When Medical Cure = Mutilation

[Broomstick]

Inspired by this: http://www.suntimes.com/output/news/cst ... ile11.html

So I suppose it could have gone into News but I'm really more interested in the ethical/moral dimensions of this man's life.

Summation - man develops mouth cancer, undergoes aggressive treatment that, apparently, got all the cancer but left him disfigured, in pain, and disabled.

By coincidence, my late father-inlaw also had jaw cancer. In fact, he went three rounds with it before finally giving up the ghost. He, too, had to have teeth removed, and part of his jaw, and underwent surgeries and chemo and radiation... but apparently with much different impact.

Clearly, the doctors viewed his cure as a victory - and really, I have no reason to doubt that they acted from the highest motives, utilizing the latest knowledge and treatments, and honestly did their best for the man. He lived another ten years - obviously, the cancer treatments worked.

However -- the oncologists didn't have to live with the consequences of their treatments.

And I have a few questions, as well -

This man was from Poland. How well did he really understand his doctors explanation of treatments? Did they listen to HIS concerns? Did they even ask? Was this really informed consent, or did the man, with broken English and terrified at the word "cancer", nod go along with whatever was done without really understanding what was being done, and what the consequences would be.

Was ANY attempt made to connect this man with a reconstructive surgeon? Clearly this man started with some assets - better they had been spent reconstructing his face than buying surveillance cameras and guns.

When is the cure not worth it? Who deals with the consequences of a cure that isn't perfect, that leaves lingering pain and side effects and disability?

Nor is this limited to cancer - consider that 30 years ago brain damage from head trauma was much less an issue, because so few people survived severe head injuries. Now... they live, but they're damaged, they're changed, and we don't have good answers. I could probably dredge up other examples, but I think the point is plain.

Anyhow, this is probably rambling but I thought it was interesting food for thought. So... any thoughts?

[Junghalli]

Clearly, the doctors viewed his cure as a victory - and really, I have no reason to doubt that they acted from the highest motives, utilizing the latest knowledge and treatments, and honestly did their best for the man. He lived another ten years - obviously, the cancer treatments worked.
However -- the oncologists didn't have to live with the consequences of their treatments.

But the man is still alive, is he not? I'd much rather be alive with a fucked up face than dead with an intact one.

This man was from Poland. How well did he really understand his doctors explanation of treatments? Did they listen to HIS concerns? Did they even ask? Was this really informed consent, or did the man, with broken English and terrified at the word "cancer", nod go along with whatever was done without really understanding what was being done, and what the consequences would be.

I can't answer that because obviously I wasn't there. All I can say is that if I were in his shoes I wouldn't regret going through the treatment. Like I said, the way I understand it he had a choice between a reduced quality of life and almost certain death. To my mind the first one is clearly the lesser of two evils.

Was ANY attempt made to connect this man with a reconstructive surgeon? Clearly this man started with some assets - better they had been spent reconstructing his face than buying surveillance cameras and guns.

Yeah, I'd definitely have looked into that if I were him. Maybe the damage was too severe to reconstruct? I really don't know, but to my mind your point here makes sense.

When is the cure not worth it? Who deals with the consequences of a cure that isn't perfect, that leaves lingering pain and side effects and disability?

Obviously I can't answer for this man, but I can say that for myself personally it'd have to be pretty fucking horrible for me to consider the cure not worth it. Sure, going through life with a messed up face isn't fun, but if the alternative is dying I'd be willing to put up with it.

Nor is this limited to cancer - consider that 30 years ago brain damage from head trauma was much less an issue, because so few people survived severe head injuries. Now... they live, but they're damaged, they're changed, and we don't have good answers. I could probably dredge up other examples, but I think the point is plain.

Again, I can only speak for myself here. It would have to get pretty horrible for me to think I'd be better off dead. Maybe if I thought there was an afterlife I'd feel differently, but as far as I know death means the end of my existence as a conscious sapient entity. Like I said, I'll take a reduced existence over nonexistence.

