Ethical Issues in the Management of Thyroid Disease

[helvella]

One thing is obvious - this paper has the potential to cause a lot of disagreement, both with its contents and between people commenting. Please try to be civilised even if you flat out disagree!

The focus of this article is on clinical ethics issues in the thyroid disease context. Clinical ethics is a subspecialty of bioethics that deals with bedside ethical dilemmas that specifically involve the provider-patient relationship. Such issues include consent and capacity; weighing therapeutic benefits against risks and side-effects; innovative therapies; end of life care; unintended versus intentional harms to patients or patient populations; and healthcare access. This article will review core ethical principles for practice, as well as the moral and legal requirements of informed consent. It will then discuss the range of unique and universal ethical issues and considerations that present in the management of autoimmune thyroid disease and thyroid cancer.

endo.theclinics.com/article...

Follow the link and you can choose to download a PDF or read the full article in your browser.

Rod

[Hidden]

Hi Rod, I started to read the document, and got as far as

"The standard of care that best meets the beneficence standard for thyroid hormone replacement is monotherapy with levothyroxine (LT4) with a prescription for a generic or brand the patient can afford. However, because of a vast, confused alternative medicine literature that has framed LT4 as synthetic or not optimal, and desiccated porcine thyroid hormone as better and supposedly natural, many patients insist on this lesser standard of care. Moreover, combination therapy with T3, potentially a harmful therapy for many patients ..........."

and decided not to carry on.

It will be interesting to hear what others think about it.

[helvella in reply to Hidden]

You have immediately hit one of the disagreement issues!

Sometimes it is good to know the enemy you are facing...

[Hidden in reply to helvella]

Very true, but sometimes it can seem like "enough already". Hopefully others will have more staying power and can report back.

[Hidden in reply to helvella]

but before battle first one must know oneself (Sun Tzu)

grasshopper

[HarryE in reply to Hidden]

How can it possibly be a 'lesser standard of care' if it makes people feel better???? Good Grief!

[Hidden]

When I see ethics I wince, I get the distinct feeling it's an excuse not to treat .... grr...

I know Downs sufferers often have Thyroid problems - it's a form of discrimination in my book (if I had a book). grr...

[Clutter]

Cheers, Rod, Notebook almost met the wall reading this!

I think the author is the worst kind of paternalistic, T4 monotherapy fascist endonob. She got up my nose in her first sentence with the phrase provider-patient relationship (I'm a doctor and I know best?) and then positively infuriated me with "More challenging still are euthyroid patients claiming (my bold & u/score) to be hypothyroid despite no objective evidence, after ruling out TSH-inhibiting conditions, or other conditions that can create many of the same symptoms. In these cases, beneficent-based obligations require that practitioners engage in truth telling and trust building, and refrain from prescribing unnecessary medications, despite the patient’s insistence.40, 41, 42"

The 3rd party danger bit was interesting though. I wasn't advised that I might not be fit to drive when I had to go hypo on two occasions prior to RAI.

I'm so cross I'm having palpitations

[helvella in reply to Clutter]

I don't remember anyone saying here that they were ever advised not to drive on the basis of thyroid hormones - high or low. (Though obviously on the basis of anaesthetic, etc.) There have been several posts about driving and thyroid.

[Clutter in reply to helvella]

Sorry Rod, I wasn't clear. I meant that not one medical professional advised me about the dangers of driving. I wasn't accessing thyroid fora so wouldn't have seen advice . It isn't something I've forgotten either as I had a notebook to make sure nothing important was forgotten in the brain fog days.

[humanbean]

I don't think the author could have been more condescending and patronising if she had tried!

[PR4NOW]

Well, this is a beautiful example of the patriarchal stance so familiar with allopathic medicine. We've been to medical school therefore we are absolute and infallible. I'll quit there before I get myself in trouble. PR

[HarryE]

"Diagnostic problems become ethical problems when they lead to negligently

delayed diagnoses, improper follow-up, and prolonged patient suffering, which can

create situations in which patients are highly distrustful, and may be unfairly labeled

as “difficult”...."

You're telling me!!!

[dolphin5]

I started reading it carefully but quickly became bored. I just found it to be more of the same attitude so many of us have experienced before - no matter what the patient says, thinks or feels, doctors know best and can/must do whatever they think best. Despite the fact that there has been insufficient research to allow proper diagnosis and treatment of thyroid patients, she, like most other doctors seems to be happy to do whatever she thinks best, according to inadequate and therefore very poor "evidence". The evidence provided by patients who live with debilitating negative symptoms apparently doesn't count for anything. We must be unreal! We are figments of our own imagination. Kings new clothes??????