Steve Jobs, Surgery and Surgeons' ethics?

[sailforjoy]

After reading Dr. McDougall's article I was struck by the rather obvious moral conflict that must be rampant in the medical community if facts he presents are "well known in the medical-scientific community" and especially if his post-mortem diagnosis is accurate. At the time of the initial diagnosis wouldn't it have been obvious to Steve Jobs' doctors that the surgery would be hopeless, and that surgery would only inflict suffering and additional trauma to weaken an already sick person?

The doubling math and time line are very disconcerting, given the overall picture. Considering that it is common to operate on detectable tumors (which by Dr. McDougall's explanation are already too far along for the disease to be stopped by surgery) is there a widespread pattern of malpractice being perpetrated by the medical establishment? Or is there a success rate which warrants taking a chance, but that wasn't discussed in the article?

Dr. McDougall also wrote: "With one honest sentence his doctors could have relieved him of this heavy burden. This simple fact could have been told: “Mr. Jobs, you had a body full of cancer long before October of 2003, when you were diagnosed by a needle biopsy.” Apparently, not one of his doctors—not Jeffrey Norton, who had operated on his pancreas in 2004, nor James Eason, who had performed his liver transplant in 2009—told Jobs this indisputable truth." (bold emphasis mine)

If these facts are indeed "indisputable truth" and they are aware of it, wouldn't those specific surgeons (and thousands of others in the medical community) be wrong to recommend and perform surgery on cancer patients who most likely have no hope of being cured by such procedures? Or are these doctors providing a beneficial service to the patients (and families) by holding out hope through taking action (albeit perhaps futile or desperate) rather than forcing them to confront the helplessness of the situation? (After losing my mother to cancer I'm very familiar and sympathetic to the feelings of hopelessness and desperation that come with cancer, for the entire family.)

I question whether all cases of cancer should be treated with aggressive chemotherapy drugs, radiation and surgery. In many cases, particularly in older or even mid-age patients, the patient might live longer without the treatment (and have a better quality life during the remaining time), or might be statistically as likely to die sooner by some other cause. It sounds as if Steve Jobs might have been one of those cases where the patient would have been better off without treatment.

[BarbG]

At the time of the initial diagnosis wouldn't it have been obvious to Steve Jobs' doctors that the surgery would be hopeless, and that surgery would only inflict suffering and additional trauma to weaken an already sick person?

The way I have seen medicine (including veterinary that killed a cat of mine who was too weak to undergo surgery) applied is: aggressively. And, I don't see the bigger picture taken into account. In other words, if there is something to treat, just do it. Nevermind weighing adverse effects against benefits, nevermind the bigger picture, e.g. the body is too weak to withstand some assaults. Nevermind how advanced a cancer is. Just treat, treat, treat. Short term, tunnel vision, and profit making.

But then again, I err on the side of cautious and cynical. People really need to do as much homework as they can to try to know best how to weigh risks and benefits, and to understand their situation as best as they can in order to know when it's wise to refuse treatment.

[shell-belle]

This is what I wonder about also. My 81 year old aunt had lymphoma in 1991 and had surgery. The doc said she had to have chemo. I knew this was not a good idea-she was very weak and had never really exercised her whole life long. Sure enough the chemo make her terribly sick after only 4 treatments and she also began falling down. She had to move from independent living to assisted living in the retirement care community she was in. So the chemo was discontinued and a few months later she was diagnosed with colon cancer! She was scheduled for surgery and I called the doctor and I even asked him " so you are going to save her from colon cancer so that she can die from lymphoma ?"
His answer was if he did not operate, the cancer would grow and obstruct her bowel and it would be an awful way to die. So I don't know if that would have really happened. She did have the colon cancer surgery - which was very hard on her and she died a few months after that - from the lymphoma - and it was an awful way to die! At the time I was very distraught and saw the doctors as greedy - trying to make as much $$ as they can off old terminally ill people before they die!

[patty]

It amazes me when I hear a doctor or a nurse say someone's end of life condition will be a very painful death. Dr. McDougall shares in his online MS video, no one ever talks about a natural death. There is so much we don't know that we don't know. That is what is exciting about breaking the cycles that no longer work for us, because the hippocampus, the organ that makes the unknown known, thrives. Eating low calorie dense foods where starch creates long term satiety our bodies are whirlpools of energy that takes in what it needs, and releases what it doesn't. In hospitals where the doctors joke, they send the bill while nature heals, is a reality that is fast fading. Communion is a sign of maturity vs. communication of cutting, burning, numbing is old style reality of adolescents.

Aloha, patty

[sailforjoy]

shell-belle I share your views and concerns. Doctors SHOULD be questioned. There is much wrong with our healthcare system and training of doctors.