[Broomstick]

I understand your point of choosing mutilation over death, but it's one thing to discuss that and another to actually have to face that state for the rest of one's existance.

This man had no teeth. A substantial amount of his jaw had been removed. He was physically unable to eat in anything like a normal manner. From what I can tell, he basically had to run everything through a blender. He was able to open his mouth only about 1/4 to 1/2 inch. He was in constant pain, even with the use of narcotics. Between his heavy accent and the damage to his mouth and throat he was unable to talk intelligebly most of the time.

As a result of these things, he was unable to obtain employment for over ten years. He had lost pretty much everything he'd ever worked for, ever owned.

But the man is still alive, is he not? I'd much rather be alive with a fucked up face than dead with an intact one.

As a matter of fact, no, he's not alive. When stopped for a traffic violation in Milwaukee he put a gun to his own head and pulled the trigger. Prior to doing that, he had gunned down a judge's husband and mother in cold blood. The note he left behind clearly indicated that the judge had been his intended target. He also, apparently, had a "hit list" of his former doctors, several judges and attorneys, and various other people who had either been involved in his medical treatment or in the legal cases that had gone nowhere.

I would say that the man disagreed with you, if he had been intending to hunt down and murder the doctors who had saved his life.

Which lends an interesting slant to the whole thing - the doctors who save lives do not expect those actions to come back in the form of death, do they?

Another thing to consider, of course, is the possibility that the cancer had come back - and returning in his brain is certainly not out of the question. If he had suffered a relapse and it metasticized to his brain that, also, could have factored into his increasing delusions. Even so - his legal actions started very soon after the "cure".

So, while YOU might choose mutilation... clearly not everyone thinks it's a good choice. Ask yourself - is there some limit to what you would consent to, in order to live?

[Junghalli]

I understand your point of choosing mutilation over death, but it's one thing to discuss that and another to actually have to face that state for the rest of one's existance.

To me having to actually face the inevitability of my imminent nonexistence would be five times worse.

This man had no teeth. A substantial amount of his jaw had been removed.<snip> He was in constant pain, even with the use of narcotics. Between his heavy accent and the damage to his mouth and throat he was unable to talk intelligebly most of the time.

While I wouldn't find such a state of existence very pleasant I would find it infinitely preferable to being a corpse.

As a result of these things, he was unable to obtain employment for over ten years. He had lost pretty much everything he'd ever worked for, ever owned.

Obviously I can't speak for everybody, but I'd much rather face this than die.

When stopped for a traffic violation in Milwaukee he put a gun to his own head and pulled the trigger. Prior to doing that, he had gunned down a judge's husband and mother in cold blood. The note he left behind clearly indicated that the judge had been his intended target. He also, apparently, had a "hit list" of his former doctors, several judges and attorneys, and various other people who had either been involved in his medical treatment or in the legal cases that had gone nowhere.
I would say that the man disagreed with you, if he had been intending to hunt down and murder the doctors who had saved his life.

Evidentally he did. As I said many times already, I can only speak for myself, not everybody else. If you want my opinion on this case, if he really hated his life that much he should have just killed himself and not gone after people who were only trying to serve what they sincerely percieved to be his best interest.

So, while YOU might choose mutilation... clearly not everyone thinks it's a good choice. Ask yourself - is there some limit to what you would consent to, in order to live?

Not much. I once read over what being in the burn zone of a nuclear detonation could do to you, and I remember thinking that if it came down to that I'd rather just have an instant death in the middle of the fireball (for the record, you get third degree burns over your whole body, your clothes get burned onto your flesh, you get impaled by lots of flying glass, and the force of the blast can knock your eyeballs out of their sockets). But if you get that badly maimed you usually don't live more than a few hours or days anyway. I can't really think of a permanent state that I could realistically live in indefinitely that I would consider worse than being dead.

[Broomstick]

Ok, in the interests of having a conversation, let's rephrase a few questions.

1) If a doctor knows that a patient would (as in the case of Mr. Bart Ross referenced in the OP) have a tremendously difficult time with mutilation/disability and has no social support system, should that be a consideration in treatment? Or should the doc just concentrate on his area of expertise, curing the disease?

