How Doctors Die

Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.

That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.

Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.

Well, here we get into bioethics, which is a tremendously involved field, but I'll just give the nickle tour of the applicable issue.

The big one is the notion of patient autonomy. The patient (or their appointed medical decision maker) gets to choose what happens, provided they are competent to do so. As a medical professional, it is my job to determine what course is most appropriate, explain it to the patient, and once they understand what's going on, what the pros, cons and risks of the treatment are, they give me consent and I do it, if they refuse consent, I find the next most appropriate thing...rinse and repeat. In cases where there are multiple courses which balance the pros/cons/risks, I present them all, and let the patient choose.

A couple of quick sidelines we need to explore here, in order to have a decent understanding of the beast.

First is consent, and the second is competency, and the two are very closely linked, so we're going to do them as one.

There are two forms of consent, implied and expressed, expressed is relatively easy, the patient says "Yes do that" or "No go away.", alternatively, actions can be interpreted as expressed consent, if I need to take someone's blood pressure, and when they see the cuff in my hand, they roll up their sleeve, that's expressed consent...this can, of course get a little murky, and is part of why I have to carry malpractice insurance, since if I do something a competent patient didn't want, even with the best of intentions and in the full faith that I had been given consent, technically, I've just committed battery.

Implied consent isn't nearly as clear cut as that. Implied consent is used when a patient for one reason or another is not capable of giving consent, it could be because they're unconcious (obviously not going to be telling me to go ahead), they're a child (You're not legally competent until you're 18, or a variety of rare loopholes), they're confused and disorientated (If you don't know where you are, you surely can't understand medical procedures) or they're in the midst of a psychiatric emergency (If you think I'm a giant talking turtle, you're not going to understand medical procedures.). In the care of implied c

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