There are cases of body integrity identity disorder (https://en.wikipedia.org/wiki/Body_integrity_identity_disord...) being treated by amputation. It's a rare condition, but the discussion about the ethics of voluntary amputation as treatment is quite extensive:

https://www.ncbi.nlm.nih.gov/pubmed/15948330 https://www.ncbi.nlm.nih.gov/pubmed/19132621 https://www.ncbi.nlm.nih.gov/pubmed/17115518

It's interesting to think about decisions that involve an action vs decisions that involve stopping an action.

  Doctor: undergo my recommended treatment or you will die
  Patient: no

  Patient: Doctor, please chop off one of my hands for no good reason
  Doctor: no

In the former we respect the rights of the patient, in the latter we do not. Kind of weird isn't it?

"First, do no harm." https://en.wikipedia.org/wiki/Primum_non_nocere

in the first example the doctor is compelling the patient to do something and the patient exercises her right to refuse. In the second example the patient is compelling to the doctor to do something and the doctor exercises her right to refuse. You never have a 'right' to compel another person to do anything. You may have legal, ethical or moral reasons to compel someone to do something, but you never have a right to.

I think this is mostly right but it is worth noting that in some cases doctors are obligated to act. If I run into the ER with a serious issue and a doctor says "sorry, I can't treat you right now, it's my coffee break" that can be malpractice.

Understood - but that is a legal or ethical obligation, not one of your rights.

>You never have a 'right' to compel another person to do anything.

There are plenty of instances where you have the right to compel another person to do things.

I'm not disagreeing with you, but your case would be stronger if you could provide some examples.

You walk into my house. I have the right to compel you to leave. You try to stab me. I have the right to compel you to stop with reasonable force. You arbitrarily try to deny my passport application because you don't like my face. I get a Writ of Mandamus issued against you and compel you to do your job. We enter into an agreement which you breach. I obtain an order mandating specific performance and compel you to personally do what we agreed upon. You're wanted for arrest and I'm a peace officer. I compel you to come down to the station.

I can go on all day.

The poster above you does not understand what a 'right' is and is trying to make a point about positive vs negative rights, but doesn't actually understand the distinction.

You just listed a bunch of examples where people are legally compelled to do something, which I mentioned.

> The poster above you does not understand what a 'right' is and is trying to make a point about positive vs negative rights, but doesn't actually understand the distinction.

Ok. Nice talking with you. Have a good day.

I know you mentioned it - you just weren't correct. Hope the clarification was helpful. Here's some additional reading if you're interested: https://en.wikipedia.org/wiki/Negative_and_positive_rights

I think it's fitting. In the US, we tend to side with supporting the rights of either party to choose not to preform an action. Patient has the right to not undergo treatment. Doctor has the right to not preform treatment.

It stems from respecting a persons right to liberty, and when trying to respect some other rights of one party involves the forced action of another party, it often may incroach on right to liberty of the latter party.

The idea of when it's acceptable to encroach on someones liberty using some type of forced complience is a complicated dance, as it should be. Personally, I usually lean on the side of respecting liberty above others. This necessarily involves respecting everyone's right to excercise their liberty in order to be an asshole, idiot, bigot, etc.

I think this is contained within "do no harm". There is an inherent risk in all treatment, even if it's 0.01% or 99%. We can't force that risk on the patient, even if the odds and upsides are objectively great.

In the latter there's no clear upside other than "for fun", and definite harm.

The line is drawn between "do no harm" and "force good".

It's not that weird. We also generally draw a legal/moral distinction between killing someone and allowing them to die.

I think you've hit on the nub of the problem: what "causes no harm" to the client in the lawyer-client relationship, and are lawyers supposed to act like doctors?

It's in the interests of the judicial system that each client is entitled to a vigorous defense on a level playing field. That's the only thing that keeps the system working (as broken as it is). It's in the interests of the clients to do various things. Those things do not necessarily involve a vigorous defense or the best possible outcome for them.

If I signed a paper absolving my lawyer from damages, then asked him to punch me in the nose, should he? I don't see why not. If I did the same thing with my doctor, should he? Absolutely not.

This is the study of ethics, that is, the types of behaviors that professionals expect of one another as part of their profession. Ethically, I think the lawyer felt he should enter and defend the guilty plea. Whether or not that is the correct ethical decision -- and whether or not that decision is in the best interests of the judicial system -- is the interesting part.

Remember, this lawyer's action was part of a vigorous defense: He was trying to save the client from the death penalty.

