A friend was recently diagnosed with multiple myeloma, a cancer of a type of white blood cell called plasma cells. There is often significant pain associated with this condition, and my friend has been treated with high doses of different opioid combinations, in addition to chemotherapy. My friend lives in Colorado, where he has easy access to medical marijuana, and he asked his oncologist if he could add this to his regimen in hopes of decreasing his dependence on opioids. The oncologist told him that he would refuse to treat my friend if he took any form of cannabis. Given his insurance coverage, my friend does not have the option of changing physicians.
The National Cancer Institute states that cannabis may benefit patients suffering from cancer-related side effects. Cannabis is routinely recommended for cancer patients to improve appetite, decrease nausea and alleviate pain. The medical literature is fairly consistent on the efficacy and minimal side effects of cannabis, which has specifically been shown to help patients decrease opioid dependence. There are even some reports that cannabis may be a valuable adjunct to chemotherapy in cancer patients.
Is it ethical for the physician to deny treatment based on my friend’s taking cannabis? Is it ethical for my friend not to inform his oncologist if he chooses to use cannabis?
D.A. Kinderlehrer, M.D.
Let me start with your question about the right of doctors to refuse service. Doctors in the United States can be legally required to treat patients in medical emergencies. Otherwise, though, doctors can mostly refuse service — as long as it’s consistent with whatever agreements they’ve made with their health care organizations or provider networks and isn’t in violation of anti-discrimination laws. There are shortages of doctors in many places, so clinicians — especially the ones with the best reputations — often truthfully say they simply won’t take new patients on board.
While doctors don’t have a general obligation to take patients, they do have obligations to patients they have taken. Yes, doctors sometimes “fire” patients they find unpleasant, overly demanding or abusive. But the American Medical Association rightly calls for physicians to ensure “continuity of care” in these cases — which involves making sure that the patient can secure another physician. You say that your friend has access to only this one oncologist. That’s disturbing, if true. In a decent medical system, the ability to switch doctors is a central element in respecting patient autonomy. A situation in which a doctor can fire a patient but not the other way around strikes me as insupportable.
As a general rule, what’s more, noncompliance is a poor justification for terminating care. If this oncologist has medical reasons for objecting to your friend’s use of cannabis — if he has specific concerns about drug interactions, say — he should explain them. (I’m assuming your friend isn’t enrolled in an experimental protocol.) If it’s just that he disapproves of legal marijuana use, that’s an abuse of the doctor-patient relationship. Patients aren’t obliged to help their doctors enforce a tyrannical demand, so there would be no moral reason your friend should inform him of his cannabis use. Indeed, your friend might want to consider filing a complaint against the oncologist for making this threat.
As a medical matter, though, it’s not a great idea to have a doctor who doesn’t know what drugs you’re taking. Ideally, your friend would enlist the services of a specialist in pain management or palliative care who could work with his oncologist. Treating pain involves subjective considerations that make it very different from giving chemotherapy, which is why people skilled at the second sometimes falter at the first. And if your friend can’t come to terms with this oncologist, the oncologist is ethically required to find him another.
I have a friend in a long-term relationship who has always wanted kids but has been putting off getting married to her boyfriend and starting a family. I think it’s because she’s ambivalent about him. I’m worried that she is going to lose her fertility window if she doesn’t leave him soon and find a better match. I don’t want to say anything because I don’t want to add to her anxiety, but I don’t want to see her miss her chance and later regret it. Is it more ethical to share my concern or to stay quiet?
Everything you say about your friend’s situation is, if true, known to her. What you want her to do is to draw what you think is the obvious conclusion: that she needs to break up with her partner, find a new one and settle down to motherhood. Perhaps you think that forcing her to face reality will get her to snap out of it and take some new course of action.
If you had reason to be confident that your promptings would guide her to a life as a happily married mother, it would certainly be ethical to proceed. You’d be offering a gift of friendship. But I suspect you don’t have reason to be confident about this. And you’ve identified the downsides: adding to her anxiety, sparking her resentment. It is an important maxim, widely ignored, that intervention is a good idea only if it is likely to make things better. Many people think that a mediocre partner is better than no partner at all. And depending on their character and temperament, they may be right.
