# A no win situation for doctors **URL:** \ **Category:** The Quarantine Zone\ **Tags:** covid-quarantine\ **Created:** [August 30, 2021, 6:11pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790 "2021-08-30T18:11:57Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [August 31, 2021, 12:24am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/21 "2021-08-31T00:24:40Z")
What I can’t figure out is the basis for the judges to order a hospital to provide a treatment that the hospital doesn’t believe is effective/medically indicated. I mean, if I end up hospitalized and I want my perfectly healthy left leg amputated, can a judge order the hospital and surgeon to do it? Typically, when hospitals are involved with court orders, it’s either the hospital ordering treatment if for example a parent refuses consent for necessary treatment or the patient/family getting a court order to refuse treatment. I could even see a doctor on the hospital staff getting a court order to be allowed to provide the treatment the doctor thinks is best, if the hospital won’t allow it. But something like this, I’ve never heard of before. ---
**Author:** ![gdave](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gdave/32/3683_2.png) [@gdave](https://boards.straightdope.com/u/gdave)\ **Post date:** [August 31, 2021, 12:43am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/22 "2021-08-31T00:43:46Z")
Caveat: I Am Not A Doctor Nor Am I A Lawyer. From the reporting, it seems likely the husband is either too heavily sedated or too sick to make his own medical decisions. His wife is his legal guardian. She has what appears to be a valid prescription from a physician licensed in Ohio. He’s on a ventilator in an ICU, so it’s not like she can just take him home to administer the treatment, and the doctor who issued the prescription doesn’t appear to have privileges at the hospital in question. If she wants him to receive a particular treatment, it seems like her only recourse is to request the hospital administer it, and if they refuse, to sue them. I’m sure I won’t get the legal terminology correct, but effectively I imagine she’s suing them for nonfeasance and requesting a writ of mandamus (or whatever the medical equivalent is) to force them to give “proper” treatment to her husband. If you had a life-threatening infection, and a valid doctor’s order for an amputation to treat it, and the hospital doctors disagreed over the course of treatment, but you were in too fragile a state to discharge or move to another facility, I imagine you might well have a solid legal case to demand an amputation. In principle, the general idea that you can sue a hospital where you are currently in an ICU to force them to treat you for a life-threatening condition doesn’t seem outlandish to me. The _specifics_ of this case are a different story. It seems like the court should be relying on some sort of outside standard of care (like FDA and CDC recommendations, for example), rather than substituting its medical judgement for the hospital’s. Again, though, I Am Not A Lawyer, so for all I know, under Ohio law a medical guardian has the legal right to over-ride hospital advice and demand certain treatments for life-threatening conditions. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [August 31, 2021, 12:48am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/23 "2021-08-31T00:48:48Z")
> [@psychobunny](#): > > There is a reason that it takes screwing to get hospital privileges. Damn autocorrect. Just for the record there was absolutely NO screwing involved in my getting hospital privileges. (I don’t remember what I initially typed. Maybe scrutiny?) ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [August 31, 2021, 1:55am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/24 "2021-08-31T01:55:52Z")
Didn’t read the article. But as the doctor I would refuse to do it. I would state all the reasons why and document them in detail. If the hospital insisted because of some court decision, I would ask them to make the medication available and for the informed patient to self administer it. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [August 31, 2021, 2:00am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/25 "2021-08-31T02:00:08Z")
Oh. Uh… Yeah, yeah, me, neither. ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [August 31, 2021, 2:57am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/26 "2021-08-31T02:57:58Z")
> [@psychobunny](#): > > Damn autocorrect. Just for the record there was absolutely NO screwing involved in my getting hospital privileges. (I don’t remember what I initially typed. Maybe scrutiny?) Geez, when I read your original statement, I didn’t even question it. Dunno what that says about me. ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [August 31, 2021, 3:08am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/27 "2021-08-31T03:08:46Z")
> [@susan](#): > > Having had cancer, I assure you that there are canceridiots as well who swear by nonsense cures and dangerous interventions while railing against available medical treatments. It’s not just COVID that brings out the odd treatment logic (sic). Was hanging out getting my infusion o’toxins for my cancer, and the blithering idiot in the next chair was chatting on and on with my tech and I about how she goes through some whacked detox procedure when she gets done with her chemo and it makes her feel so much better … After she left, the tech and I were discussing exactly how much of an idiot she actually was. Not that the body normally needs detoxification if the various organs are working correctly, but the insanity of detoxification from the toxins designed to kill off her cancer. ---
**Author:** ![Morgyn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/morgyn/32/3041_2.png) [@Morgyn](https://boards.straightdope.com/u/Morgyn)\ **Post date:** [August 31, 2021, 3:13am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/28 "2021-08-31T03:13:27Z")
Once a year, according to a livestock expert I follow on Twitter. IIUC, these idiots are taking that dose every day for a period of days, and it’s very like chemotherapy in that you’re taking in a poison that will, hopefully, kill the parasites before it kills you. ---