2) Would it be moral to steer a patient away from mutilating surgery in such a case, even if that greatly increases the risk of death?

3) What obligation does a doctor have to help such a person get rehabilitation and reconstructive services? Or is that the patient's problem?

[Illuminatus Primus]

No doctor in the country is going to not try and cure the disease and push it to the full extent.

If he fucking dies on you and his brother or something is pissed, congratulations, you have a lawsuit. Its called defensive medicine.

I think the most likely explanation is he accepted the surgery because he did not want to die, and after the fact found he could not live with the choice he made. And in this country you cannot be euthenized, so that's what happens.

There should be more medical and official routes toward ending your life with dignity and free of pain or disability, if that is your choice. Unfortunately in the current political climate and legal system, its definitely dangerous to encourage that, and its only getting worse with this Schiavo horseshit.

[Aaron]

3) What obligation does a doctor have to help such a person get rehabilitation and reconstructive services? Or is that the patient's problem?

The doc is obligated completley by his oath to ensure that the patient gets all the care he needs. If that includes reconstructive surgeries and extensive rehab than so be it. Typically this involves a referal to a different specialist, it is however the patients responsibility to ensure that he gets to these appointments.

For example if you have a breast removed, it is customary for a implant to be put in. There's no real medical reason for it, but it makes the patient feel better that she still has two breasts. This can do wonders for their mental health and can speed recovery, as a good deal of recovery is mental.

[Junghalli]

1) If a doctor knows that a patient would (as in the case of Mr. Bart Ross referenced in the OP) have a tremendously difficult time with mutilation/disability and has no social support system, should that be a consideration in treatment? Or should the doc just concentrate on his area of expertise, curing the disease?

Obviously he should try to cure the disease. But he should also consult with the patient, make sure he understands what's going on, and let him make his own decisions.

2) Would it be moral to steer a patient away from mutilating surgery in such a case, even if that greatly increases the risk of death?

No. The doctor should steer the patient toward whatever will save his life. If the patient insists that the cure isn't worth then that's his call, but the physician should most definitely not try to talk someone out of getting treatment that they need to live.

3) What obligation does a doctor have to help such a person get rehabilitation and reconstructive services? Or is that the patient's problem?

I think Cpl. Kendall already answered this.

[Broomstick]

No doctor in the country is going to not try and cure the disease and push it to the full extent.

If he fucking dies on you and his brother or something is pissed, congratulations, you have a lawsuit. Its called defensive medicine.

First off, this guy didn't have any family to pursue a lawsuit.

Secondly, you are allowed to refuse medical treatment in this country, even if that refusal will mean your death. This comes up with Jehovah's Witnesses and blood transfusion frequently. In that situation, a doctor can be sued for providing treatment that's not wanted (and they have been, and they have lost)

My father-in-law begged for more treatment until the docs satisfied him that there was no more to be done. I currently have an acquaintance/friend who has terminal cancer. It may be because he absolutely refused surgery and insisted solely on chemo and radiation because, upon finding out the consequences of surgery, he decided he wouldn't be able to handle it.

So the idea that docs will force treatment down your throat against your expressed, stated wishes is false. They may ask you to sign a legal document to cover their asses, but the right to refuse ANY and all medical treatment is, in fact, the legal right of all mentally competant adults in this country.

I think the most likely explanation is he accepted the surgery because he did not want to die, and after the fact found he could not live with the choice he made. And in this country you cannot be euthenized, so that's what happens.

Yes, but he could have just shot himself in the head, first - he didn't have to take anyone else with him. THAT crime is solely his responsibility, assuming he was mentally competant at the time he commited the murders.

its only getting worse with this Schiavo horseshit.

Part of the problem with that case is that Terri Schiavo never formally declared her wishes ahead of time. If the docs had a written document signed by her stating what treatment she did or did not consider acceptable the whole fiasco would never have happened. If she had said "no, do not keep alive in this state" her parents would have had no say. If she had said "keep me alive at all costs" the doctors would be obligated to do so and her husband would have no say. Moral of the story: write your preferences down NOW, today, so no one has to guess or battle it out in court.

