![]() ![]() Disability rights advocates argued that judgments about which conditions are compatible with a “livable life” - not to mention the higher standard of a good life - are not best made by medical experts alone. Just as physicians were beginning, in the 1980s, to consider QoL more explicitly in their treatment recommendations, the disability rights movement was building and disability studies programs were being launched. Cowart’s case was one of the first to highlight the importance - ethically, not just medically - of letting the patient’s own QoL valuation guide surgical decision making. His physicians, on the other hand, believed it was their ethical duty to preserve his life regardless of his assessment of its quality. 8 Cowart’s refusal was based in part on his judgment that if he survived, his QoL would be such that death was preferable. ![]() Just a few years before the Quinlan case, physicians had treated the severely burned patient Dax Cowart against his express and capacitated refusal of treatment. That these two cases forced physicians to take into account a patient’s QoL, rather than only life itself, in making treatment recommendations is significant. The highly publicized Karen Ann Quinlan and Nancy Cruzan cases of the late 1970s and 1980s made it clear that supporting life regardless of its conditions ran afoul of the ethical principle of beneficence and perhaps other core ethical principles undergirding medical practice. Neither the Hippocratic, nor the Maimonidean, nor any other professional oath helps a physician determine the point at which to cease interventions in light of the advances of modern medicine. With the rapid development of new life-sustaining technologies in the mid-20th century, it became possible to keep people “alive” in conditions that would have spelled death at any other point in human history. 6 In many ways, an emphasis on QoL is understandable. QoL - or the presumed lack thereof - is commonly used as a justification in medical and surgical decision making, just as it’s used in everything from the deliberations of a hospital ethics committee to those of the World Health Organization. Ensuring that physicians and health care organizations do not discriminate on the basis of disability requires careful consideration of the question of to whom surgery is offered and to whom it is denied. Such understanding may allow us to create better tools for making high-stakes clinical decisions. To address this problem, it’s helpful to understand the history and norms behind “the eyeball test” - intuitively sizing up a patient’s physical appearance in order to estimate surgical risk - and the reasons why subjective judgments often fall prey to problematic ableist assumptions. Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not 1,2 and that such judgments by medical practitioners in particular can be biased. Judgments about the relationship between quality of life (QoL) and various disabilities, whether those disabilities predate a surgical or medical intervention or result from it, are a case in point. Many seemingly objective decisions about whether to offer life-sustaining surgical interventions are actually rooted in subjectivity. ![]() From early in medical training, the ability to make rapid decisions and snap judgments is inculcated in aspiring physicians, perhaps no more dramatically than in the field of surgery. This adage rings true for all who decide when and whether to wield the scalpel. But only the wisest surgeons know when not to operate.” “Good surgeons know how to operate better surgeons know when to operate. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. ![]()
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