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The Official MacNN COVID-19 Thread (Page 27)
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OreoCookie
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Oct 13, 2021, 04:49 AM
 
Originally Posted by subego View Post
For example, an explicit premise of my question is the procedure isn’t a strain on resources.

You offer strain on resources as a reason to deny the procedure. This is a good and correct answer, which I agree with… but it’s an answer to a different question than the one I’m asking. If there’s a strain on resources (i.e., damage to the common good) then the procedure absolutely should be denied, but strain on resources is explicitly not a variable in my question.
Sure, but then I'd say the case under consideration here as it probably violates your fourth assumption (no overstrain on the system).

Clearly, if the health care system could accommodate these extra complications in the future, then this removes some of the arguments I mentioned, but not all of them. Whether additional precautions could mitigate the risks enough to allow for the transplant to go forward, I don't know. In my mind, this scenario will crop up once we are in the endemic phase of Covid-19. On the one hand, almost everyone will either be vaccinated and/or contract Covid-19 at some point. Have the two patients protection against Covid-19 by having contracted it earlier?

We do accommodate people who make personal choices that are suboptimal. (E. g. my mom didn't stop smoking after her stroke some years ago. Many other patients are obese, which carries with it a whole assortment of risk factors.) Not getting vaccinated is one of those choices. Outside of a pandemic, I have no objection to accommodate them if that makes sense. However, right now in the middle of a pandemic, I have no qualms of being stricter on people who choose not to get vaccinated.

Hence, the risk calculus would be quite different in my mind, both, on the individual and the societal level. However, I reckon that vaccination status factors into your ranking on transplant waiting lists, and I don't think that the Covid vaccination would be any different. So perhaps not getting your Covid shot will effectively remove you from the transplant waiting list (because you are ranked so far down that getting a transplant in time is highly unlikely). The latter is a medical decision that should be made on scientific grounds. Even though I don't like when people refuse vaccines without having any good reason, I don't think my and other people's anger should be a criterion.


PS By the way, reader noticed that I had included one bit twice. That was because macnn does not like iPad OS's privacy feature that uses relay servers. So a first post was eaten and I was reconstructing what I wrote from a partial post and memory. Sorry about that. I would have edited it, but you were quicker to reply.
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Laminar
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Oct 13, 2021, 09:27 AM
 
Originally Posted by subego View Post
Unfortunately, the way civil liberties work, you have to go to the mat all the time to defend utter morons, because if you don’t, the liberty isn’t there anymore when someone needs to make legitimate use of it.

I agree though, liberty is not unlimited, and comes with qualifiers. So far, that list is:

1) Direct donor (i.e., no waiting lists)
2) Must still be a fit candidate with the added risk
3) Must be able to be admitted COVID-free
4) Does not overstrain resources

If these qualifications are met, on what grounds do we deny the transplant?
These seem fair, and your idea of quarantine seems valid, as long as it doesn't strain resources.

But analyzing each of these scenarios on a case-by-case basis is also a strain on administrative resources, which is where the blanket policy comes in handy.
     
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Oct 13, 2021, 09:28 AM
 
Originally Posted by OreoCookie View Post
Are you talking about doing harm/minimizing harm for the individual or for society?
He's referencing the Hippocratic Oath.
     
subego
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Oct 13, 2021, 10:02 AM
 
Originally Posted by OreoCookie View Post
However, I reckon that vaccination status factors into your ranking on transplant waiting lists
I said this was a direct donation of a kidney, right?
     
subego
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Oct 13, 2021, 10:08 AM
 
Originally Posted by Laminar View Post
He's referencing the Hippocratic Oath.
You got it!
     
subego
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Oct 13, 2021, 10:31 AM
 
Originally Posted by Laminar View Post
These seem fair, and your idea of quarantine seems valid, as long as it doesn't strain resources.

But analyzing each of these scenarios on a case-by-case basis is also a strain on administrative resources, which is where the blanket policy comes in handy.
I only see that having an appreciable effect with 3.

1 makes it less work than normal, and they need to do the analysis for 2 and 4 with everyone, we’re just adding a variable we presumably have data for already.
     
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Oct 13, 2021, 01:40 PM
 
Would you say that if all four conditions can be met and the hospital still refuses to do the procedure, that counts as punishment for not being vaccinated and seems a bit...icky?
     