At the gym, I often see a woman who appears to be severely underweight; I can’t help thinking that she may have an eating disorder. I’m not a medical professional, I don’t know her, I don’t work at the gym and I don’t have any information that isn’t plainly visible. I don’t want to intrude on her privacy (for all I know, this woman may have some other underlying medical condition and already be receiving medical care for it), but at the same time, it’s difficult for me to see someone looking so painfully thin. For what it’s worth, I’ve seen this woman at the gym for a year or more, which suggests that her weight is relatively stable, albeit very low.
What is the most ethical course of action? And how would it be most helpful to engage with this woman if ethics demand that I can’t simply be a bystander?
You know almost nothing about this woman and have no relationship with her. Unless she’s completely friendless, there’s almost certainly someone who is better placed than you to judge whether she’s ill and, if so, to help her deal with it. Maybe that has already happened.
You don’t have very good reason, in short, to involve yourself here. And bear in mind that one feature of eating disorders is a preoccupation with how you look to others; being addressed by a stranger in a gym who is worried by your appearance is likely to exacerbate that problem. Shame is part of the psychic burden of many eating disorders (she may be struggling to recover from it), but so is a profound body dysmorphia. Hearing that she’s too thin may have the opposite effect than what you intend, by making her feel pleased that her behavior has succeeded in making her look the way she wants to look. As I cautioned in my previous answer, we should intervene only when we’re likely to make things better.
I recently started a new job. During the application process, I was asked if I would be applying to graduate school in the near future, as their intention was to have the new hire stay on for two to three years. At the time, I was not intending on applying to graduate school, but this has since changed. Must I inform my new employers of my change in plans? There is a chance I may not be accepted into a program or receive enough funding to attend. I also took on personal risk by moving to the other side of the country when accepting the offer.
Unless you promised your new employers not to apply to graduate school, the truthful answer you offered in the interview was what you owed them. You might consider sticking around for a year, though, so that you could give them a good chunk of what they’d been hoping for. That you’re not obliged to do so doesn’t mean that it wouldn’t be a decent thing to do.B:
需锋论坛雷锋论坛【雪】【团】【被】【带】【去】【皇】【后】【宫】【的】【第】【一】【天】【小】【顺】【子】【便】【一】【声】【接】【一】【声】【叹】【气】，“【皇】【后】【娘】【娘】【这】【样】【和】【娘】【娘】【不】【对】【付】，【能】【对】【雪】【团】【好】【吗】？“ 【我】【正】【在】【将】【银】【丝】【鎏】【金】【球】【里】【的】【香】【丸】【取】【出】，【同】【时】【到】【处】【下】【层】【的】【香】【会】，【冷】【冷】【道】，“【自】【然】【不】【会】【好】。“ “【那】【娘】【娘】【还】【把】【雪】【团】【送】【过】【去】？” 【我】【将】【香】【灰】【倒】【进】【他】【手】【中】【石】【盂】【中】，【头】【也】【不】【抬】，“【我】【们】【当】【初】【带】【雪】【团】【进】【宫】，【不】【就】【是】【为】【了】
【直】【升】【飞】【机】【离】【开】【之】【后】，【夜】【幕】【缓】【缓】【降】【临】，【四】【周】【逐】【渐】【失】【去】【阳】【光】【所】【有】【房】【屋】【当】【中】【各】【自】【亮】【起】【了】【照】【明】【灯】。 【但】【是】【那】【位】【小】【姑】【娘】【再】【次】【小】【跑】【到】【我】【们】【身】【边】【严】【肃】【说】【道】：“【各】【位】【晚】【餐】【已】【经】【准】【备】【好】，【是】【时】【候】【吃】【饭】【了】！” 【站】【在】【我】【们】【身】【边】【的】【女】【王】【面】【带】【微】【笑】【再】【次】【做】【出】【了】【邀】【请】，【婷】【姐】【没】【好】【气】【说】【道】：“【那】【好】【吧】，【吃】【完】【饭】【准】【备】【修】【复】***！” 【于】【是】【我】【们】【再】【次】
【符】【晞】【看】【了】【眼】【纪】【然】【递】【过】【来】【的】【谢】【礼】，【并】【没】【有】【打】【算】【收】【下】【的】【意】【思】。 “【不】【必】【了】。”【不】【过】【是】【意】【外】【遇】【上】，【至】【于】【帮】【忙】，【她】【只】【不】【过】【嫌】【麻】【烦】【罢】【了】，【倒】【也】【没】【有】【真】【的】【想】【要】【帮】【他】。 【见】【到】【符】【晞】【拒】、【绝】【了】【自】【己】【的】【谢】【礼】，【纪】【然】【脸】【上】【的】【表】【情】【闪】【过】【一】【丝】【僵】、【硬】。 【没】【想】【到】【他】【第】、【一】【次】【从】【女】【生】【礼】【物】，【就】【被】【当】【场】【拒】、【绝】。 【纪】【然】【看】【了】【眼】【伸】【出】【去】【的】【手】，【明】【显】需锋论坛雷锋论坛【凯】【撒】【略】【微】【仰】【头】【看】【着】【卡】【罗】【丝】，【一】【时】【间】【说】【不】【出】【话】，【先】【宰】【了】【他】【们】？【之】【后】【再】【戴】【上】‘【佩】【尼】【尔】【之】【环】’，【拿】【起】‘【达】【涅】【斯】【之】【戟】’，【这】【么】【一】【听】，【没】【任】【何】【问】【题】。 “【既】【然】【你】【坚】【持】，【那】【好】【吧】。” 【凯】【撒】【缓】【步】【退】【后】，【寝】【厅】【内】【侧】，【卡】【罗】【丝】【单】【手】【持】【长】【剑】，【上】【面】【代】【表】【死】【亡】【的】【银】【灰】【色】【火】【焰】【升】【腾】，【而】【她】【的】【妹】【妹】【卡】【美】【拉】，【此】【时】【正】【趴】【在】【她】【背】【上】，【头】【搭】【在】【卡】【罗】【丝】【左】
“【直】【接】【晋】【升】，【中】【级】【奴】【隶】？” 【听】【到】【军】【官】【的】【话】，【梅】**【刻】【感】【觉】【到】，【周】【围】【这】【些】【奴】【隶】【们】，【呼】【吸】【都】【变】【得】【急】【促】【起】【来】。 “【长】【官】【大】【人】，【能】【不】【能】【透】【露】【一】【下】，【这】【个】【什】【么】【资】【质】【测】【验】，【究】【竟】【是】【什】【么】【内】【容】？·” 【似】【乎】【是】【感】【觉】【到】【眼】【前】【这】【个】【军】【官】【并】【没】【有】【那】【么】【凶】【戾】，【这】【些】【奴】【隶】【们】【也】【没】【有】【一】【开】【始】【那】【样】【的】【紧】【张】【和】【拘】【束】【了】。 “【透】【露】【什】【么】？【没】【什】【么】【好】
【出】【了】【火】【圈】，【见】【到】【乐】【惜】，【呆】【坐】【着】，【脸】【上】【好】【像】【还】【挂】【着】【眼】【泪】。 【而】【乐】【惜】【看】【着】，【在】【火】【圈】**【来】【的】【一】【个】【不】【人】【不】【鬼】【的】【人】【样】。 【很】【是】【害】【怕】【道】“【学】【姐】，【你】【死】【了】【吗】【对】【不】【起】，【我】【没】【想】【到】，【这】【将】【会】【害】【死】【你】，【对】【不】【起】。” “【傻】【丫】【头】，【谁】【说】【我】【死】【了】，【让】【姐】【看】【看】【你】【是】【不】【是】【流】【泪】【了】。”【蓝】【月】【焰】【笑】【着】【说】【道】。 “【学】【姐】，【蓝】【学】【姐】，【你】【不】【要】【开】【玩】【笑】【了】，
【风】【雪】【对】【这】【回】【答】【很】【不】【满】【意】，【气】【鼓】【鼓】【问】：“【只】【是】【比】【她】【好】【看】？” 【顾】【铭】【机】【灵】，【立】【马】【改】【口】：“【不】！【你】【比】【这】【世】【上】【的】【任】【何】【女】【孩】【都】【好】【看】。” 【两】【人】【微】【笑】【对】【视】，【彼】【此】【的】【眼】【睛】【里】【都】【只】【有】【对】【方】，【空】【气】【里】【也】【弥】【散】【一】【抹】【甜】【味】。 【此】【时】，【许】【成】【语】【还】【不】【知】【道】【陆】【思】【的】【心】【境】【变】【化】，【他】【沉】【默】【着】【走】【过】【来】【时】，【恰】【好】【听】【到】【这】【两】【人】【的】【对】【话】。【他】【知】【道】，【自】【己】【和】【陆】【思】【还】
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