Dr. Sunita Sah
speaker
332 appearances
4 recordings
4 series
first heard Jan 2025
last heard 6 Feb
Dr. Sunita Sah’s voice in public audio — every appearance, attributed to the second.
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Appearances
So we need to know about the situation, have full information about that situation. And third, understanding of that. Do we understand the risks, the benefits, the alternatives? Then number four, do we have the freedom to say no? In some situations, we don't have the freedom to say no. It might be too risky. Your life might be on the line in some situations.
Exactly. You might not have the freedom to say no. Another one is if you're a black guy and you're stopped at a traffic stop, right? That's not the place to defy.
So freedom to say no. And then if you have those four things, the fifth element is your considered authorization of an informed consent. And if you want to say no, informed refusal.
And we do have trust in our doctors and it would be a shame if that disappeared, right? That element of public trust. But there's also a lot being written on end of life treatment and how aggressive it can be. But it's really difficult. Again, it's an ideal that can never be fully attained in medicine and elsewhere.
I think if people want to have that conversation and then even as I told Grande talks about, people prefer different types of care, right? Somebody wants the paternalistic advice. Just tell me what to do and I'll follow it. Other people want more of a guided, informed, shared decision making and the doctor to be more of a coach.
Yeah, some people find that really hard.
So true yes is consent. So having those five elements there would be your true yes. Or a true no is the same. The informed refusal is just having those five elements. But sometimes you have those five factors there, but you decide to actually do what I call conscious compliance. So you consciously comply because the costs might be too big or this is not the right time to do it.
And because, as you said, it's exhausting. So you need to choose, is this situation going against my values? Otherwise we'd be defying every day. We wouldn't get anything done. And we need to really choose what situations are going against our values that this is worth me speaking up and saying something about.
I interviewed a few of my students that have been in the military, which was really fascinating to hear their stories. And in fact, one of the first ones, and I remember it really well because we were speaking on Zoom on a Sunday afternoon. I was calling Matthew. He told me about when he went into the military and he did it because he grew up with 9-11 sort of seared into his memory.
And he wanted to prove that he's an American, he's a patriot, and he was deployed to Iraq. And his best friend got killed in the first few months. And there was an incident where they were on some nighttime mission and he's like, nothing usually happens at nighttime. But there was this flash and then a grenade going off that was too close for comfort. And they immediately started opening fire.
Some people went off in his squad and they came back with four prisoners. One of them, Matthew, had and had to look after. And this person was just screaming out in Arabic. And his supervisor said to him, he's talking too much. He's screaming, shut him up. And Matthew said, what should I do? And he was like, oh, it's simple. Hit him in the mouth.
And so he looked at the man and there was blood coming out from his nose into his beard. So he hit him and the man didn't stop talking. And his sergeant said, he's not stopped. Hit him again. Hit him in the stomach. And Matthew just looked at me and he just said, and that's what I did. And then later on, he told me that he found out that these weren't insurgents at all.
They were young teenage boys.
They were 15 or 16 years old. He couldn't understand what they were saying. And he felt really bad about it. And he said in that instant, he just trusted. He had no option. The next time they were on some kind of mission and they stopped and they basically formed like a circle, what they do in war, right? And what he told me is that you're not supposed to get out and just spray and pray.
You have to have a target. Otherwise you can hurt civilians. And he said, but they just got out and they did spray and pray. And in that moment, he did not do that. he kind of turned around and looked at the desert behind him. And later on, his superior said to him, what were you doing? And he said, oh, I was just providing security. I was looking at providing cover.
And he said that was the only thing he could think of for not doing it. But it actually was because his feelings were getting really complicated about whether he was doing the right thing or not. And he didn't describe his actions as defiant. He even said they were kind of cowardly. If he had actually said what he felt, he would have gone to military prison. And he said, and maybe they'd be right.
But that one incident that he said was half conscious, he did start becoming a little bit more defiant. So I call that quiet defiance where you're not actively saying no to someone else, but you're not going against what you think is the right thing to do.
Right. And so later on, then he became less quietly defiant. There was another nighttime mission that he thought was way unsafe. It involved going out at the nighttime with goggles very close to a cliff edge. And he went to see his superior and he just said, I don't think we should do this. It's far too dangerous. And his superior was just like, shut up. Do as I say. Are you disobeying me?
He's like, no, but I'm adamantly against the idea. And of course, the mission went ahead. People came back after half an hour. It didn't work out. It was too unsafe. But he wasn't rewarded for that. He was basically punished. He didn't get his promotion, but he said it was the right thing to do. And he became a little bit more comfortable with sort of saying those things.
But yes, in the military, I hear time and time again from my students that have been there, it's yes, yes, yes. And one of them said, you are trained to do, not to think.
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