Neurophilosophy

The ethics of memory erasure

In Time magazine, orthopaedic surgeon Scott Haig relates his practical experience of an ethical dilemma.

While performing a biopsy, Haig’s patient inadvertently finds out her prognosis of cancer. In the operating room is an anaesthesiologist who has a dose of propofol (“milk of amnesia”) at the ready.

If you were the anaesthesiologist, would you administer – without consent – the propofol, so that the patient’s memories of the last few minutes are erased? For Haig, there is no dilemma.

Comments

  1. #1 none given
    October 19, 2007

    Doesn’t matter. The two alternatives are approximately equivalently correct / incorrect.

  2. #2 Eric Johnson
    October 19, 2007

    I just read the article you link to, and I must say I’m a little confused by your last remark. What do you mean when you say ‘For Haig, there is no dilemma.’? It looked to me as though Dr. Haig is still very troubled by this, even though it happened at least six years ago. As I read it, he is still very much undecided about the ethics of administering the sedative for reasons other than unbearable physical trauma. He even says that something about it is ‘unmistakably [...] wrong’. I’m not a doctor, but my personal sense of ethics tells me that the anesthesiologist did the right thing. They didn’t conspire to hide anything from the patient, they merely bought some time to prepare her to receive the news in a less catastrophic way, by means of a pre-approved administration of a sedative. Did they violate the spirit of the agreement they had made, that she would retain consciousness throughout? Maybe. Was the breach of that agreement justified? I think so. But I don’t think that it’s fair to characterize Dr. Haig’s justification of what happened as a lack of dilemma.

    I hope you’ll forgive me if I’ve misinterpreted what you meant, but as it stands the last sentence of your post doesn’t seem fair to Dr. Haig, and seems to ignore the main points of his article.

  3. #3 speedwell
    October 19, 2007

    If I was in that patient’s place, I would want Dr. Haig to do what he did. It wasn’t just protecting the doctors, it was protecting the patient too.

    My mom died of cancer and my dad is dying from a brain tumor. Her case was handled badly by a nasty doctor and his case is being handled by a doctor of equal competence who is compassionate and concerned. I know that the two cases are very different, but I figure I know Mom and Dad pretty well and I can tell Dad is definitely having an easier time of it because his doctor cares about his feelings.

  4. #4 James
    October 19, 2007

    If postponing the delivery of knowledge by a day or two allows a more calculated delivery from the doctors then I must admit I don’t see the harm in it. I agree that there is something many people see in each other that seems to transcend the idea we’re simply biological machines, but, without sounding like PZ Myers too much, there is little evidence to support that. If anything, it seems more humane to give the patient a nicer delivery of such horrible news.

    Of course, it’s a gray area…

  5. #5 Derek James
    October 19, 2007

    Hell no, I wouldn’t. In this case the patient learned the diagnosis while on the table, and started to become erratic. I’m sure there’s something the anaesthesiologist could have administered that would have calmed her down so that she wouldn’t hurt herself, but he had no right to alter her memories without her consent.

  6. #6 gerald spezio
    October 19, 2007

    Why not discuss the so-called possible options before-hand with the patient who must call his/her own shots, period.

    Professionalism all too often a classist excuse for claiming; “We know what is best for you.”

  7. #7 travc
    October 19, 2007

    Screwing with people’s minds (without their knowledge) is a big taboo for me, and I think it should be for everyone. There are cases where it must be done, side effects of life saving treatment and such, but these should be exceptions to an otherwise iron-clad rule.

    One’s mind and memory is what makes a person who they are. It is unethical in the extreme to screw with it.

    BTW: I’ve always found the notion of brain damage deeply disturbing, more so by far than mere death. The existential questions are profound (even if one is a strict materialist).

  8. #8 carolyn13
    October 19, 2007

    This woman very specifically did not want to lose consciousness. She endured pain and distress to avoid that. She would not have consented to what was done to her, and it seems to me the doctors there did it because they wanted to avoid dealing with an unpleasant situation, not solely for the patient’s benefit. It was a violation of her personhood and the trust she placed in her doctors.

  9. #9 Caledonian
    October 21, 2007

    Between the taking of ten minutes of someone’s life and taking the entirety of their life there is only a quantitative, not a qualitative, difference.

  10. #10 mgarelick
    October 22, 2007

    I think administration of the propofol was justifiable; I’m more bothered by Haig’s last sentence:

    Those comforts — of ultimate meaning, virtue, peace and joy — have little to do with molecules.

    First, about the propofol, two points. One is that Haig did not ultimately withhold any information; the objective was not to keep the patient from knowing something (unlike Men in Black). The second is that the communication of a diagnosis or prognosis is part-and-parcel of the treatment of the patient; it can have an effect on outcome that may not be as significant as course of treatment but is still of great importance. I think the inadvertent revelation of her dire condition can be analogized to an physical error that accidentally causes horrible pain, and in either case the physician can be justified in taking whatever steps are necessary to ameliorate.

    OK, now to the molecules. I hope that what Haig, as a science-based professional, meant to say was that “ultimate meaning, virtue, peace and joy” cannot be understood solely in terms of molecules; but what he did say will inevitably be interpreted as asserting that human feelings are due to something other than molecules. This talk of “mere molecules” irks me, because I have exactly the opposite reaction: isn’t it amazing that molecules can do this stuff?

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