**Author:** ![ParallelLines](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/parallellines/32/3575_2.png) [@ParallelLines](https://boards.straightdope.com/u/ParallelLines)\ **Post date:** [August 31, 2021, 3:34am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/29 "2021-08-31T03:34:23Z")
You know, I am deeply disgusted by medical/insurance billing issues in the US, but just this once… if I was the MD being forced to do this, I would say that this is a non-standard, non-approved treatment, and I’ll do it under -written protest- which will lay out how stupid and dangerous I think it is, and require both the attny, prescribing doctor and guardian to sign. BUT … as such, since this isn’t an insurance approved treatment, I’m charging $2500/hr, with a 2 hour minimum, cash up front, no financing, for my time and effort (and brain cells killed by their argument). ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [August 31, 2021, 4:41am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/30 "2021-08-31T04:41:18Z")
Maybe she thought that the cells destroyed by her chemo treatments were what the detox regimen was flushing out of her body? When my oncologist walked into the room with a big smile on his face and told me that I didn’t need and would not benefit from chemo, I replied, “Guess I can go raw vegan after all!” I then cringed and said, “yuck, I’d rather have chemo.” ---
**Author:** ![Melbourne](https://avatars.discourse-cdn.com/v4/letter/m/b5e925/32.png) [@Melbourne](https://boards.straightdope.com/u/Melbourne)\ **Post date:** [August 31, 2021, 7:13am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/31 "2021-08-31T07:13:21Z")
> [@doreen](#): > > I mean, if I end up hospitalized and I want my perfectly healthy left leg amputated, can a judge order the hospital and surgeon to do it? That’s at the extreme end of the scale, so it’s a useless argument that has nothing to do with anything, but since you ask: courts around the world have held that doctors have a reasonable responsibility to provide care that people can’t get in any other way, regardless of their personal feelings. So the courts would (and have) decide if the request was reasonable in the circumstances (taking expert evidence on suicide risk and informed consent etc), and what other opportunities there are for the patient to receive treatment elsewhere, and would make a judgement requiring a _particular_ person/doctor/hospital to undertake an action only when it was reasonable and unavoidable to do so. On the other hand, a doctor could reasonably expect to be disbarred if they cut off a leg without a medical reason or a court order. It’s a situation where ‘informed consent’ is not usually enough. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 31, 2021, 8:03am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/32 "2021-08-31T08:03:41Z")
> [@psychobunny](#): > > I would say that if the wife wants him to prescribe for the patient, she should transfer him to a hospital where he has privileges and can be the accepting MD. That makes sense in theory. But from everything I could find, Wagshul is a quack (at least with regard to his beliefs about COVID) and has no hospital admitting privileges anywhere, let alone at a hospital that has the appropriate life support systems that this woman’s husband currently needs. That’s probably why she took it to court, stupid though the whole thing was. Wagshul’s “Lung Center of America” in Centerville (Dayton) Ohio is basically just a medical office with a pretentious name, and he’s the only doctor there. My dentist’s office has more staff than they do, FFS. ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [August 31, 2021, 9:32am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/33 "2021-08-31T09:32:11Z")
> [@nearwildheaven](#): > > Maybe she thought that the cells destroyed by her chemo treatments were what the detox regimen was flushing out of her body? > > When my oncologist walked into the room with a big smile on his face and told me that I didn’t need and would not benefit from chemo, I replied, “Guess I can go raw vegan after all!” I then cringed and said, “yuck, I’d rather have chemo.” Who knows. She just sounded like a nutter. Way back in the days of USENET I was on a rec.alt.\ that was a compendium of odd dietary folks ranging from strict Atkins to raw food nutter. There was one guy that had his own website !!! He made one huge chopped salad for the week, ate it 3 meals a day with one or two different dressings he would use [he proudly posted the picture of the fridge with all the containers of salad] He was pretty much twig gaunt thin, no idea exactly how healthy he was, but he claimed that it was strictly raw, vegan and all the nutrients and micronutrients a human body needs. [I remember it mainly because it was all salad and nothing but salad, and he was so stick thin. It was fun, though I got into more fights with the raw foodies insisting all grains were T0XiCCCCCC and if you ate them you would poison yourself and die, and cooking killed any nutritional value in your food. I commented more than once I grew up pulling handsful of random grain to snack on as a kid from the fields behind the cottage on the way to wander around in the woods and I seem to still be alive, despite cooking my food and eating bread. ---
**Author:** ![tofor](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tofor/32/13727_2.png) [@tofor](https://boards.straightdope.com/u/tofor)\ **Post date:** [August 31, 2021, 11:38am UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/34 "2021-08-31T11:38:24Z")
The original article starts with this: > A suburban Cincinnati woman, whose husband has been on a ventilator in the hospital with COVID-19, won a court order [forcing the hospital to treat her husband’s virus](https://bit.ly/38mRqVR) with an anti-parasitic treatment commonly used for livestock. While true, it’s not particularly relevant to mention the livestock if Ivermectin is also approved for human use. It’s the medical equivalent of “chemicals used in yoga mats”. True, but misleading. That drives me nuts in reporting. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [August 31, 2021, 12:05pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/35 "2021-08-31T12:05:49Z")