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Oct 13, 2021, 03:21 PM
 
COVID is just one more consideration for qualification, on top of a bunch of others. Kidneys are actually less ethically challenging than livers; if you drank yourself into liver failure, do you "deserve" a second chance with a new liver? (Keep in mind that a liver transplant can be done with only a portion of a donor liver - I think they can get at least three transplants out of one donor liver, but don't quote me on that.)

Read this National Institutes of Medicine paper, particularly the last section, for more insight.

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Oct 13, 2021, 05:25 PM
 
     
OreoCookie
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Oct 13, 2021, 07:30 PM
 
Originally Posted by Laminar View Post
He's referencing the Hippocratic Oath.
Yes, I know. But triage is also practiced in case the need calls for it (e. g. a mass casualty event or a pandemic), so this isn’t really unusual, it is just that global pandemics on this scale happen infrequently.

That’s why I said that when the situation normalizes, experts need to think this over how to handle people who refuse the Covid vaccine specifically or are not vaccinated generally. I would expect that the resulting policy is more nuanced than now. We do and should accommodate personal choices and failings to some degree. (Obviously, we do not accommodate every whim of a patient: if an alcoholic with a failing liver continues to drink, they are not going to get a transplant.)

In fact, I think one point of disagreement is that some people seem to think the situation already has normalized even though it hasn’t.
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subego
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Oct 14, 2021, 12:24 AM
 
Originally Posted by Laminar View Post
Would you say that if all four conditions can be met and the hospital still refuses to do the procedure, that counts as punishment for not being vaccinated and seems a bit...icky?
I’ll be charitable and say they’re trying to strong-arm the person. Of course, punishment is part of that strategy.
     
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Oct 14, 2021, 05:40 AM
 
Originally Posted by subego View Post
I’ll be charitable and say they’re trying to strong-arm the person. Of course, punishment is part of that strategy.
I don’t see any evidence of that.
The simpler explanation is that in reality your fourth assumption is not satisfied, in the middle of a pandemic people who choose not to get the Covid vaccine do put unnecessary strain on the health care system. I think that is a far easier explanation that is consistent with what we see. In the present situation asking patients who can to get vaccinated is like asking someone who hopes to have a liver transplant to stop drinking alcohol — would you also say that we strong arming that person into compliance?

Lastly, specialized procedures like organ transplants, they can only be performed at a smaller number of hospitals by highly specialized staff. So if these fail because of staff shortages or a Covid outbreak among at-risk patients, the impact would be higher than the loss of hospital beds may make it appear.
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Oct 14, 2021, 08:55 AM
 
If we consider that “not following basic medical advice for everyone” is a predictor of poorer outcomes from any medical intervention (from “eating right” to “taking your anti-rejection meds” to whatever), then not being vaccinated against COVID - on purpose - predicts negative outcomes that other patients would not have.

Also, let’s look at the ethics of doctors not treating unvaccinated people. Read this article from the director of the division of medical ethics at NYU’s medical school.

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Oct 14, 2021, 11:47 AM
 
Originally Posted by OreoCookie View Post
The simpler explanation is that in reality your fourth assumption is not satisfied
That my fourth assumption was satisfied was an explicit condition of the (hypothetical) question.

As I said earlier, you are giving good and correct answers that I agree with, but they’re answers to different questions than the one being asked.
     
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Oct 14, 2021, 07:43 PM
 
Originally Posted by subego View Post
That my fourth assumption was satisfied was an explicit condition of the (hypothetical) question.
This was in response to you writing that the vaccine requirement was to strongarm people into getting their shot, and that one of the motivations was punishment. Inferring people’s motivations from flawed premises inevitably to lead you misattributing people’s and organizations’s motivations. I’m not quite sure what the point of that exercise is. :shrug:
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OreoCookie
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Oct 14, 2021, 08:03 PM
 
Originally Posted by ghporter View Post
If we consider that “not following basic medical advice for everyone” is a predictor of poorer outcomes from any medical intervention (from “eating right” to “taking your anti-rejection meds” to whatever), then not being vaccinated against COVID - on purpose - predicts negative outcomes that other patients would not have.

