Cutting off your finger

[arahant]

So, the son of a friend of mine intentionally cut off one of his fingers with a steak knife (he's not well, mentally speaking). She packed the finger in a baggie, and packed that in ice, and went to the hospital.

Tip 1 - this is the correct way to preserve a severed digit, rather than placing it in direct contact with the ice

When they got to the hospital, the staff started to arrange to have him transferred to a larger hospital for the reattachment. As it turns out, though, the larger hospital declined to reattach. Apparently, if you cut off your own finger intentionally, they WON'T reattach it. (At least if you do so as a result of mental illness...not sure about "I lost a bet").

Tip2 - In cases of digit amputation, don't say you (or your children) did it intentionally.

Question for the ethicists...Can't they just attach the finger and put a cast on or something (like those cones they put on dogs after surgery). How is attachment a worse expenditure of funds than, say, This (http://www.cbn.com/CBNnews/134741.aspx)

[Lestat]

Would her son agree to having his finger re-attached? If he wouldn't I guess I understand. Also, how old is he? If he is a minor, I would think they'd have to do the surgery. Personally, I think they should do it anyway. Maybe have a 2 strike minumum. If he does it again, then no re-attachment.

[vhawk01]

[ QUOTE ]
So, the son of a friend of mine intentionally cut off one of his fingers with a steak knife (he's not well, mentally speaking). She packed the finger in a baggie, and packed that in ice, and went to the hospital.

Tip 1 - this is the correct way to preserve a severed digit, rather than placing it in direct contact with the ice

When they got to the hospital, the staff started to arrange to have him transferred to a larger hospital for the reattachment. As it turns out, though, the larger hospital declined to reattach. Apparently, if you cut off your own finger intentionally, they WON'T reattach it. (At least if you do so as a result of mental illness...not sure about "I lost a bet").

Tip2 - In cases of digit amputation, don't say you (or your children) did it intentionally.

Question for the ethicists...Can't they just attach the finger and put a cast on or something (like those cones they put on dogs after surgery). How is attachment a worse expenditure of funds than, say, This (http://www.cbn.com/CBNnews/134741.aspx)

[/ QUOTE ]

Don't get me started. The issue is similar to the "giving an alcoholic a liver transplant" problem, although it has the added caveat that probably only about 50% of us think that the mentally disturbed person "did it to himself" in terms of culpability, while almost all of us assign blame directly to the alcoholic.

The parallels are actually pretty solid. Both are diseases (this is assumed for the analogy, although certainly not unarguable) and both can be treated to decrease the likelihood of relapse. Both patients are going to be at a much increased risk of further damage to the finger/liver, so the value of the transplant/reattachment goes down drastically. Its really difficult to take these on a case-by-case basis, so blanket policies have been enacted against both.

Long story short, if your friends son gets his finger back, I expect a lifetime supply of livers.

[Hopey]

If he is mentally ill, how can they claim that he did this "intentionally"?

Also, is this in Canada or the US?

[arahant]

I believe that he is not a minor (20 ish, maybe), but he doesn't have the capacity to make decisions for himself. I'm not sure what the legal recognition of his status is, but I think she was still his guardian.

Also, I believe he didn't want the finger reattached, which is the root of the problem, i think. They assume that the patient will just sever the finger again.

With a finger, this is probably the right decision. But what about, say, a hand? I would think they should reattach, sedate, and give anti-psychotics or something (assuming the guardian wants this).

[arahant]

Yeah, I think I more or less agree with you.
Although, here we don't have the same absolute resource shortage, just a question of money. Which I guess is economically similar, but it seems like it might be an important distinction.

[vhawk01]

[ QUOTE ]
If he is mentally ill, how can they claim that he did this "intentionally"?

Also, is this in Canada or the US?

[/ QUOTE ]

I don't think thats the driving force behind the policy, its the recurrance risk. Why spend hundreds of thousands to reattach if he is just going to do it again?

[vhawk01]

[ QUOTE ]
Yeah, I think I more or less agree with you.
Although, here we don't have the same absolute resource shortage, just a question of money. Which I guess is economically similar, but it seems like it might be an important distinction.

[/ QUOTE ]

Everyone in my entire class seems to think its an important distinction, I most certainly don't, especially not in the US. Every dollar spent (wasted) costs lives, or at least suffering, and there isn't much different to me in wasting a liver or wasting a million bucks, except for the actual, monetary difference between a liver and a million bucks (I have no idea the exact scarcity of livers vs. million-dollar-bills).