[Broomstick]

3) What obligation does a doctor have to help such a person get rehabilitation and reconstructive services? Or is that the patient's problem?

The doc is obligated completley by his oath to ensure that the patient gets all the care he needs.

Except that fewer and fewer doctors these days take the hippocratic oath - it is in no way legally required. It also restricts certain common practices that are considered entirely routine these days, such as surgical removal of kidney stones, so it's not like anyone is adhering to it anyway.

For example if you have a breast removed, it is customary for a implant to be put in. There's no real medical reason for it, but it makes the patient feel better that she still has two breasts. This can do wonders for their mental health and can speed recovery, as a good deal of recovery is mental.

Not a good example. While the lack of a breast or two is disfiguring, it does not impair ones ability to eat, which gets into all sorts of issues like maintaining proper nutrition and social awkwardness. Yes, a woman lacking breasts is in an awkward position as well, but even before we had adequate reconstructive surgery there were ways of maintaining a normal appearance while clothed. Nothing of the sort is possible with this sort of jaw defect - not only is the face, which is constantly exposed, greatly affected but eating in public would probably not be possible. Eating at all could be very difficult.

Also, a significant number of women, even today, refuse reconstructive breast surgery. It's an option, not a mandate. The reasons for this are various - in some cases a woman is so prone to scar tissue and keloids that ANY surgery must be approached with extreme caution and cosmetic surgeries almost out of the question. In others, a woman is just tired of surgery and wants no more of it. Loss of breasts simply doesn't affect some women to the same extent as it does others, so one woman might be horrifically devastated and another thinks, well, I've lost my hair and a breast and I've puked my guts up and been scared shitless... but hey, the cancer's in remission and yeah, I've gotten scars but they're the signs of being a survivor. Or something. I'm not sure I entirely understand the mindset of women who, instead of breast reconstruction, opt instead for, say, a frilly tattoo over the scar but those women do exist and they're out there living lives as fully able-bodied human beings.

I've never heard of anyone refusing to get their jaw reconstructed if it was at all possible to do so. It's just too basic a loss-of-function item. You can live without breasts. You can't live without eating.

This, of course, is why health insurance companies used to refuse to pay for breast reconstruction. It really is NOT medically necessary. Mentally necessary, perhaps, but not medically.

For a male parallel... castration can be a part of treatment for prostate cancer. They don't usually call it "castration", more typically "orchiectomy" or something like that, but that's what it comes down to. You don't need your testicles to live. Hell you don't need any genitals to continue living, the body can function just fine without them. Plastic surgery to mimic their appearance and testorone shots to maintain hormone levels are NOT medically necessary - however mentally important they might be.

So... should we really be paying for such reconstructive surgeries out of the public coffer, or compel a private business to do so? Or is the mental dimension in these cases so important that yes, these procedures should be covered?

[Aaron]

Except that fewer and fewer doctors these days take the hippocratic oath - it is in no way legally required. It also restricts certain common practices that are considered entirely routine these days, such as surgical removal of kidney stones, so it's not like anyone is adhering to it anyway.

Thats the first I've heard of that.

Not a good example. While the lack of a breast or two is disfiguring, it does not impair ones ability to eat, which gets into all sorts of issues like maintaining proper nutrition and social awkwardness. Yes, a woman lacking breasts is in an awkward position as well, but even before we had adequate reconstructive surgery there were ways of maintaining a normal appearance while clothed. Nothing of the sort is possible with this sort of jaw defect - not only is the face, which is constantly exposed, greatly affected but eating in public would probably not be possible. Eating at all could be very difficult.

