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Live or let die?

18:49 / 06.05.03

In a universe far, far away, a lonely goatherd said

I can see none of you have probably EVER been in a position where you have to choose who can live and who can die.

You bleedin' ponces. You know nothing of life...

Well, I have. Have you?

Solitaire Rose as Tom Servo

18:52 / 06.05.03

I have been in a position to choose how people live, but not if they can live.

But I have asked for the power to decide who lives or dies for every Giftmas and Birthday for years and no one has gotten it for me. So, if anyone here likes me enough to get me something this year...

Cloned Christ on a HoverDonkey

19:09 / 06.05.03

I was trying to figure out, Ganesh, which situation you've been in where you've had the power of life and death.

The only thing that sprang immediately to mind was an image of you carrying out some form of 'spree' killing, storming through some workplace where you have been 'wronged', carbine in hand, making snap decisions whether or not to kill that supercilious twat cowering underneath his desk in accounts or not.

Although I may be wrong.

19:19 / 06.05.03

If we're talking about deciding who can live and who can die then I haven't. If we're talking about who will live as a result of actions or decisions you make then I have, because I've phoned an ambulance for someone I found unconsious, but whom I knew really intended to kill themself.

Ganesh, now I have an image of you lording it over a rabble of people, pointing at them and going "Yes, no, no - too short, no no, definitely no...."

19:23 / 06.05.03

Only if you count driving on I-95.

(This comment is far less facetious than it might at first appear.)

19:23 / 06.05.03

Being honest, if I'm discounting those situations where I'm the one deciding whether to discharge or admit someone saying "I'm going to kill myself", my role is probably more akin to having influence (within a medical team) over those live-or-die decisions. I'm thinking of when I did Liaison Psychiatry on a renal/hepatic unit, and my psychiatric assessment would carry some weight in terms of Who Gets The Donated Liver...

19:31 / 06.05.03

But clearly, those life or death decisions raise all sorts of ethical dilemmas. I mean, what if you have to decide between a dole scrounger and a hard working mother? Easy, right? But what happens if it then turns out that she was secretly a slapper all along and the dole scrounger could probably be made to work if you threatened them with a melee weapon?

Its a moral minefield.

19:36 / 06.05.03

Not at all. As the vast majority will agree, it's utterly self-evident.

19:37 / 06.05.03

I think we've established that slappers deserve nothing, certainly no help from the state, so definitely not livers, haven't we? *Sinks into the corner gibbering with the circularness of it all.*

Ganesh, that must have been an exceedingly hard thing to cope with personally. I know it was your job, but did anyone give you any support on how to deal with making those kind of calls?

19:40 / 06.05.03

Oh yeah, everyone's aware of the stresses involved - which is why it was always a group decision based on several assessments. I always had colleagues I could approach as a 'safety valve' too.

21:24 / 06.05.03

I was swimming in the Red Sea once with a friend (and she's a right old slapper) when we got caught in a nasty, nasty riptide. By dint of Thorpedo-like effort, I managed not to be dragged too far out and when I was out of puff, managed to balance precariously on pinnacles of coral at intervals until shore began to seem a bit closer.

However, my friend wasn't quite such a good swimmer and was drifting off. So I had to go get her and do some heroic stuff. Unfortunately, she's a big lass and was not being terribly helpful, as panic set in. So she started haranguing me and getting right up my nose, just as I was calculating that I was struggling to make headway without my friend to tug along behind.

I had this awful image of being in the impossible decision of having to choose between letting her drift off and save myself, or both of us drifting out beyond a chance of powering ourselves back to shore. I found some herculean reserves and got us both safely back to the beach but the memory of that flash of just having to let her drift chills me still.

Good job this was 1990 and I was younger and fitter. We'd both be fish food if it happened today. I remind her that I saved her life every now and then when I'm feeling a bit evil. We don't mention the possibility that I might have panicked too and made a hasty and fatal decision.

00:35 / 07.05.03

grant's right about I-95, even 2000 miles away from him, it's still a horrible place to be.

11:00 / 07.05.03

I've been in a few situations where I've had to prevent a weekend-alcoholic relative from killing herself. It's a very scary position to be in - knowing that if you say the wrong thing you might just push them over the edge.

It's not quite the same as having to choose *who* lives and who dies, or choosing *whether* someone lives or dies, though. All I really have to do is sit up with her, because by the morning she'll be sober and un-suicidal.

Still scary though.

11:37 / 07.05.03

With your liver patients Ganesh, would I be right in thinking that your assessments, in part, would be based on what sort of lifestyle choices you felt the potential recipients might make? i.e. no point in giving a liver to someone who would only go and poison it.

13:30 / 07.05.03

Partly, but also on their personality type, the presence or absence of psychiatric illness, life situation, etc., etc.

17:09 / 07.05.03

first i'd like to say that i just love the term 'slapper.' love, love, *love* it.

next: perhaps i'm wondering so i can live a better life in order to get a new organ, in case that should ever come up, but ganesh, i'm well interested in the criteria you and yr team used to decide who got much-needed organs. could you elaborate?

17:22 / 07.05.03

Well, see, it was all very much case-by-case, and my psychiatric opinion was only one element of a much larger assessment; of equal (if not greater) import were the physician's assessment of their overall prognosis with or without dialysis, the surgeon's views on whether an implant would 'take', the anaesthetist's views on their fitness for a lengthy operation, etc., etc. Outwith the situation, it's difficult to articulate specific protocols.

17:38 / 07.05.03

ok, so yr psych opinion was only part of it...but what did you discriminate against? slappers? people into scat? people against welfare? what?
seriously, was it like, "this one's such a case, she'll never get her life together anyways, give it to someone else." (which is me totally projecting what i fear they'd say about me...)

17:52 / 07.05.03

To generalise, we psychiatrists "discriminated against" individuals whose histories indicated major substance dependence (usually alcohol) they were powerless to resist - as evidenced by multiple failed attempts, loss of livelihood, home, relationships, etc. That was the biggie. People who overdosed on a regular basis (thus placing their livers and kidneys under enormous physiological stress) could also be considered a dodgy prospect.

18:16 / 07.05.03

thanks, ganesh. i feel better now, as i'm not *that* bad of a drinker/druggie.

18:19 / 07.05.03

We've got one you can have, Mantis; we ran out of Chianti. Shall I start defrosting it?