List Archives

Tue Jul 31 04:13:41 BST 2007

Ladies and Gentlemen,

  It sounds like "do no harm" doesn't apply to the criminal justice system when it comes to victims of crime in all parts of the world. Philosophically I think it could be argued that ordering a medical proceedure against medical advice would be further victimizing a person. That seems to go against the idea of "justice." It is though a Socratean arguement that when you live in the protections of society you are subject to its demands even when not in your best interest.

  As a personal decision though, I would strenuously advise the patient against such a proceedure. If the patient decided that they wanted to proceed I would do my very best for them. If I found myself ordered by a court, I think I would simply counter with a legal challenge on the manner hoping the judge would decide it was not worth the effort and drop the order.

  I would also stipulate that if law enforcement needed a bullet fragment so badly, they had a pretty weak case. Though I do not consider myself an anarchist or such, I personally do not subscribe to the theory that the good of the state takes precedence over the rights of the individual.

  Mike   

Sanjay Gupta MD <sanjaygupta99_91 at yahoo.com> wrote:
  Suppose that you (the physician) have been shot. 
There is no indication to remove that bullet for any
of the medical reasons listed in here. The gun that
is supposed to be the one responsible is found, but
the only way to figure out if the bullet came from
this gun is to remove the bullet (and this would not
jeopardize your life), what would your ethics say. 
Remove the bullet and get the assailant his due
punishment (and maybe some reward to you) or leave the
bullet in your body and let the miscreant get away? 
What am I, as a physician to do in this situation, if
you (the victim) happens to be someone near and dear
to me?

Sanjay

--- caesar ursic wrote:

> I the USA there is no way that any court, judge,
> police agency or other
> official can legally oblige any physician to remove
> any bullet from any
> patient. Period. The bullet might eventually get
> removed, but only by a
> doctor who agreed to do so williingly - not because
> of any legal pressure.
> 
> Those of you who believe otherwise please provide
> specific citations of
> specific cases.
> 
> CM Ursic, MD
> Santa Fe
> USA
> 
> 
> 
> On 7/30/07, Hardcastle, Tim, Dr 
> wrote:
> >
> > Pret
> >
> > The way the law and ethics combine here are site
> specific: In South Africa
> > the doctor would be issued with a subpoena to
> undertake the bullet removal;
> > refusal is contempt of court. You therefore comply
> stating in your notes
> > that this is undertaken "against scientific
> evidence and under duress"
> > (legal-speech, not mine!) and the court response
> is usually (at the time of
> > the trial) "so-noted and thank you for compliance
> with the higher
> > authority". The doctor is covered for any action
> by the patient who will
> > have to prove that the action of the doctor
> violated his right to either a
> > fair trial (unlikely, since most bullets we remove
> are in victims rather
> > than perpetrators) or appropriate health-care!
> >
> > Also remember we use Roman-Dutch law without a
> jury system - the judge
> > makes the call based on the law rather than the
> feelings of a mini-mob. :-)
> >
> > Tim
> > Dr T C Hardcastle
> > M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> > Senior Surgeon / Senior Lecturer: Surgery (Trauma
> and ICU)
> > ATLS instructor and DSTC Cape Town Course
> Director
> > Intern program Coordinator: Surgery
> > M.Med (Emergency Medicine) Executive Committee
> member
> > Clinical Head (Director): Diana Princess of Wales
> Trauma Unit
> > Division of Surgery (General) Room 4064
> > Department of Surgical Sciences
> > Tygerberg Hospital / University of Stellenbosch
> > PO Box 19063
> > Tygerberg 7505
> > Western Cape
> > South Africa
> > e-mail: tch at sun.ac.za
> > Cell: +27824681615
> > Office: +27219389281 or 4911 pager 0302
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]On Behalf
> Of Bjorn, Pret
> > Sent: Monday, July 30, 2007 2:35 PM
> > To: Trauma & Critical Care mailing list
> > Subject: RE: Bullet removal
> >
> >
> > Okay, I'm here to learn:
> >
> > The court can order it; but must a doctor violate
> his or her oath in the
> > process of compliance? Seems to me that even if
> the State gives proxy
> > consent, you still have to get past the medical
> necessity condition
> > before this passes the ethical straight-face
> test...
> >
> > Pret
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf
> Of Hardcastle, Tim, Dr
> > 
> > Sent: Monday, July 30, 2007 6:33 AM
> > To: Trauma & Critical Care mailing list
> > Subject: RE: Bullet removal
> >
> > Unless he is "under arrest"
> >
> > In most places then the court may order such a
> step!
> >
> > On the topic: our five indications for bullet
> removal:
> > -You see it in the wound
> > -You feel it under the skin / in the soft tissue
> > -It communicates with CSF or joint space fluid =
> risk of electrolysis
> > and lead poisoning long term
> > -In or near a vascular injury - embolisation risk
> and sepsis of graft /
> > repair
> > -The justice system orders the removal of an
> awaiting trial prisoner's
> > bullet.
> >
> > In my mind these are the only sound reasons for
> removing bullets
> > anymore, this is our day to day practice and we
> see anything from 5 to
> > 20 GSW's per week!
> >
> > Tim
> > Dr T C Hardcastle
> > M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> > Senior Surgeon / Senior Lecturer: Surgery (Trauma
> and ICU)
> > ATLS instructor and DSTC Cape Town Course
> Director
> > Intern program Coordinator: Surgery
> > M.Med (Emergency Medicine) Executive Committee
> member
> > Clinical Head (Director): Diana Princess of Wales
> Trauma Unit
> > Division of Surgery (General) Room 4064
> > Department of Surgical Sciences
> > Tygerberg Hospital / University of Stellenbosch
> > PO Box 19063
> > Tygerberg 7505
> > Western Cape
> > South Africa
> > e-mail: tch at sun.ac.za
> > Cell: +27824681615
> > Office: +27219389281 or 4911 pager 0302
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]On Behalf
> Of Pret Bjorn
> > Sent: Monday, July 30, 2007 11:18 AM
> > To: 'Trauma & Critical Care mailing list'
> > Subject: RE: Bullet removal
> >
> >
> > You comply with such an order only after the
> patient's consent, I
> > presume.
> > Otherwise it sounds like a good case for your
> ethics committee: you're
> > both
> > committing assault and violating his Fifth
> Amendment rights. That is,
> > if
> > America still has a Bill of Rights.
> >
> > Wait. We still have amendment number two, don't
> we? Hence the missile
> > of
> > interest...
> >
> > Pret Bjorn, RN
> > Bangor, ME USA
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of Hall, John R
> > Sent: Sunday, July 29, 2007 11:31 PM
> > To: Trauma & Critical Care mailing list
> > Subject: RE: Bullet removal
> >
> > CM
> > We once had a "court order" to remove the bullet
> for evidence.
> > j
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org on behalf of
> caesar ursic
> > Sent: Mon 7/16/2007 12:37 PM
> > To: Trauma &, Critical Care mailing list
> > Subject: Re: Bullet removal
> >
> > Consensus? What's that?
> >
> > I do know one thing: failure to remove all bullets
> will severely
> > compromise
> > your credibility as a trauma surgeon with the
> family. In their eyes,
> > the
> > primary purpose of emergency surgery is to get the
> bullets out.
> >
> > However, I was indoctrinated to believe that only
> bullets in the
> > following
> > areas actually require removal:
> >
> > 1. when in contact with synovial fluid (i.e.
> joints): because they
> > compromise joint integrity and mobility and, if
> unjacketed, may lead to
> > lead
> > intoxication;
> >
> > 2. when in a vessel lumen, to avoid distal missile
> embolus and vascular
> > occlusion;
> >
> > 3. when inside the heart, because, well... because
> loose objects within
> > heart chambers will only cause mischief.
> >
> > 4. when under the skin on weight-bearing surfaces
> (eg: the buttocks) or
> > surfaces subject to contact with clothing (eg:
> belt line) that produce
> > discomfort or pain.
> >
> > 5. when visibly bulging beneath the skin and
> causing cosmetic distress.
> >
> > I've never heard that the indications are
> different in women versus men.
> >
> > Once in a while a law-enforcement type will tell
> me that I need to
> > remove a
> > bullet for 'evidence.' I've never done that nor
> think that one can be
> > forced to do so, at least in this country (USA).
> >
> > CM Ursic, MD
> > Santa Fe
> >
> >
> >
> > On 7/16/07, William Bromberg
> 
wrote:
> > >
> > > Hey there,
> > >
> > > Is there any consensus on indications for bullet
> removal in:
> > >
> > > asymptomatic men (I vote leave it)
> > > asymptomatic child-bearing age women - this is
> where I'm uncertain
> > >
> > > Symptomatic, in joints/blood vessels, impinging
> on the SC I figure
> > need
> > > to come out.
> > >
> > > Any advice appreciated.
> > >
> > > Bill Bromberg
> > >
> > > --
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> > >
> >
> >
> >
> > --
> > 'Twas brillig, and the slithy toves
> > Did gyre and gimble in the wabe:
> > All mimsy were the borogoves,
> > And the mome raths outgrabe.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> >
> > --
> > trauma-list : TRAUMA.ORG
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> > --
> > trauma-list : TRAUMA.ORG
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> >
> >
> > --
> > trauma-list : TRAUMA.ORG
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> >
> 
> 
> 
> -- 
> 'Twas brillig, and the slithy toves
> Did gyre and gimble in the wabe:
> All mimsy were the borogoves,
> And the mome raths outgrabe.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 

Sanjay Gupta MD
Tel: 412 335 6304

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