Also, a significant number of women, even today, refuse reconstructive breast surgery. It's an option, not a mandate. The reasons for this are various - in some cases a woman is so prone to scar tissue and keloids that ANY surgery must be approached with extreme caution and cosmetic surgeries almost out of the question. In others, a woman is just tired of surgery and wants no more of it. Loss of breasts simply doesn't affect some women to the same extent as it does others, so one woman might be horrifically devastated and another thinks, well, I've lost my hair and a breast and I've puked my guts up and been scared shitless... but hey, the cancer's in remission and yeah, I've gotten scars but they're the signs of being a survivor. Or something. I'm not sure I entirely understand the mindset of women who, instead of breast reconstruction, opt instead for, say, a frilly tattoo over the scar but those women do exist and they're out there living lives as fully able-bodied human beings.

I've never heard of anyone refusing to get their jaw reconstructed if it was at all possible to do so. It's just too basic a loss-of-function item. You can live without breasts. You can't live without eating.

This, of course, is why health insurance companies used to refuse to pay for breast reconstruction. It really is NOT medically necessary. Mentally necessary, perhaps, but not medically.

For a male parallel... castration can be a part of treatment for prostate cancer. They don't usually call it "castration", more typically "orchiectomy" or something like that, but that's what it comes down to. You don't need your testicles to live. Hell you don't need any genitals to continue living, the body can function just fine without them. Plastic surgery to mimic their appearance and testorone shots to maintain hormone levels are NOT medically necessary - however mentally important they might be.

So... should we really be paying for such reconstructive surgeries out of the public coffer, or compel a private business to do so? Or is the mental dimension in these cases so important that yes, these procedures should be covered?

Ok it was a bad example. I feel that if the reconstructive surgery is needed to continue to function realitivly normally than it should be covered by medi-care/insurance depending on what country you live in. However perhaps things that are purely cosmetic should be up to the patient to pay.

[Pick]

I would rather be dead, honestly. Yes, this as someone who believes in oblivion after death. I wouldn't want to live that way. Have you seen how miserable people can be with mere scars on their faces, or even lack of part of a finger digit? In our society, bodily multilations are very difficult to live with. Something as major as that kind of jaw issue would make life a living Hell socially before we even get into the pain and difficulty of actually having it.

It's better to live a life of relative acceptance for a shorter while than a longer one of misery. In my opinion, anyway. You're free to be one of those people young children gawk and cry looking at, if you want to.

[Aaron]

I would rather be dead, honestly. Yes, this as someone who believes in oblivion after death. I wouldn't want to live that way. Have you seen how miserable people can be with mere scars on their faces, or even lack of part of a finger digit? In our society, bodily multilations are very difficult to live with. Something as major as that kind of jaw issue would make life a living Hell socially before we even get into the pain and difficulty of actually having it.

It's better to live a life of relative acceptance for a shorter while than a longer one of misery. In my opinion, anyway. You're free to be one of those people young children gawk and cry looking at, if you want to.

Speaking as someone who has quite a few visible mutilations, I'd rather be alive. I get alot of ignorant comments on my appearance and alot of staring. But I'd much rather be around to watch my kids grow up, I'll happily live with the physical pain and the BS that society shoves at you for being "different".

It all boils down to the kind of person you are. Some will accept it and get on with life, others will choose to take their own life. A very few will decide to kill those they blame for their condition.

It's easy to say that you'll do x. But when cold reality looks you in the face, you'll be surprised at the choices you make.

[Broomstick]

Except that fewer and fewer doctors these days take the hippocratic oath - it is in no way legally required. It also restricts certain common practices that are considered entirely routine these days, such as surgical removal of kidney stones, so it's not like anyone is adhering to it anyway.

Thats the first I've heard of that.

Just for kicks, here's the Hippocratic oath in colored text, with my commentary in white:

I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath

Swearing oaths by Greek Gods sort of went out of fashion around 300 AD.

and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation;

It's been a long time since medical students or their professors looked on this teaching relationship as a sort of adoption. No one expects doctors to support their old professors in dotage.

And no one teaches doctoring for free any more, to anyone.

and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

Med schools no longer require you to be a male relative of a doctor or a "disciple"

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

This is the most often quoted part of the oath, the idea of first of all, do no harm. This part I'd like to keep.

