Killing a Patient to Save His Life

http://nytimes.com/2014/06/10/health/a-chilling-medical-trial.html

by danso • 12 years ago

81 50 12 years ago

I like the 'out-of-the-box' thinking. The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so much.

67726e• 12 years ago

"The 'opt out' if you don't want to, in combination with a high change of poor black males being the guinea pig... Not so much."

My understanding is that they only use this procedure if your chances of otherwise surviving without this are very slim, per the article the injuries are the kind where "Less than 1 in 10 survive". As for the opt-out/opt-in, you cannot really opt-in to any procedure if you're undergoing cardiac arrest, so perhaps we should let anyone in this scenario die since they cannot truly consent?

vog2• 12 years ago

-1 for the strawman: The alternative to "opt-out before" is "opt-in before", not "opt-in afterwards".

digitalengineer5• 12 years ago

It's not so simple, I'm afraid. People have opt-out of a lot of things to prefent them 'turing in to a plant' as the popular saying is. Things like DNR or even human blood (religion based opting out). There was no ad-campagin in the region informing people what could happen. There is a specific demographic (poor black people) so they could target them with information about what's going on and specifically what the risks are. Other than that, they could ask a relative/parent/child's permission if possible.

_mulder_• 12 years ago

Are you really suggesting a Hitleresque racial motive behind these experiments? Or just sad that black males (in that locale) have a higher incidence of homicide, and therefore more likely to be suitable for this procedure?

digitalengineer5• 12 years ago

I did not. As the article stated: poor (black) people do have a significant higher change to end up in that experimental room.

Your comment did made me think about not-so-old CIA experiments on poor powerless people: http://en.wikipedia.org/wiki/Unethical_human_experimentation...

But lets be clear: this is not CIA stuff.

sp3324• 12 years ago

Black males have a lot going against them, which makes them vulnerable to all kinds of things. Sure they're more likely to be victims of violence, but this makes them more open to any abuse going on at hospitals. It's just a compounding of an already bad situation - now you got stabbed and experimented on.

(Hitlerian? as if Americans aren't racist.)

6d0debc071• 12 years ago

What's the alternative to test the thing practically? Getting people to opt in before they got stabbed or shot or whatever would be phenomenally difficult - making contact with that demographic - and could delay the study by years or decades. And in the mean time more people would possibly be dying, something they haven't consented to either.

vacri• 12 years ago

It's not like they're selecting for poor black males. Remember, if this treatment works, it's not going to be primarily applied to rich whites; it's going to be applied to the exact same demographic as the guinea pigs.

ceejayoz• 12 years ago

Remember, if this treatment works, it's not going to be primarily applied to rich whites; it's going to be applied to the exact same demographic as the guinea pigs.

What are you basing this on?

Chances are this is absurdly expensive (ICU stays can cost millions) and may be unlikely to see wide use in poor areas - the hospitals'd be eating the cost most of the time.

VLM• 12 years ago

Also science does not stand still. If this improves outcomes for stabbed black men (of which we have a vast supply compared to other subjects), there are a zillion logical next research steps none of which necessarily involve stabbed black men.

So... if "generic major surgery" goes horribly wrong, they'll chill you and fix it rather than letting your brain die.

I wonder if you could come up with a cancer chemotherapy treatment that has such severe effects that the patient literally can't live thru it, but if you chill them first and then reboot them with a clean blood supply... imagine something that successfully kills tumors but coincidentally liquifies brain tissue. Well, just shut off the brain for awhile by shutting off its flow of blood. Can't poison something if no poison ever gets there. Do the treatment and kill the cancer, then flush out the circulatory system with saline, replace with fresh blood, reconnect the brain to the circulatory system (note to self; don't forget this step) and then reboot them.

I would have to think if there's anything else interesting you can do with a complete "flush -n- fill" of the circulatory system. Maybe treat horrific industrial or research lab accidental poisonings. Sure maybe its less risky to just pour in and drain out 100x your blood capacity to flush it, but what if the industrial accident affected 50 people, that's 5000 people's worth of blood, lots will have to die untreated unless you find a more scalable treatment.

js2• 12 years ago

Reported on and discussed here a few months ago:

https://news.ycombinator.com/item?id=7477801

skizm2• 12 years ago

I think I've seen this House episode before. Spoiler alert: The chick dies in the end.