Also, let’s look at the ethics of doctors not treating unvaccinated people. Read this article from the director of the division of medical ethics at NYU’s medical school.
That is an important point that becomes more relevant when Covid has become endemic: if getting vaccinated is part of the treatment plan and people partially refuse it, it is a difficult ethical question to decide how far people can go to refuse to follow their doctor’s recommendations. Depending on where you live, insurance companies might be barred from raising prices for specific risk groups, for example. Or to decide against treatment for certain groups? An example that comes to mind are joint replacements. Is it worth it to replace hip or knee joints when the patient is very old or severely overweight? This isn’t just about money, but about the risks for the patients themselves. With age the probability to react badly to the anesthetic increases and patients take a lot longer to recover. The bone density decreases with age, which, in turn, increases the risk of failure of the artificial joint. Similar arguments can be made for overweight patients. As a result the patient might be bound to a wheel chair for the rest of their lives. Where do you draw the line? I think on an individual level you almost always make a case for why you should make an exception.
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Oct 14, 2021, 09:51 PM
 
Pharmacy in Indiana makes a mistake.
Joshua and Alexandra Price say they and their two children were mistakenly given the Covid-19 vaccine instead of a flu shot a week ago at their local pharmacy -- and they are now dealing with some adverse symptoms.
The Prices took their 4- and 5-year-olds to the Walgreens in Evansville, Indiana, on October 4 for their yearly shots. About 90 minutes later the pharmacist called saying they had made a mistake. The entire family had been injected with adult doses of the Covid-19 vaccine.
...
"They will probably do OK," said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. "The difference is they got a three times higher dose of a vaccine than is being tested in clinical trials."
"It is concerning they got a higher dose, and they have to be monitored, but they should do really well," Hotez said. "There is a lot of data out there now in 5-year-olds and older."
He added that Alexandra and Joshua's extra dose of the vaccine is similar to receiving a booster shot.
Some potentially-serious symptoms continue a week after the mistake. I hope for a followup story in a few days to another week.

In theory, they should all be fine, as the vaccine is a straw man. It doesn't fight back. But I would have expected all symptoms to pass by now. It would be a significant concern if things got worse.
     
subego
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Oct 14, 2021, 11:39 PM
 
Originally Posted by ghporter View Post
If we consider that “not following basic medical advice for everyone” is a predictor of poorer outcomes from any medical intervention (from “eating right” to “taking your anti-rejection meds” to whatever), then not being vaccinated against COVID - on purpose - predicts negative outcomes that other patients would not have.
The importance of this due to waiting lists. If it’s a direct donor, or condition one on my my list, that’s irrelevant.¹



¹ Unless the patient’s behavior is so self-destructive that performing the transplant would make their life expectancy worse than doing nothing.
     
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Oct 15, 2021, 01:16 AM
 
Originally Posted by subego View Post
The importance of this due to waiting lists. If it’s a direct donor, or condition one on my my list, that’s irrelevant.¹
I don't see why this is supposed to be limited to transplants via waiting lists. Not following essential parts of treatments (selectively or as a whole) is a significant factor no matter how you get the organ.
Originally Posted by subego View Post
¹ Unless the patient’s behavior is so self-destructive that performing the transplant would make their life expectancy worse than doing nothing.
This isn't just about life expectancy, but also quality of life (see my example of joint replacements) and the impact on others (because e. g. doctors and staff who can perform transplants are rare).
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Oct 15, 2021, 01:21 AM
 
Originally Posted by reader50 View Post
In theory, they should all be fine, as the vaccine is a straw man. It doesn't fight back. But I would have expected all symptoms to pass by now. It would be a significant concern if things got worse.
Given that Pfizer/BioNTech seems to have the performed trials and intends to ask for approval for use in children 5–11 soon, I seriously doubt that there will be lasting ill effects. Sure, AFAIK children get 1/3 of an adult's dose, but still.
Originally Posted by reader50 View Post
Pharmacy in Indiana makes a mistake.

Some potentially-serious symptoms continue a week after the mistake. I hope for a followup story in a few days to another week.
Most of the people I know had a some side effects after getting one of the mRNA vaccines. But in the end you know that it is only limited and soon you will be over it.
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Oct 15, 2021, 11:05 AM
 
Originally Posted by subego View Post
The importance of this due to waiting lists. If it’s a direct donor, or condition one on my my list, that’s irrelevant.¹



¹ Unless the patient’s behavior is so self-destructive that performing the transplant would make their life expectancy worse than doing nothing.
However, because of the depth and complexity of the ethical issues involved, direct donors don’t get “a pass” for any of the qualifications. That looks like a form of favoritism, and isn’t allowed.

