Zulu

Suppose [and this may well be true] that the onset of a disease like epilepsy is associated with
an intense but very realistic 'relationship' with god. There are other fairly severe side effects
typical of epilepsy but this side effect stands out. The patient says he's never felt better in
his whole life. He finally sees the light. He 'understands' everything in the universe now. Let's
assume he's feeling great about life. Now, if there was an obvious treatment that is normally
given to epipileptics should the treatment be given to his individual in light of the seemingly
beneficial repercussions of the disease?

Would you answer the same way if a certain disease was associated with greater happiness but
greatly reduced mental capabilities. [Ie; would you prescribe an antidote?]

To further complicate things imagine that after having treatment such a person claims that they're
grateful to be themselves again. However, prior to the treatment they say they feel great. So what
is the right choice to make? The person almost has two split personalities. What is the 'self' in
this instance and how should one act with such a patient?

-Zulu

Misso

I'd say don't treat the patient unless he or she wants it. If one says one feels great, why change anything about it?
This also goes for your last example. In the experience of the patient, the current happiness is as good as it gets, in the mind of the patient in can't get any better. It doesn't matter if that is imagined or not, teh result is still hapiness in the current situation.

yguy

A very questionable supposition, considering that according to the Judaeo-Christian paradigm, there are two Gods: the real One and the pretender. It is not clear which we are dealing here.

Zulu

But if it happened to you, wouldn't you want to regain your 'self' again? Suppose we gave you the treatment...wouldn't you be grateful?

yguy,

Oh, I'm not implying that this person is really taking to god...only that they think they truly are. I didn't mean to imply that god exists...only that epilepsy may cause people to feel a connection with what they believe is god. Hope this clarifies.

-Zulu

yguy

"Suppose [and this may well be true] that the onset of a disease like epilepsy is associated with
an intense but very realistic 'relationship' with god."

You appear to think that their belief in the idea that they are relating to God somehow confers reality on that idea. If not, they are possibly deluding themselves, and you are suggesting that they refuse treatment so as to remain pleasantly deluded - or so it appears to me.

Psychic

Well, if we are talking medicine here, then I'd like to point out that in the medical code of ethics, you are not allowed to offer any one any kind of treatment against their will. even if you know that a patient is going drop dead within a week, if the patient doesn't -for any reason- want to get treated then it's up to the patient. of course you do try to explain things but you can't decide.

second thing: Epilepsy can have such effects! I am sure you all heard about ECT (Electro-convulsion-therapy) (the electrical shocks given to pshyciatric patients in movies). well the mechanism of action of this kind of treatment is still largely debateable. but the discovery of this mode of therapy came as an observation on those psychiatric patients suffering from depressive disorders with a very low mode, and who have epilepsy too. they noted that the mood is significantly elevated after in those patients after an epileptic fit!

So ECT as the name implies, is simpley Induced epileptic attack. and now the effect of the electrical distrubance on mood has been well documented.

and about the side effects of epilepsy, not every case of epilepsy have side effects, there are many many types of epilepsy and there are many factors to determine wither the patient is likely to suffer from those side effcts of not.

Gurdur

Actually, you are alllowed under certain circumstances:
1) if the patient's unconscious or comatose

2) if the patient is deemed mentally incapable

3) if the patient is judged to be not mentally competent owing to temporary psychosis or mental illness

The question is for Zulu:

When is a patient to be treated forcibly owing to mental incapacity on the patient's part ?

There is also another question:

When do the effects of a condition outweigh the treatment ?

I can think of quite a few examples:

1) Epilepsy: there was a case of a women cited by the neurologist Klawans; this woman "suffered" from numerous orgasms caused by pre-onset epileptic auras.
She decided the orgasms weren't worth it, and preferred treatment.

2) Toulette's Syndrome patients sometimes decide (in consultation with their doctors) to take treatment on weekdays, but not on weekends --- since they need to be calmer at work, but enjoy their Toulette's rush on the weekends

3) Tertiary syphilis can cause a mild euphoria --- that is irreversible, even when the syphilis itself is treated succesfully -- there seems to be no reason to want to counteract the mild euphoria by for example use of "downers".

