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Comment Re:Privacy != Paranoia (Score 5, Insightful) 78

Actually, it's worse than that. What will undoubtedly affect most people is not the power imbalance between the individual and the government as a whole, but the tremendous power imbalance between an individual and the lowest tier public worker that has access to that information. When your local policeman will be browsing your daughter's naked photos (that she took in the shower with her cell phone) while contemplating which would be better to coerce her into sex, her confession about cheating in French class, smoking a joint once a year ago, or going on a date with two different people without them knowing it; and when you find out, and the same person will threaten you with being arrested for anything he could make up he saw in the surveillance, put you on a watch list, destroy your life.... that's when you will realize how far the power separation has gone.

Take it from someone who was brought up in the Soviet Union - even the lowliest civil servant had power, and exercised it. There was no action without bribery, and there was not even a concept of freedom... not because of power coming from the top down, but because the system was so skewed at a traffic cop could pull you over, rob you, rape your wife, then kill you both, and if anyone witnessed it, they'd keep their mouth shut.

Power corrupts.

If you give someone absolute access to your information (even forgetting the concept that the latter will likely mean absolute access to making stuff up), you given them absolute power over you.

Comment Re:More dehumanization in medicine (Score 1) 120

Well, if we didn't have to document several fold more, and got paid less for interacting with patients, we may do it. As it stands, unless a doctor is doing something to you, he/she is unlikely to get paid much. Obviously there are upsides and downsides to a system that rewards cutting but not measuring.

Comment spirals (Score 5, Insightful) 415

Information imbalance creates a vast power imbalance. And we'd be fools to think that this power imbalance would not be exploited. Generally, in military terms you talk about capabilities, rather than intentions when making assessments. So when universal surveillance becomes a capability, we have to assume it's not just used, but used universally. And one doesn't have to go far in history to search for consequences of having such a system. While not nearly as sophisticated, East Germany during the Soviet era provides plenty of evidence for what WILL be done with the information obtained as a result of a vast surveillance network. In a few words, mainly ammunition for the government to persecute and discredit critics (which isn't new), but also alarmingly but unsurprisingly, a way for those with access to this information (specific individuals within law enforcement and government) to exert this power over other private individuals for spite, profit, blackmail, coverup, etc. It's happened before. We have to be fools to think it won't happen again.

Comment Re:We have a reform process in the US? (Score 2) 75

Yes, the reform is in the direction of no-privacy for everyone.

I have to say it, but we should mod up the AC.

The active privacy reform across the industrial world (yes, EU, UK, AU I'm talking to you as well, not just US) is the assertions that:
1. there no right to privacy for the citizens
2. there IS a right to privacy for n, where n=power or money (read: police, government, corporate interests)
3. noting a vast power unbalance as a result of 1 and 2 makes one a terrorist

Comment Re:Surrogate decisionmaking (Score 1) 961

Intent is the key. If your goal is to control pain at any cost in a terminal patient, and the next dose of opiate happens to stop them from breathing, that's fine. But I am not going to give them a dose of opiates that's INTENDED to stop them from breathing. It's a fine line, but an important one.

Comment Re:Surrogate decisionmaking (Score 1) 961

Step 1.
Most importantly, TALK TO YOUR LOVED ONES. If they don't know your wishes, they will be unable to interpret them if that time comes.
Step 2.
Fill out a healthcare proxy form, available from any primary care MD or even the state itself, with preferably a hierarchy of surrogate decisionmakers (in case of an accident involving more than one person).
Step 3.
Discuss your wishes with your doctor and lawyer, who can help you iron out the language for a living will.

Consider though that 1 and 2 are much more important, because unless you specifically prohibit something in your living will, your proxy or surrogate may overrule it on your behalf. However, I would discourage you from writing any absolutes in your living will. It's not instructions, it a reminder and guidance for your healthcare proxy. Otherwise, you may miss a potential live-saving treatment that was unknown to you or unavailable when you filled out the form.

Comment Re:Surrogate decisionmaking (Score 1) 961

When it get to the point where even the most powerful pain meds are no longer very effective, agony and torture are properly descriptive.

There is no such point. Opiates have no ceiling effect. In terminal patients, unless it is was prohibited by the patient, or the surrogate disagrees, it is appropriate to escalate opiate dosing to any level required to achieve pain control. What the effects of that dose would be otherwise is irrelevant.

Now that's not always done, sometimes because of family, sometimes because of the doctor's discomfort... which is why it is so important that palliative care education be a large part of medical education in the US.

Comment Re:Ironic (Score 2) 961

How ironic that a doctor doesn't want "extraordinary measures". It is like a car mechanic who says "take it to the scrap heap" rather than opting to replace the engine or transmission on his '57 Chevy.

That's a silly comment. Extraordinary measures are fine, as long as they accomplish something. Hence the word "reversible" in my original post. If all "extraordinary measures" (by which I assume you mean enteral feeding, mechanical ventilation, etc) are doing is keeping a shell physically alive, that's not at all equivalent.
The equivalent would be keeping a car that's been crushed in a press in your garage for sentimental reasons.

Comment Re:Surrogate decisionmaking (Score 5, Informative) 961

I think you're making a lot of assumptions that are fundamentally false by projecting your imagination into a situation that is very different.
People with mental status that is sufficiently compromised to fall under the category I am describing are not really able to feel hunger the way we do. Actually, starvation due to decreased drive to eat is one of the primary mechanisms of end-stage dementia.
Also, appropriate end-of-life care within the palliative setting involves very aggressive pain control.
At no point should anyone in hospice care die in pain.

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