It comes down to “everyone must be treated equally,” even if their situations are nowhere near the same.

There’s a case to be made for both encouraging more direct donation and avoiding it. On the one hand, direct donors don’t have to be “found,” which makes coordinating the whole thing a lot easier, less costly, etc. But it also opens the door to the potential for Bad Things; under-the-table payoffs of donors, donation under threat of X, etc.

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subego
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Oct 15, 2021, 12:34 PM
 
Originally Posted by ghporter View Post
However, because of the depth and complexity of the ethical issues involved, direct donors don’t get “a pass” for any of the qualifications. That looks like a form of favoritism, and isn’t allowed.
Here’s a question.

In general, do they kick alcoholics (for example) off the list, or just put them at the bottom?

Strictly in terms of conserving a precious resource (organs), does not putting a person at the bottom of the list successfully achieve that goal?
     
Thorzdad  (op)
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Oct 15, 2021, 01:30 PM
 
I'm not sure they allow active alcoholics on the list in the first place.
     
subego
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Oct 15, 2021, 01:31 PM
 
Originally Posted by OreoCookie View Post
I’m not quite sure what the point of that exercise is. :shrug:


The point of the exercise is to learn about and from each other by playing pretend.

Pretend performing the transplant on the vaccine refuser is safe by an objective measure.

Would you still refuse the procedure? If so, why?

If not, what do you think would motivate someone to refuse it anyway? This was the question my “strongarm” comment was an answer to.

These aren’t questions about a real-wold case. You don’t have to worry about misattributing the motivation because the person you’re attributing it to doesn’t exist. They’re hypothetical. You have been granted permission to hypothesize.

To bring this back around to the beginning, the point of these questions is to learn about and from you by the answers.
     
subego
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Oct 15, 2021, 01:39 PM
 
Originally Posted by Thorzdad View Post
I'm not sure they allow active alcoholics on the list in the first place.
Off-the-cuff, that sounds unethical to me, unless the procedure will make things worse. If it won’t make things worse, and there’s no one else who can use it, what’s the justification for not allowing it?

I can be sold on deprioritizing. Refusal I’m having trouble with.
     
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Oct 16, 2021, 08:28 AM
 
Originally Posted by subego View Post
Here’s a question.

In general, do they kick alcoholics (for example) off the list, or just put them at the bottom?
AFAIK you get kicked off if they catch you drinking alcohol. And stories like this one seem to confirm my impression that this is at least the case for liver transplants.
Originally Posted by subego View Post
Strictly in terms of conserving a precious resource (organs), does not putting a person at the bottom of the list successfully achieve that goal?
That depends. In case of alcohol and liver transplants, I think it is quite clear this is a strong counter indication against even having the surgery. I don’t think it is unethical if the patient does not follow essential recommendations by doctors.
Originally Posted by subego View Post
Pretend performing the transplant on the vaccine refuser is safe by an objective measure.

Would you still refuse the procedure? If so, why?
I have addressed this specific point in at least two of my earlier posts. We should follow the science, not anger, fear and resentment.
Originally Posted by subego View Post
If not, what do you think would motivate someone to refuse it anyway? This was the question my “strongarm” comment was an answer to.
These are usually not decisions that are made on an individual level, the guidelines for transplants are highly complicated and depend very much where you are. In some cases there are (transplant) committees that determine the general guidelines. I don’t think personal resentment enters on that level in any way. For specific cases, I am sure there are ethics committees that deal with edge cases.

Defiant patients will most likely always perceive this as strongarming, no matter the reasoning on the other side. My mother had to deal with overweight patients who were too big to be scanned by the usual equipment (X-rays, CT, MRT). So they had to be sent to the veterinary department of the university where they were then scanned using the equipment meant for horses. Some protested, because they thought it was degrading and humiliating. Of course, I can see why, but these were just physical limitations of the equipment and staff (she worked in a orthopedic hospital, so these patients had mobility issues).

Personally, I’d just take the personal feelings out of it, the feelings of the patients and the feelings of the doctors by developing guidelines. Of course, doctors usually have some leeway in many circumstances, but they are operating within the bounds of guidelines.
Originally Posted by subego View Post
Off-the-cuff, that sounds unethical to me, unless the procedure will make things worse. If it won’t make things worse, and there’s no one else who can use it, what’s the justification for not allowing it?