I will give no deadly medicine to any one if asked, nor suggest any such counsel;

That eliminates assisted suicide, euthanasia, and participation in any form of execution. Strictly interpreted, it might also eliminate things like cancer chemotherapy, which IS an out-and-out poison; warfarin, which is a diluted form of a chemical used as a rat and other pest poison; and botox, which is a very dilute form of an extremely powerful toxin.

and in like manner I will not give to a woman a pessary to produce abortion.

Well, we don't use pessaries for that purpose any more, but some folks (like the religious right) interpret this to mean no abortion (of course, they're like that... they'll quote pagans to support their position if they can)

With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work.

The second sentence here is the "no kidney stone surgery" line. There's been some amusing arguing between the surgeons (who maintain they are the "practitioners of this work" even if they have sworn the oath) and the rest of the MD's for a couple centuries, at least.

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.

OK, this part is another keeper...

Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

This is where we get the concept of medical confidentiality.

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

It's actually got a lot of great, relevant concepts in it, but parts are rather old fashioned and ignored to one degree or another these days. In the US many doctors take this oath as part of their medical school graduation ceremonies, but many don't - and there is no requirement that they do so. Which is not to say docs don't pay attention to its principles or ignore them - there IS a lot of good stuff there. But it's not as binding as many people think it is.

[Broomstick]

It's easy to say that you'll do x. But when cold reality looks you in the face, you'll be surprised at the choices you make.

And sometimes you make the wrong choice.

People are usually more adaptable than they give themselves credit for, which is why docs are reluctant to take the first refusal as final. However, our society does not seem to have a good solution of the problem of someone who survives a devastating illness or accident and afterwards can't come to terms with their changed body.

[Sriad]

With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work.

The second sentence here is the "no kidney stone surgery" line. There's been some amusing arguing between the surgeons (who maintain they are the "practitioners of this work" even if they have sworn the oath) and the rest of the MD's for a couple centuries, at least.

That was interesting; I don't think I've ever read that Oath wholly before. I'd just note that, although you seem to know more about it than I, "cutting for the stone" refers to bladder stones, not kidney.

[Aaron]

And sometimes you make the wrong choice.

People are usually more adaptable than they give themselves credit for, which is why docs are reluctant to take the first refusal as final. However, our society does not seem to have a good solution of the problem of someone who survives a devastating illness or accident and afterwards can't come to terms with their changed body.

I've been thinking that part of that may stem from societies "quick fix" fixation. People don't understand that it will take years to come to terms with the results of a disfiguring condiotion, and as a result they may not be willing to put the effort into it.

It took me the better part of 5 years to come to terms with my disfigurements, and I still haven't come to terms with the fact that I live in chronic pain. But my acceptance of my disfigurements didn't happen in a vacumn, I had to actively work to progress to this level. Often times that involved seeing a counsellor.

Now some people might not have access to that kind of resource, their medical coverage may not include counselling to deal with disfigurements. Or they may beleive that it's a sign of weakness to seek out such help, a great number of people hold the mental health professions in contempt. There is definetly a lot of work needed in this area.

[Broomstick]

That was interesting; I don't think I've ever read that Oath wholly
before. I'd just note that, although you seem to know more about it than I, "cutting for the stone" refers to bladder stones, not kidney.

Quite right, my mistake - it does, indeed refer to bladder stones.

Although kidney stones can certainly wind up in the bladder on occassion.

[Broomstick]

And, of course, I mess up the coding in a forum where I can't go back and edit....

[Aaron]

Quite right, my mistake - it does, indeed refer to bladder stones.

Although kidney stones can certainly wind up in the bladder on occassion.

Can't those be broken up via ultrasound? I thought surgery was no longer needed except in extreme cases.

[Broomstick]

Quite right, my mistake - it does, indeed refer to bladder stones.

Although kidney stones can certainly wind up in the bladder on occassion.

Can't those be broken up via ultrasound? I thought surgery was no longer needed except in extreme cases.