[arahant]

[ QUOTE ]
If he is mentally ill, how can they claim that he did this "intentionally"?

Also, is this in Canada or the US?

[/ QUOTE ]

This is the US.
I don't think it's like a moral decision...if you did it as a result of a lost bet, i suspect they reattach. I think the case is that people who want to get rid of part of their body REALLY want it gone, and will try to cut it off as soon as they wake up.

[Lestat]

Well, I'm not a lawyer, but I would think the hospital could be sued. I liked your original idea. Sew the finger back on and put some type of temporary contraption on his hand that prevents him from doing it again while he undergoes psychiatric treatment. Then, if he does it again, I guess there's not much you can do and the finger stays off.

The key (for me), is that he wasn't in the right state of mind to have made that decision for himself. Since it's a first time deal, I think they should've sewed it back on. I understand not doing so a second time.

[vhawk01]

[ QUOTE ]
Well, I'm not a lawyer, but I would think the hospital could be sued. I liked your original idea. Sew the finger back on and put some type of temporary contraption on his hand that prevents him from doing it again while he undergoes psychiatric treatment. Then, if he does it again, I guess there's not much you can do and the finger stays off.

The key (for me), is that he wasn't in the right state of mind to have made that decision for himself. Since it's a first time deal, I think they should've sewed it back on. I understand not doing so a second time.

[/ QUOTE ]

The hospitals agree with your reasoning exactly. They just set the cutoff one re-attachment earlier.

[Lestat]

[ QUOTE ]
[ QUOTE ]
Well, I'm not a lawyer, but I would think the hospital could be sued. I liked your original idea. Sew the finger back on and put some type of temporary contraption on his hand that prevents him from doing it again while he undergoes psychiatric treatment. Then, if he does it again, I guess there's not much you can do and the finger stays off.

The key (for me), is that he wasn't in the right state of mind to have made that decision for himself. Since it's a first time deal, I think they should've sewed it back on. I understand not doing so a second time.

[/ QUOTE ]

The hospitals agree with your reasoning exactly. They just set the cutoff one re-attachment earlier.

[/ QUOTE ]

Well, I don't think it's the same reasoning, because they set the cutoff at zero chances for the vicitim to have made a mistake. I'm saying the number should be something higher than zero.

[vhawk01]

[ QUOTE ]
[ QUOTE ]
[ QUOTE ]
Well, I'm not a lawyer, but I would think the hospital could be sued. I liked your original idea. Sew the finger back on and put some type of temporary contraption on his hand that prevents him from doing it again while he undergoes psychiatric treatment. Then, if he does it again, I guess there's not much you can do and the finger stays off.

The key (for me), is that he wasn't in the right state of mind to have made that decision for himself. Since it's a first time deal, I think they should've sewed it back on. I understand not doing so a second time.

[/ QUOTE ]

The hospitals agree with your reasoning exactly. They just set the cutoff one re-attachment earlier.

[/ QUOTE ]

Well, I don't think it's the same reasoning, because they set the cutoff at zero chances for the vicitim to have made a mistake. I'm saying the number should be something higher than zero.

[/ QUOTE ]

Its the same reasoning. Nothing special about one mistake, two mistakes, or ten mistakes. Its not the mistakes made that bother them, its the likelihood of future ones. How much more likely is the third after the second? How about the second after the first? They think both numbers are high enough, you think only the first one is, but the reasoning is the same.

[chezlaw]

Yeah lie through your teeth. We have an ethical duty to undermine stupid authorities.

chez

[vhawk01]

[ QUOTE ]
Yeah lie through your teeth. We have an ethical duty to undermine stupid authorities.

chez

[/ QUOTE ]

I'm with Kant on this one, so don't come to me expecting me to fudge your chart to get insurance to cover it.

[chezlaw]

[ QUOTE ]
[ QUOTE ]
Yeah lie through your teeth. We have an ethical duty to undermine stupid authorities.

chez

[/ QUOTE ]

I'm with Kant on this one, so don't come to me expecting me to fudge your chart to get insurance to cover it.

[/ QUOTE ]
I'm kinda with kant on this as well. Hence the ethical duty bit.

but I was talking from the perspective of a national health system. I wouldn't advocate defauding an insurance company but I would happily (and believe ethically) lie to them in the way I did to that printer manufacturer.

chez

[Lestat]

Ok, maybe I'm being really nitty here, but I think there is a big difference between zero and anything that is not zero.