I can be sold on deprioritizing. Refusal I’m having trouble with.
I think that only applies to alcoholics who are still drinking, AFAIK alcoholics in recovery can get on the list. I am sure they’ll have to prove their sobriety for a certain time period, though.
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subego
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Oct 16, 2021, 09:05 AM
 
Originally Posted by OreoCookie View Post
I have addressed this specific point in at least two of my earlier posts. We should follow the science, not anger, fear and resentment.
The question asks you to pretend the procedure is safe by an objective measure.

The replies you cite do not do this.
     
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Oct 16, 2021, 11:51 AM
 
Originally Posted by subego View Post
Here’s a question.

In general, do they kick alcoholics (for example) off the list, or just put them at the bottom?

Strictly in terms of conserving a precious resource (organs), does not putting a person at the bottom of the list successfully achieve that goal?
Typically active drinkers are excluded from either liver or kidney lists. One protocol I read required proof of abstinence for 90 days - by regular blood tests, like methadone programs. Basically the patient has to show real buy in to the whole program, not just "I've been clean for a week" level of participation.

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Oct 16, 2021, 01:17 PM
 
My dad, who is over 90, is getting married to his HS girlfriend. After thanksgiving. Indoors.

Fucking idiot.
     
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Oct 16, 2021, 06:37 PM
 
That's sweet, in a way. And perhaps it's a matter of "screw it, we're not doing this outdoors at our age."

Is it "after Thanksgiving dinner" or just after the holiday? It might be worse one way or the other.

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Oct 16, 2021, 09:55 PM
 
Originally Posted by subego View Post
The question asks you to pretend the procedure is safe by an objective measure.

The replies you cite do not do this.
In my mind I have done exactly that: I have ignored risks during the transplant procedure, the surgery. That’s how I interpreted your sentence that I should “pretend the procedure is safe by an objective measure.” 

My arguments focussed on risks after the surgery for life with the new organ. For example, if you give a new liver to an alcoholic who hasn’t stopped drinking, they will destroy their new liver at least as quickly as they did with their old liver. Whether someone is drinking alcohol is therefore a valid criterion in my mind. Another example concerns vaccinations, they could be crucial to help the suppressed immune system to deal with infections. AFAIK immunosuppressants are with the current technology a necessity for transplants. So vaccination status seems like a sensible medical criterion even if we ignore the risks during surgery.

Do you want me to pretend that these added risks after the procedure don’t exist either?
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Oct 16, 2021, 09:56 PM
 
Originally Posted by MacNNFamous View Post
My dad, who is over 90, is getting married to his HS girlfriend. After thanksgiving. Indoors.

Fucking idiot.
Have they been vaccinated at least?
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subego
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Oct 17, 2021, 06:24 PM
 
Originally Posted by OreoCookie View Post
I have ignored risks during the transplant procedure, the surgery. That’s how I interpreted your sentence that I should “pretend the procedure is safe by an objective measure.”
If a person needs a transplant and we do nothing, we can calculate the probability of various outcomes. Things like (but not limited to) life expectancy, or quality of life.

We can also calculate these probabilities for doing the procedure. Should the patient be self-destructive, these probabilities need to reflect it.

After accounting for the patient’s self-destructive behavior, if the distribution of outcomes ends up worse than doing nothing, the procedure is unsafe. A safe procedure has a better distribution of outcomes than doing nothing.

So, yes. If we are to call the procedure safe, it must offer better outcomes over doing nothing, even when accounting for the patient being an active drinker, or a dumbfuck boomer.
     
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Oct 17, 2021, 08:07 PM
 
Originally Posted by subego View Post
If a person needs a transplant and we do nothing, we can calculate the probability of various outcomes. Things like (but not limited to) life expectancy, or quality of life.

We can also calculate these probabilities for doing the procedure. Should the patient be self-destructive, these probabilities need to reflect it.
Yes, and that was exactly what I was focussing on in my previous posts, no?
Originally Posted by subego View Post
After accounting for the patient’s self-destructive behavior, if the distribution of outcomes ends up worse than doing nothing, the procedure is unsafe. A safe procedure has a better distribution of outcomes than doing nothing.

So, yes. If we are to call the procedure safe, it must offer better outcomes over doing nothing, even when accounting for the patient being an active drinker, or a dumbfuck boomer.
The only thing I'd add is that you again only focus on the individual and forget about others. Hospitals and staff who can perform transplants and aftercare are rare, and a suboptimal candidate might take away resources — a bed — from a better transplant candidate with higher chances.