Psychic

well, I didn't figure out someone will dig deep so i didn't elaborate.
but please note that the ONLY medical case a doctor is allowed to take actions without permission is uncounsicous patient in an emergency, Usually cases of cardiopulmonary resuscitation. while the mentally incapable and ill are not to be touched before the approval of their families or whoever is responsible for them.

When is a patient to be treated forcibly owing to mental incapacity on the patient's part ?

If the patient is a menace to society or others, OR the patient has not insight of the disease while his/her condition fits the criteria of diagnosis for psychiatric illness. if the patient is not reliable his family should be consulted.

sorry the question is not for me to answer I know, but I couldn't resist.

When do the effects of a condition outweigh the treatment ?

well the example you've given are quite interesting. but I think there are un-countable cases where treatment side effects/disease complications analysis is in favour of the disease. ranging from treating common cold virusess with anti-viral agents, to hepatitis B which mostly resolves, to treating a terminally ill cancer patients with chemotherapy.

The ethics of treating patients with malignancies are quite complex and interesting actually. because you have to consider lots of factors in decision making. like some one who wants to live 2 years as a normal individual rather than having all the immune system bombarded with chemotherapy plus the many side effects.



and to Zulu: i still don't understand where god fits into the topic? God (presuppsing its existence!) can't cause any disease in medicine, and if god is able of causing any disease please do inform me! may be some day we'll find a treatment for God infestation.

God syndrome:

1) patients suffer from heavy sclerosis and formation of fibrotic bands around the matter of the brain, rendering their brains a closed system lossing the transmissiblity of ideas in and out.

2) euphoric feeling of rightousness

3) Obssesive complusive rituals.

4) severe delusions about the source of all this world, and paranoid delusions that all scientists are pulling a universal conspiracy to corrupt their minds.

5) obsessions of killing some atheists.

6) complete and total loss of insight of the disease.

Zulu

Yes, this is what I mean.

Would you agree with this? What if beforehand,you had mentioned that if such a scenario were to occur you'd want treatment?

Gurdur, hi,

Personally I'd say:

1.) If it was explicitely stated beforehand by this person that they'd want the treatment under these [or very similar] circumstances.

2.) If they're mentally retarded or show on signs of being able to choose what's best for them.

3.) If the treatment will result in severe loss of happiness and or mental faculty and the patient isn't completely aware of this. If they are aware of this and don't care it becomes more troubling. [Almost Catch 22-ish]

Frankly, I can't say I have a well grounded answer...that's why I started the thread. What are your thoughts?

A greater mental awareness. I wouldn't include happiness, because I certainly wouldn't advocate allowing someone to remain a happy vegetable as opposed to a normal rational being [with perhaps less happiness]. I don't think the examples you adduced illustrate lessened mental capacity, so I'd support the action being taken in each case.


Pyschic,

I see I really confused people by mentioning god. I just meant that the epileptic fit caused this person to firmly believe in god. I'm not stating anything about his existence, or whatever. Just that this person is now a very convinced and spiritual believer as a result of the disease.

-Zulu

mdn

I have epilepsy, and the seizures can sometimes be very interesting; I have felt as if I've learned things from them, the same way you can learn things from psychotropic drugs - it's not a window into greater reality, but a window into the wonder of the human mind. Like lucid dreaming.

Anyway, like I said, I do feel a certain amount of affection for my disorder: BUT. The aftermath is not enjoyable at all - like a hangover for a nice evening of drinking, actually, the way you can feel that euphoria for a while, but have to pay for it the next day. And, more important, you can't control when it comes: with using drugs or alcohol, you can wait until important things are over to enjoy some recreational activity. With epilepsy, you could be slipped a tab at any moment - in the middle of live performance, or a special ceremony, or a class, or while scuba diving, or doing surgery, or flying a plane - there are a lot of downsides to being hit with a seizure randomly.

So, I doubt many people would refuse treatment, though if they did, that's their choice.