cancer.

Not everyone wants treatment when they find out they have cancer. Some people just want to live their life until it takes them down.

biggiy05 wrote:Not everyone wants treatment when they find out they have cancer. Some people just want to live their life until it takes them down.

There probably are indeed people like that out there, but given her reaction, I would think it was highly unlikely that she was one of them.

Anarchy_Balsac wrote:There probably are indeed people like that out there, but given her reaction, I would think it was highly unlikely that she was one of them.

She knew she had cancer after the operation but she obviously didn't seek treatment.

This is something that nobody will ever know the whole story too. Without knowing what she wanted or did it's hard to tell.

Here's the actual quote:

Ten minutes later Ellen woke up, happy and even-keeled, not even knowing she'd been asleep. From the recovery room she was home in time for dinner. "The procedure went smoothly, but we'll have to wait for the final pathology reports," I said, which was not exactly the whole truth, but it let me get the oncology people cued up, a proper diagnosis, and Ellen herself emotionally prepared. I would give her the bad news at a more appropriate time.

The ending was not quite happy; it was a recurrence of the cancer she'd had years before � fairly rare for that type of tumor. Ellen died of it about six years later. I confess I never told her about the incident with the intercom.

It doesn't exactly say she didn't seek treatment. I somehow doubt that, panicked as she was to hear what she did, that when the news was indeed brought, she didn't want to be treated. Having died of it six years later doesn't specify why she died of it, only that she did. She may or may not have been being treated as she was dying, it doesn't say.