Now that is the case, yes - but only within the last 15 years or so. I do remember a time when stones meant surgery and there were no alternatives. Well, you could continue in pain and have problems with emptying your bladder off and on, but few found that an acceptable alternative.

[Pick]

I would rather be dead, honestly. Yes, this as someone who believes in oblivion after death. I wouldn't want to live that way. Have you seen how miserable people can be with mere scars on their faces, or even lack of part of a finger digit? In our society, bodily multilations are very difficult to live with. Something as major as that kind of jaw issue would make life a living Hell socially before we even get into the pain and difficulty of actually having it.

It's better to live a life of relative acceptance for a shorter while than a longer one of misery. In my opinion, anyway. You're free to be one of those people young children gawk and cry looking at, if you want to.

Speaking as someone who has quite a few visible mutilations, I'd rather be alive. I get alot of ignorant comments on my appearance and alot of staring. But I'd much rather be around to watch my kids grow up, I'll happily live with the physical pain and the BS that society shoves at you for being "different".

It all boils down to the kind of person you are. Some will accept it and get on with life, others will choose to take their own life. A very few will decide to kill those they blame for their condition.

It's easy to say that you'll do x. But when cold reality looks you in the face, you'll be surprised at the choices you make.

There's a lot of factors that depend on different people. Not to give "oh no, poor me" factor to my statements, but I think it would be more difficult for a female to have those disfigurements than a guy. Now more to the particular point, I honestly admire that you can so well deal with what happened to you, but I think that you are unusual in that strength. Either way, as I said, to each their own. I do not think I would be able to handle it, any way, shape or form.

[Aaron]

There's a lot of factors that depend on different people. Not to give "oh no, poor me" factor to my statements, but I think it would be more difficult for a female to have those disfigurements than a guy. Now more to the particular point, I honestly admire that you can so well deal with what happened to you, but I think that you are unusual in that strength. Either way, as I said, to each their own. I do not think I would be able to handle it, any way, shape or form.

No I completely agree that females would most likely have more trouble with physical disfigurements. Western society places a great emphasis on a females appearance.

[Broomstick]

Yes, pretty much every recognizes that appearance is much more of an issue for women, especially face and breasts. (Conversely, preserving sexual function is more important for men as a general rule). However, men are quickly catching up in the "appearance is all" game, as seen by rising rates of men undergoing cosmetic procedures.

Not that I think cosmetic medicine is bad - fixing or replacing teeth, certain forms of dermabrasion or cosmetic peels, rhinoplasty to straighten a once-broken nose... while these don't adddress life-threatening conditions they do vastly improve the quality of life and correct or mitigate the damage that accumulates over time.

Then we get horrific abuses such as the "Rent a Patient" scheme:
http://www.surgicenteronline.com/hotnew ... 61020.html
http://www.latimes.com/news/local/la-me ... -headlines

From one of the above:

Some of the surgeries, which are inherently dangerous, left patients with health complications.

A 24-year-old Phoenix man underwent an endoscopy, colonoscopy, sweaty palms surgery, nasoplasty and a circumcision at one clinic — all unnecessary, said Blue Cross/Blue Shield investigator Tom Brennan. The man lost sensitivity in his hands as result of the palm surgery, a procedure that involves collapsing a patient's lung to clamp a nerve near the spine that controls perspiration.

The drive to look perfect can get people into trouble. They overestimate what can be done and underestimate the risks involved. A facelift gone bad is very rare, but it can leave you with the same scars as third degree burns, or in chronic pain, or leave your face paralyzed. Liposuction not only is extremely painful, but has the highest risk of death of any of the common cosmetic procedures. ANY surgery can potentially kill you. And so on, and so forth. Add the incentive being paid to undergo procedures you can have a real tragedy in the works.

So, there are several forces at work here. There are doctors who underplay the gravity of what a patient will face down the line, or who blithely assume everyone has equal ability to adapt. There are patients who hear only what they want to hear - which isn't always what they should hear. Medicine doesn't always work, and doesn't always work as intended even if everything is done right.