> [@gdave](#): > > But since it has no possible benefit, any risk is medically unjustified. There are serious studies to test whether it’s beneficial. This doctor appears to be a quack, but there certainly _might_ be a benefit. [https://www.nature.com/articles/d41586-021-02081-w](https://www.nature.com/articles/d41586-021-02081-w) Is an article about a paper that has been withdrawn, due to ethical concerns, but it mentions several other studies are being done. I don’t see how a hospital can be required to do something on the say-so of a doctor who doesn’t have admitting privileges, if no doctor there backs it, though. That’s the part that seems off to me. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 31, 2021, 12:17pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/36 "2021-08-31T12:17:28Z")
> [@tofor](#): > > While true, it’s not particularly relevant to mention the livestock if Ivermectin is also approved for human use. It’s the medical equivalent of “chemicals used in yoga mats”. True, but misleading. That’s what threw me as this reporting start rolling out. However, it’s worth noting that while Ivermectin may be approved for human uses, these people are still going to feed stores and buying tubes of the stuff with horses on the package. I mean, Ivermectin (and pyrantel) are in your dog’s Heartgard. While both approved for human use, it’s still ‘dog medicine’. Now, the yoga mat thing pissed me off. That wasn’t yoga mat material in food, it was a chemical that happened to be used in both yoga mats and food (and lots of other things). It would be like complaining that [some food] is made out of lipstick when, in reality, what you mean is that they both happen to use the same coloring agent. Any media/news outlet that suggested that subway bread was made out of yoga mats or didn’t explain that the two simply shared one chemical was probably lucky they weren’t sued by subway. ---
**Author:** ![tofor](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tofor/32/13727_2.png) [@tofor](https://boards.straightdope.com/u/tofor)\ **Post date:** [August 31, 2021, 12:24pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/37 "2021-08-31T12:24:32Z")
> [@Joey\_P](#): > > That’s what threw me as this reporting start rolling out. However, it’s worth noting that while Ivermectin may be approved for human uses, these people are still going to feed stores and buying tubes of the stuff with horses on the package. I mean, Ivermectin (and pyrantel) are in your dog’s Heartgard. While both approved for human use, it’s still ‘dog medicine’. While some people are doing that, the people in the article apparently have a legitimate prescription for human medicine from an actual real doctor (however questionable the ethics of that doctor). So the veterinary thing is just misleading and irrelevant in this particular story. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [August 31, 2021, 12:27pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/38 "2021-08-31T12:27:58Z")
“Studies are being done” about lots of drugs for various purposes. A high percentage never pan out. Hydroxychloroquine was supposed to be a terrific low-cost, safe Covid-19 cure that They were suppressing, just like ivermectin. It flopped. We don’t have the data to force physicians to use ivermectin against their judgment. "Based on the current very low- to low-certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID-19,” the (Cochrane review) authors write in their report, posted last week (July 28). “The completed studies are small and few are considered high quality. . . . Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized trials.” “The hype around ivermectin is driven by some studies where the effect size for ivermectin is frankly not credible,” Paul Garner, the coordinating editor of the Cochrane Infectious Diseases Group, says in a [statement](https://www.lstmed.ac.uk/news-events/news/ivermectin-treatment-in-humans-for-covid-19)." > **[Ivermectin (Still) Lacks Scientific Support as a COVID-19 Drug](https://www.the-scientist.com/news-opinion/ivermectin-still-lacks-scientific-support-as-a-covid-19-drug-69049)** > > A Cochrane review bolsters scientists' advice that ivermectin should not be used against the disease outside of clinical trials, while a study claiming to have found beneficial effects in patients was withdrawn following allegations of data... ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [August 31, 2021, 12:39pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/39 "2021-08-31T12:39:15Z")
Apparently, the guy is dying despite all the standard treatments. It’s not, a priori, crazy to try something unproven. (The cumulative dose prescribed in this case seems crazy, and may be why the hospital has refused to do it, but the idea of "try something that someone, somewhere, thinks might help isn’t crazy in this case.) Odds are, it won’t do any good. But I think it’s a bit overstated to say “it has no possible benefit”. There’s a reason that doctors are allowed to prescribe drugs “off label”. There are some conditions that have no proven treatment, and it’s common for the only approved treatments to fail (or be inappropriate) for some patients. New uses are found for drugs all the time, due to doctors giving them to patients “off label”. I don’t think the hospital should be forced to go along with a doctor they don’t trust enough to allow admitting privileges, though. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [August 31, 2021, 1:22pm UTC](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790/40 "2021-08-31T13:22:55Z")
Speaking of a no-win situation: I think we can take it as a given that if this patient survives, ivermectin promoters will give all the credit to their favorite drug and none to the evidence-based care he received. If he dies, their excuse will be that he wasn’t given ivermectin soon enough. [Previous page](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790.md?page=1) [Next page](https://boards.straightdope.com/t/a-no-win-situation-for-doctors/949790.md?page=3)