> Directly contradicting his client's instructions, he suggested that McCoy suffered from diminished mental capacity and should therefore only be convicted of second-degree murder. But as the prosecutor would soon explain to the jury, that defense was legally unavailable to McCoy because Louisiana only allows a diminished capacity argument if the defendant has pleaded not guilty by reason of insanity. It was one of many mistakes English appears to have made during the trial.

Seems like this might be a boutique definition of "vigorous defense."

Hey, deliberately setting your client up for a claim of ineffective assistance of counsel could be considered a vigorous, even self-sacrificing, defense approach, though it's quite unorthodox (as well as both unethical and unlawful.)

There's a gap here that the lawyer (and the expert quoted) is talking about. At some point, you are menally impaired enough that the state should treat you differently. You are incapable of knowing right from wrong. But just before that point, there are a ton of folks who are severely impaired who might either wish self-harm or take actions that consistently harm themselves. How should we treat those folks?

He was judged competent to stand trial, though. If he wasn't, it seems like the problem is with the way that determination is reached, not in his not taking his lawyer's advice.

Is there a difference between "standing trial" and managing your defense? If so, people could fall into the cracks. I think that's what the article is getting at. If not, then either you're able to stand trial or you aren't. If so, you should be able to make whatever decisions you'd like.

(I'm a big lover of freedom, so I'm in the second camp. If you're able to stand trial you're able to plea anything you'd like. But I guess there's some question here because of the public's desire not to let anybody be put to death by the courts that might have avoided it with a better defense?)

If they decide this lawyer did the right thing then it seems to me like we've created three tiers where there used to be two: competent and incompetent. Now there's competent to stand trial, competent to stand trial yet incompetent to defend themselves, and completely incompetent to stand trial. Things would get a lot more complicated.

I don't think any such distinction is recognized legally.

What if my doctor wants to cut my hand off by I refuse it?

So the original premise was

scenario 1:

> Doctor: undergo my recommended treatment or you will die > Patient: no

scenario2:

> Patient: Doctor, please chop off one of my hands for no good reason > Doctor: no

lets add a scenario 3:

> Doctor: I need to chop off your hand within the next hour or you will die > Patient: no

What do you think the doctor should do?

The doctor should not cut off the hand, in your scenario.

A more realistic scenario is probably DNR orders, which doctors do honor.

Doctors often do not honor DNR orders because there is no penalty for disobeying them while they can face severe penalties for failing to save someone's life if their DNR order is invalid for some reason.

According to an article I found [0], a doctor may at least theoretically be subject to legal penalties for disregarding a DNR.

> Wrongful life. Theoretically, if a patient is resuscitated in the OR against the patient's wishes, a “wrongful, life” lawsuit could be filed. Under this suit, a patient could request compensation for ensuing expenses for continued life, negligence, and battery. An Ohio appellate court reviewed a case in which a patient was resuscitated after a DNR order was documented on his chart.12 Although the court in this particular case rejected the wrongful life theory, it did uphold the possibility that battery and negligence had occurred. This case has made it certain that the advance directive is an important component of a patient's chart.

[0] Evelyn Eckberg RN: The Continuing Ethical Dilemma of the Do-Not-Resuscitate Order http://onlinelibrary.wiley.com/doi/10.1016/S0001-2092(06)626...

Yeah in theory their could be penalties, but in practice no court wants to discourage doctors from saving people's lives.

scenario 4:

> Doctor: I need to chop off your hand for no good reason > Patient: no

But what about trans-abled people and their rights?

Key phrase:

  > for no good reason

For some individuals, there is substantial therapeutic benefit to reassignment surgery.

> If you choose to have your hand cut off because you think it would be awesome,

Does that cut mustard? Why not?

That's begging the question. The point is, "Who decides what a good reason for this is?"

After all, it seems self-evident that nobody would seriously ask for these things if they themselves didn't believe they had a good reason, yes?

I think the doctor should always have the right to refuse an elective surgery. It's up to the patient to find a willing doctor.

The argument proffered through is that it is necessary for their mental health. Which then begs the question, what about people who compulsively get plastic surgery? Which is exactly why the DSM carefully says that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition". Body dysmorphic disorder on the other hand is itself pathological, so continued surgeries do not rank as humane treatment.

Surgery is not the only possible answer to psychological distress, if it is one at all. Some people have body dysphoria and surgeons aren't required to weigh their distress about having an arm above everything else.