Seriously though, with these new types of procedures I feel like we need another checkbox next to the organ donor one that says: "Try risky medical procedures if the attending doctor honestly thinks it gives me a better chance of living with no permanent brain damage when compared to conventional treatment." Or probably something a little more succinct.

digitalengineer5• 12 years ago

How about: "I reserve the right to have my life terminated if I come out of a procedure with no brain activity"? Edit: From the older discussion on HN: "Assuming they (patients) have been getting 'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate them, there is still a good chance that their brain was not being perfused."

gonzo• 12 years ago

CPR is nearly worthless, but not always.

mikeash6• 12 years ago

That's just a living will. Anything done after the procedure can be more deliberate. You only need the shortcut of a checkbox on your ID for things that need to be figured out right away.

s1300045• 12 years ago

I agree. I am more than okay for them to try anything possible if I was already dying. I am an organ donor already, why not? At least they tried and the process would be a part of a greater study to improve modern medicine.

I am curious how much organ they could still harvest after performing such procedure though.

Fuxy2• 12 years ago

It should be harmless to the organs. If they can be carried around in a freezer I'm sure they won't get damaged from being injected with freezing salt water.

waylandsmithers• 12 years ago

I like something more along the lines of "Trust the judgement and expertise of medical professionals, especially in emergency situations."

skizm2• 12 years ago

Well they need to know your wishes. If this procedure has a 60% success rate but 95% of those people only survived with 75% brain function would you want it done? Vs a procedure that has a 10% success rate but 95% of people who survived had complete brain functionality restored.

Personally I'd want to take the 1/10 chance, but I'm sure there are a lot of people who would want to live even if it meant diminished mental capacity.

venomsnake• 12 years ago

They are not dead until they are warm and dead.

There are enough cases known to science where cold has done wonders. And the technology seems viable. I say go for it. At worst we will be getting valuable knowledge.

Fuxy2• 12 years ago

Yep.

If your odds are already very low taking a risk for better odds seems like a good deal to me.

You're most likely dead anyway why not try something new to give you a better chance.

afarrell3• 12 years ago

"But researchers at a number of institutions say they have perfected the technique, known as Emergency Preservation and Resuscitation, or E.P.R., in experimental surgeries on hundreds of dogs and pigs over the last decade."

Did they actually do dry runs of the surgery from shooting to triage to finish? I wonder whose job it was to shoot the dog with a .45

spingsprong• 12 years ago

http://www.independent.co.uk/news/uk/home-news/ministry-of-d...

afarrell3• 12 years ago

Huh. More medical organizations should do this sort of training.

quotient• 12 years ago

I'm annoyed by the headline. I know it's meant to grab attention by seeming counter-intuitive, but as it is, the headline is simply wrong. This medical procedure does not involve "killing" the patient. It involves cooling the patient down internally to essentially suspend them, so the doctors have a greater window of time to perform the necessary procedures. The best way of doing this happens to be to temporarily replace the patient's blood with a saline fluid, and if you think that's "killing" the patient, then I suggest you grab the nearest dictionary and smack yourself with it.

enoch_r• 12 years ago

happens to be to temporarily replace the patient's blood with a saline fluid

Which, according to the article, has the effect of stopping the heart as well as brain activity. This seems pretty close to "death." If someone decided to stop the operation halfway through without replacing the saline solution or reviving the patient, it would make sense to me to claim that the "time of death" was the time at which brain activity ceased.

pygy_3• 12 years ago

General anesthesia also stops brain activity, and you can die during open heart surgery. The time of death won't be the time of loss of consciousness.

It is about conserving information. As long as your brain can be turned back on you're still alive.

mikeash6• 12 years ago

"Without heartbeat and brain activity, the patients will be clinically dead."

As far as I can tell, that statement is correct. The headline is drawing attention to the evolving nature of just what constitutes "death" and how this particular procedure is pushing it out even further.

pygy_3• 12 years ago

Clinical death is a lack of blood pulse and breathing. Hence the modern meaning of "resuscitation" for "rebooting the heart".

It hasn't been a synonym for "death" for a few decades.

"Brain death" is a total and irreversible loss of brain function.

Killing a Patient to Save His Life

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