Picking who gets a transplant is a common philosophical dilemma that at least I covered in my high school's ethics course. We all know that there is no universal good answer. It is in essence a version of the trolley problem (the Good Life's episode on that is well worth watching and covers the surgery transplant dilemma).
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subego
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Oct 17, 2021, 11:55 PM
 
If the procedure harms others, it is not safe. I address the harm to others by making the foundational premise of the question that the procedure is safe.

If due to the patient’s self-destructive nature the procedure would more likely harm the patient than help, then it is not safe. I address the issue of self-destructive patients by making the foundational premise of the question that the procedure is safe
     
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Oct 18, 2021, 12:37 AM
 
I keep thinking that most of the transplant rules can be waived for brain transplants. Prior history of drinking, antivax, or trumpism? Not an issue going forward.
     
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Oct 18, 2021, 01:30 AM
 
Originally Posted by subego View Post
If the procedure harms others, it is not safe. I address the harm to others by making the foundational premise of the question that the procedure is safe.
Before I answer: what is “the procedure” for you? Is it only the transplant surgery? Or do you include any follow-up treatment as well, including risks incurred down the road?
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subego
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Oct 18, 2021, 06:44 AM
 
Yes, it does include that… but this is the kind of reply I’m looking for. It’s bringing up a new point I hadn’t thought of, and I’d say it’s probably a tougher nut to crack than getting them in for the surgery itself.

     
Thorzdad  (op)
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Oct 18, 2021, 01:06 PM
 
     
reader50
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Oct 18, 2021, 01:29 PM
 
... is requiring students who receive a COVID-19 vaccine to stay home for 30 days after each shot ...
So, a 2-month vacation for shot + booster. To prevent the student from endangering other kids with their safety.

I wonder what this school teaches.
     
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Oct 18, 2021, 01:36 PM
 
It's like opposite land.
     
subego
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Oct 18, 2021, 04:55 PM
 
Jumping back to the transplant discussion quickly, I want to pass along something (IIRC) I picked up from one of Glenn’s articles.

There are countless ways a transplant doctor can botch the operation, and that stress has a psychological impact. The article noted it’s a big reason why doctors who could be transplant surgeons decide not to be.

If a doctor offers this as a reason they refuse, I can’t really say they’ve violated their oath.

That’s me speaking as a person. Speaking as a PR consultant, I tell the doctor they’d get eaten alive for playing this hand against the religious freedoms of a terminal patient.
     
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Oct 18, 2021, 07:09 PM
 
I’ll also throw this out there: the concept of a “wasted” organ. Say Joe Maga manages to get his sister’s kidney because she (at least in that family) is a good human being. Joe isn’t vaccinated, doesn’t wear masks, goes to crowded events, etc. Joe gets COVID, and of course, with his comorbidities (diabetes, hypertension, history of horrible diet, and so on) it goes badly.

Up to half of hospitalized COVID patients suffer kidney failure, and that’s “normal” (not kidney disease) patients. Maybe Joe pulls through. But a person with a history of severe kidney disease will probably have a very long (and expensive) recovery. And the risk that the transplanted kidney will not recover is fairly large.

If Joe doesn't pull through, it’s an example of a “wasted kidney.” I’d he does survive but the kidney doesn't recover, that’s another example. In the second situation, it’s worse because he goes back on dialysis, and takes up a space that the transplant should have freed up.

And you’re probably not going to get to the transplantation stage without at least some time on dialysis. To be accepted for dialysis, you already have to be pretty compliant. And they can tell if you’re fibbing about your diet and meds, because there’s a ton of blood analysis involved with each (usually 3 times a week) treatment. I’ve had patients “on probation” for dialysis because of their eating habits, and so on.

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subego
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Oct 18, 2021, 10:23 PM
 
As long as the donor is aware of the risk of waste, I feel that’s an issue between the donor and the recipient.

Though, as you touched on earlier, there’s always the potential the donor is being coerced.
     
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Oct 18, 2021, 11:31 PM
 
Originally Posted by subego View Post
Jumping back to the transplant discussion quickly, I want to pass along something (IIRC) I picked up from one of Glenn’s articles.

