Ethics of Deliberate Amnesia

[qos]

http://www.time.com/time/health/article/0,8599,1671492,00.html

I just read this essay by a surgeon who related the story of a young mother who was absolutely opposed to being put under total anaesthesia for a biopsy, even though it might involve the "crunching" of some bone. Before the end of the episode, a member of the team made a decision that impacted what she remembered during the procedure.

It's a fascinating story, and raises some interesting questions.

Comments

[seauleja.livejournal.com]

Ugh...this just makes me sick...I have to ask, is it a matter of what they want her experience to be, or safeguarding themselves from what they don't want to deal with.

I think it's significant that the surgeon and the anesthesiologist were both men, and the nurses (I think?) women. Maybe they wanted to protect her from the bad news...maybe also afraid of having to deal with her response in the human, non-chemically assisted way.

I think it's sad that she was never told what happened on the table, and that she didn't realize she went unconscious for a few minutes. Totally against her wishes, and yes, without her consent.

In the end it probably didn't matter that much...but if he's asking, yes, I'd agree with him that it was an unethical act.

[seauleja.livejournal.com]

My mistake...it's not clear at all if the nurses were women.

[blessed-harlot.livejournal.com]

Very interesting. I'm not sure I'd agree that it's an unethical act. The way people are told such news can have a significant impact on their psyche and their outcome. A patient has to sign away certain decisions in such a situation to get the work done well, and she's under some sort of altered state to handle the physical pain. And my first thought when she freaked out was that she's in an environment that's not built for such emotional moments, where she could be harmed or harm others if she loses control.

That's not to minimize the issues of personhood he brings up, though. Very interesting.

[heron61.livejournal.com]

Under the (rather horrid) circumstances it seemed a perfectly reasonable thing to do. Definitely a very touchy issue, but I think it was a good decision in that case.

[9thmoon.livejournal.com]

Oh, my.

I was so afraid of going under when I did it. I understand completely.

[coen.livejournal.com]

I think it can be compared to a cop shooting a criminal. It shouldn't be done. A cop's job is to protect, not to kill. Punishment should be practiced by professional judjes, not by cops.

But if an emergency is taking place, and cops have only a split second to decide, they have to choose between life and death. And that may mean that in such cases, cops have to shoot and kill, even if that is not what cops are supposed to do.

I think this is a similar situation. Medicines like these should never be given without cosulting the patient. But this was an emergency. The doctors did not know how she was going to react to the news, and how it would affect the operation. A patient panicking during surgery is the last thing you want. So they had to make a decision, and they had to make it fast.
In such cases I think it is by all means allowed for the cop to shoot the criminal, or for the doctor to drug the patient.

The fact that the patient was never told about this afterward is not okay. But I can understand why they never did it. I can understand they were too afraid to confess the truth.

[amqu.livejournal.com]

Arrogant asses. This is not an interesting question; it's just another example of an ethical lapse.

[athenian-abroad.livejournal.com]

I wonder if Dr. Haig's version of the story isn't a little bit misleading. In his telling, it is implied (though of course not directly stated) that the anesthesiologist, Dr. Frank, chose propofol from an array of available sedatives because of its side-effects on short term memory. Dr. Haig describes propfol with these words:

The drug, sometimes called "milk of amnesia," stings some patients sharply in the veins, but what it also does is erase your last few minutes. (Think of the "neuralyzer" from the Men in Black movies.) Oh, and it puts you to sleep.

Wikipedia's description of propofol has a slightly different emphasis:

Propofol is a short-acting intravenous anesthetic agent used for the induction of general anesthesia in adult patients and pediatric patients older than 3 years of age; maintenance of general anesthesia in adult patients and pediatric patients older than 2 months of age; and sedation in medical contexts, such as intensive care unit (ICU) sedation for intubated, mechanically ventilated adults, and in procedures such as colonoscopy.

That is, not so much surgical date-rape drug as perfectly routine anesthetic.

Wikipedia also tell us this:

The steep dose response curve of the drug makes such abuse very dangerous without proper monitoring, and several deaths [from recreational abuse] have been recorded.

Which makes me question the plausibility of the (carefully implicit) claim that Dr. Frank spontaneously chose propofol. A more likely reconstruction: as recorded in the article, the medical team obtained consent for emergency sedation, should it be necessary to complete the procedure. In preparation for this contingency, the anesthesiologist selected a suitable anesthetic in advance, calculated the correct dosage for the patient, and perhaps even prepared the syringe so it would be ready to hand; if it were needed, it would, after all, be needed rather promptly. And, when it appeared that the patient's reactions put her at risk of injury, Dr. Frank put her under so that Dr. Haig could finish closing the incision. All more or less according to plan.

In this version, the entire "we stole her memory" narrative exists only in retrospect. Dr. Haig doesn't claim that Dr. Frank said anything to indicate that his primary intent was to induce amnesia. Nor did the nurses, in Dr. Haig's account, actually say the things he imputes to their "eyes".

The real decision to deprive the patient of those ten minutes of memory, then, didn't take place in the operating room, and wasn't the spontaneous action of a "great anesthesiologist" (conveniently acting on his own initiative, without instructions from the author). It was, of course, Dr. Haig's decision to pretend to the patient that those ten minutes never happened -- for the rest of her life. Haig wants to write this up as some sort of mind/brain "what if we're just a bag of chemicals" ethical conundrum. It is nothing of the sort. It's just the plain old workaday ethical lapse that occurs when you know something that someone else doesn't -- and you decide to keep that knowledge to yourself for your own convenience.

There's no deep bioethics here, just the ordinary ethics of concealment and deception. But that's less fun to think about.

[seauleja.livejournal.com]

I guess it's my understanding of consciousness and reality that brings me down on the unethical side of this. I think something in her body knows what happened. Just because it gets erased from her awareness doesn't mean it gets erased from her embodied experience. So it develops a discrepancy between this bodily source of knowing and her consciousness. Which is a wicked deed, in my opinion, even though I understand it was done with good intention and professional (if sketchy) authority.

What makes it an unsafe environment for her emotional response is that the doctors would probably not take responsibility for the mistake of improper communication...but I also think it's unethical not to give patients the information you have immediately.

Why not have a chaplain on hand during the surgery to help her process the news? No, it may not be the best timing, but if those are her wishes, they should be able to discuss all the possible ramifications of being conscious during surgery, and prepare for them. Patients deserve that much. It's not the work of the doctors to provide that care, but let's get someone there who can.

[seauleja.livejournal.com]

Can you tell this story has been following me today? :o)

I guess our conscious minds purposely choose to forget some things too, and I don't really think our lives are ruined (or even too much worse off) if we are not conscious of everything the zero-point field knows.

It still seems wrong and icky that the doctor and anesthesiologist did this. Maybe it's in the tone of the doctor's writing...

I will now try to not lose sleep over this tonight! Maybe I can think of better things to lose sleep over...

[coen.livejournal.com]

This puts the story in a whole new perspective. I think you are very right about this.