Before you chop off a finger for the first time, you don't know what it's like to have chopped off a finger. So this (in my mind), is very different from doing it a second time when you know full well what it's like. If fact, I'd go so far as to say it's a completely different situation.

So I still say allow for at least once chance (which is very different than zero chance), that the victim will be mortified with his decision. After that, I agree with the hospital.

[vhawk01]

[ QUOTE ]
Ok, maybe I'm being really nitty here, but I think there is a big difference between zero and anything that is not zero.

Before you chop off a finger for the first time, you don't know what it's like to have chopped off a finger. So this (in my mind), is very different from doing it a second time when you know full well what it's like. If fact, I'd go so far as to say it's a completely different situation.

So I still say allow for at least once chance (which is very different than zero chance), that the victim will be mortified with his decision. After that, I agree with the hospital.

[/ QUOTE ]

Ok, then I guess your thinking IS different from the hospitals. I am almost positive they could care less about 'blame' or 'second chances.' They are only interested in the best distribution of scarce resources, so their main concern is going to be recurrance risk. So, in order to convince them, you'd have to make the argument that your chances of doing it a second time are <<< (ok, at least <<) your chances of doing it a third time.

[Lestat]

<font color="blue">So, in order to convince them, you'd have to make the argument that your chances of doing it a second time are &lt;&lt;&lt; (ok, at least &lt;&lt;) your chances of doing it a third time. </font>

Don't you think that's the case? I kinda do, although I've never seen studies on it. I would think most people regret doing so the first time. I could be wrong. But if even some people do, I think it's worth doing.

[vhawk01]

[ QUOTE ]
<font color="blue">So, in order to convince them, you'd have to make the argument that your chances of doing it a second time are &lt;&lt;&lt; (ok, at least &lt;&lt;) your chances of doing it a third time. </font>

Don't you think that's the case? I kinda do, although I've never seen studies on it. I would think most people regret doing so the first time. I could be wrong. But if even some people do, I think it's worth doing.

[/ QUOTE ]

I guess they would disagree. I don't personally have a horse in the race, I understand your point, but I have a hard time thinking that the reason the hospital has this policy is 'because they can,' 'spite,' or 'man, we never thought of that.'

[evolvedForm]

[ QUOTE ]
So, the son of a friend of mine intentionally cut off one of his fingers with a steak knife (he's not well, mentally speaking). She packed the finger in a baggie, and packed that in ice, and went to the hospital.

Tip 1 - this is the correct way to preserve a severed digit, rather than placing it in direct contact with the ice

When they got to the hospital, the staff started to arrange to have him transferred to a larger hospital for the reattachment. As it turns out, though, the larger hospital declined to reattach. Apparently, if you cut off your own finger intentionally, they WON'T reattach it. (At least if you do so as a result of mental illness...not sure about "I lost a bet").

Tip2 - In cases of digit amputation, don't say you (or your children) did it intentionally.

Question for the ethicists...Can't they just attach the finger and put a cast on or something (like those cones they put on dogs after surgery). How is attachment a worse expenditure of funds than, say, This (http://www.cbn.com/CBNnews/134741.aspx)

[/ QUOTE ]

What do they do with failed suicides?

[vhawk01]

[ QUOTE ]
[ QUOTE ]
So, the son of a friend of mine intentionally cut off one of his fingers with a steak knife (he's not well, mentally speaking). She packed the finger in a baggie, and packed that in ice, and went to the hospital.

Tip 1 - this is the correct way to preserve a severed digit, rather than placing it in direct contact with the ice

When they got to the hospital, the staff started to arrange to have him transferred to a larger hospital for the reattachment. As it turns out, though, the larger hospital declined to reattach. Apparently, if you cut off your own finger intentionally, they WON'T reattach it. (At least if you do so as a result of mental illness...not sure about "I lost a bet").

Tip2 - In cases of digit amputation, don't say you (or your children) did it intentionally.

Question for the ethicists...Can't they just attach the finger and put a cast on or something (like those cones they put on dogs after surgery). How is attachment a worse expenditure of funds than, say, This (http://www.cbn.com/CBNnews/134741.aspx)

[/ QUOTE ]

What do they do with failed suicides?

[/ QUOTE ]

/images/graemlins/grin.gif Good question. DNR isn't implied on that?