What they learn in medical school is taught by people who have well-established beliefs and biases. They get very little training with regard to preventive medicine or dietet. The funding in medical research and technology is usually made by private companies and doctors with a financial agenda primary and healing agenda secondary, and taught by company reps and PR agents in the guise of course-ware. The federal agencies that establish "approved" treatments are staffed by people from and for "the industry" as is the AMA, and the dietary standards set by the Agriculture Department are determined by people with interests in protecting the meat, dairy and corn industries, and the "status quo".

My father-in-law who recently passed, used to say: "Institutions exist first for those who run them and second for those they purport to serve."

I don't want to paint everyone in the medical profession with the same broad brush, many or most are genuinely interested in patient welfare and preventive medicine.

Another issue (not to be taken lightly) is the feeling of guilt for the family if you don't pursue every option to fight for life and your beloved mother/father/sister/brother/spouse/child. This puts tremendous pressure on the medical community to perform injurious treatments like chemo, surgery or radiation therapy out of desperation - due to not knowing alternatives. In these cases it's often a no-win situation and difficult to judge.

Reading about the case of your 81-year-old aunt I (like you) think the doctor was greedy or nuts. But many families would be angry if the doctor took the position that "she's going to die soon anyway so why put her through this?".

I think it wise to let the patient make informed decisions if they are capable and of sound mind. It's also wise to discuss these things with family members while they are of sound mind and do the legal papers such as "living will" and limited power of attorney. (Even do this with your children if they are over 18 so you have legal standing in case they have an accident and end up on life-support.) If you have a neighbor or dear friend who lives alone without family, it might be helpful to have this conversation also.

If you know how your family member feels and can make a decision in accordance with their wishes, then the guilt factor is diminished.

I've drifted though, and the key issue I raised in my initial post was one of whether doctors should recommend treatments (especially invasive and damaging ones that ruin quality of life) when they know it would not have a good probability of improving life for the patient. I strongly lean toward a resounding "NO".

[BarbG]

It's true that probably most (though not all) families want everything possible done. The way it looks to me is that they have bought into the marketing of medicine. Medicine has limits, but does not get presented that way. People falsely expect medicine to fix everything, and basically perform miracles. It's a set up for huge disappointment, which comes from false hope.

The best way I can think to bring expectations in alignment with reality is to fully disclose the pros, cons and big picture of a condition and its possible treatments.

Re guilt, I think there is almost always guilt and regret when a loved one dies. Hindsight is 20/20. Not to mention that deteriorating and dying can be extremely complex, necessitating decisions that are excruciating to make and are usually no win.

[didi]

I am sure, human nature being what it is, that some doctors do recommend extreme measures because it puts money in their pockets. While not an extreme measure, one oncologist I know of is campaigning (via letters to journals and I do not know what else) against oncologists who give certain cancer drugs, not because they are demonstrably better, but because they can charge the patient more for these drugs.

However, I am also guessing that surgeons will also operate because they see that as the only hope (although possibly a very very slim hope) of curing someone.

Think about family dynamics in these cases. If you advise someone not to have the surgery or other extreme treatments and that person heeds your advise and dies then it will certainly cause contention in the family and maybe irreparable damage to relationships if there are others who were for the surgery. They will always think the person would be alive if he had gone ahead with the procedure.

My mother who suffered dementia after by pass surgery, was prescribed beta blockers and took them for the whole fifteen years she lived after surgery. I know now that beta blockers lower blood pressure so that the circulation becomes poor. Mom had a gangrenous toe which a surgeon told us had to be amputated or mom would die a very painful death. So we agreed to the surgery. She only lived a couple of weeks, in very very bad shape after the amputation. After the surgery I attended a support group for people with dementia and alzheimers and a doctor was a member of the group and said she probably didn't have to have the surgery. I never had an opportunity to question him about this.

My brother and I live with many regrets and blame ourselves for mom's death and the suffering she endured in the hospital and nursing home. We feel so guilty we cannot even talk about it with each other. It is a topic we stay away from. After all, it was we who gave the go ahead for the surgery since mom was in no position to make rational decisions.

Didi

[sailforjoy]

snip
My brother and I live with many regrets and blame ourselves for mom's death and the suffering she endured in the hospital and nursing home. We feel so guilty we cannot even talk about it with each other. It is a topic we stay away from. After all, it was we who gave the go ahead for the surgery since mom was in no position to make rational decisions.

Didi

Didi you and your brother made the decision based on what you knew at the time. Your mother's quality of life wasn't good, and if you acted with good intentions to try to save her then you and your brother should leave the guilt behind. It just wasn't meant to be. Life is short and mistakes are made by everyone, including the doctors who advised you. It's only a question of when and how.