There are countless ways a transplant doctor can botch the operation, and that stress has a psychological impact. The article noted it’s a big reason why doctors who could be transplant surgeons decide not to be.
Yes, and there are other layers to it, as well. For example, a former colleague of my mothers is a long-term anorexic and because of that her kidney function is insufficient. She has to go to dialysis several times a week (I think 3, although I am not 100 % on this). I don’t think she has ever told my mother what her status is regarding her eating disorder, but let’s just say that ever since my mom has known her, she was way thinner than average. She is also a mother.

Do you give her a new kidney? Right now she is managing her kidney function with dialysis. It is very exhausting, yes, and I reckon she likely won’t celebrate her 90th birthday either way. But she is hanging in there, working, managing her life. A transplant would (for some time at least) spare her the frequent visits to the hospital for dialysis. But if the surgery is not successful or if because she has a relapse, her child won’t have a mother any longer. Is that a risk worth taking for her (assuming she and/or her doctor had the choice)? For that to be considered seriously, I reckon she would have to be sure that she is able to manage her anorexia within the strict confines her new kidneys set her.

Even if you still lean towards granting her that transplant, I would still say that this is not an easy, clear cut decision where the “right” choice is obvious. And I think this example illustrates that even if we factor out where to get the donor organ from, the risk of the procedure itself and all the resources involved, it isn’t easy.
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subego
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Oct 18, 2021, 11:45 PM
 
Maybe it’s my libertarian bent, but if someone has knowledge of the potential risks and willingly wants to donate their kidney to her, I feel she should be able to have it.
     
OreoCookie
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Oct 19, 2021, 03:23 AM
 
Originally Posted by subego View Post
Maybe it’s my libertarian bent, but if someone has knowledge of the potential risks and willingly wants to donate their kidney to her, I feel she should be able to have it.
I thought libertarians were big on personal responsibility? Personal responsibility also means to me that you have to accept the consequences of your actions.

If you are not taking personal responsibility to e. g. deal with your anorexia, get vaccinated or follow other recommendations by doctors, how can you expect the community to pay for the procedure? (Insurances, no matter if they are private or public, socialize risk, i. e. they spread it across many people.)
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Laminar
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Oct 19, 2021, 10:45 AM
 
Originally Posted by OreoCookie View Post
If you are not taking personal responsibility to e. g. deal with your anorexia, get vaccinated or follow other recommendations by doctors, how can you expect the community to pay for the procedure? (Insurances, no matter if they are private or public, socialize risk, i. e. they spread it across many people.)
Social Responsibility is doing what's best for yourself and by extension, what's best for society.

Personal responsibility is acknowledging that your actions have consequences and being willing to deal with those consequences. I.E. I'm not going to get vaccinated, and I accept that I have a higher chance of becoming sick from COVID.

The disconnect with libertarian folk is they ignore the connection between personal responsibility and social responsibility. "If everyone acted the way I'm acting, what would happen to society?" If everyone was a selfish, me-first, I-got-mine a-hole, society would circle the drain pretty quickly and reduce itself to factions of competing warlords. But because of society's socialist services and safety nets, a select few can act like total jerks but fall into the loving, caring hands of people obligated to help them.
     
subego
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Oct 19, 2021, 12:56 PM
 
Originally Posted by OreoCookie View Post
I thought libertarians were big on personal responsibility? Personal responsibility also means to me that you have to accept the consequences of your actions.

If you are not taking personal responsibility to e. g. deal with your anorexia, get vaccinated or follow other recommendations by doctors, how can you expect the community to pay for the procedure? (Insurances, no matter if they are private or public, socialize risk, i. e. they spread it across many people.)
Well, any ideology is going to have internal conflicts the adherent will need to prioritize. I prioritize personal liberty. If a potential organ donor is aware of the risks (such as the recipient ruining the organ) and still willingly wants to donate, I don’t think they should be denied on the basis of risk.

Now, denial due to inability to pay is a different matter. If no one is willing to underwrite it due to the risk, well that’s tough shit. However, with our patient who is unwilling to get vaccinated, no one that I’ve seen is claiming the problem is an inability to pay. The claim is it’s a medical ethics issue.
     
subego
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Oct 19, 2021, 03:12 PM
 
Originally Posted by Laminar View Post
The disconnect with libertarian folk is they ignore the connection between personal responsibility and social responsibility. "
Based on the principle of taking personal responsibility, I’m gonna say other libertarians are responsible for defending their own dipshit conclusions, not me.
     
 
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