[guysmilie]

You said the person was unwell mentally. If that is the case I say the digit should be reattached and the person in question put in a facility where he can get some mental help as well as be protected from himself. Assuming he is not released until he is well, and denied access to sharp things like steak knives, this should strongly counter the argument that we shouldn't do it because he will just cut it off again.

I would say that anyone who would do this to themselves probably has a serious mental disorder. In such a case shouldn't we treat him like any other sick person and try and get him the help he needs?

I think the suicide argument is a valid one. Someone slits their wrists, but is found before they die and taken to hospital. Do they say "Just let them bleed out cuz they could do it again in the future"? No, they stich them up and strap them down so they can't do it again. In most all cases they would be held and restrained until it could be determined if they were still a threat to themselves.

I also find it hard to believe that any hospital would refuse to help someone based on the fact that the injury was self inflicted. They would be leaving themselves open to a monster lawsuit. However there is a strong possibility that your insurance company would not want to cover the costs.

Guy.

[vhawk01]

[ QUOTE ]
You said the person was unwell mentally. If that is the case I say the digit should be reattached and the person in question put in a facility where he can get some mental help as well as be protected from himself. Assuming he is not released until he is well, and denied access to sharp things like steak knives, this should strongly counter the argument that we shouldn't do it because he will just cut it off again.

I would say that anyone who would do this to themselves probably has a serious mental disorder. In such a case shouldn't we treat him like any other sick person and try and get him the help he needs?

I think the suicide argument is a valid one. Someone slits their wrists, but is found before they die and taken to hospital. Do they say "Just let them bleed out cuz they could do it again in the future"? No, they stich them up and strap them down so they can't do it again. In most all cases they would be held and restrained until it could be determined if they were still a threat to themselves.

I also find it hard to believe that any hospital would refuse to help someone based on the fact that the injury was self inflicted. They would be leaving themselves open to a monster lawsuit. However there is a strong possibility that your insurance company would not want to cover the costs.

Guy.

[/ QUOTE ]

I was working off the assumption that the hospital did, in fact, do this exact thing, i.e. deny him treatment because the injury was self-inflicted. Similarly, I assumed as you did that doing so would leave themselves open to a monster lawsuit, so I used my past experience and knowledge of hospital policy to deduce that they must have an iron-clad, well-researched defense of this policy, in order to ever inact it in the first place. Admittedly, this is probably a lot of lazy thinking on my part, but trusting in hospitals to find the best ways to legally save money (whether that be denying treatments or, WAY more importantly, avoiding lawsuits) seemed a safe bet.

[arahant]

[ QUOTE ]
[ QUOTE ]
You said the person was unwell mentally. If that is the case I say the digit should be reattached and the person in question put in a facility where he can get some mental help as well as be protected from himself. Assuming he is not released until he is well, and denied access to sharp things like steak knives, this should strongly counter the argument that we shouldn't do it because he will just cut it off again.

I would say that anyone who would do this to themselves probably has a serious mental disorder. In such a case shouldn't we treat him like any other sick person and try and get him the help he needs?

I think the suicide argument is a valid one. Someone slits their wrists, but is found before they die and taken to hospital. Do they say "Just let them bleed out cuz they could do it again in the future"? No, they stich them up and strap them down so they can't do it again. In most all cases they would be held and restrained until it could be determined if they were still a threat to themselves.

I also find it hard to believe that any hospital would refuse to help someone based on the fact that the injury was self inflicted. They would be leaving themselves open to a monster lawsuit. However there is a strong possibility that your insurance company would not want to cover the costs.

Guy.

[/ QUOTE ]

I was working off the assumption that the hospital did, in fact, do this exact thing, i.e. deny him treatment because the injury was self-inflicted. Similarly, I assumed as you did that doing so would leave themselves open to a monster lawsuit, so I used my past experience and knowledge of hospital policy to deduce that they must have an iron-clad, well-researched defense of this policy, in order to ever inact it in the first place. Admittedly, this is probably a lot of lazy thinking on my part, but trusting in hospitals to find the best ways to legally save money (whether that be denying treatments or, WAY more importantly, avoiding lawsuits) seemed a safe bet.

[/ QUOTE ]

Every time this gets bumped, I try and google the issue of failure rates for self-inflicted injuries and policies towards reattachment. Unfortunately, all the results are for penises, which are apparently much more popular targets of self-amputation.