Comment by mgkimsal | Hacker News Reader

Comment by mgkimsal | Hacker News Reader

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"It's surprising how rarely we encounter good critics in our lives, everybody is focused on supporting and validating and has little practice at really challenging, reviewing, evaluating."

This is a bit off-topic but I was reading some time ago about Dan/Dani Bunten (of MULE fame, among other things), who had gender reassignment surgery. More info here: http://ai.eecs.umich.edu/people/conway/TS/Warning.html#Dani but this is what I was reminded of:

"Despite following the rules and being as honest as I could with the medical folks at each stage, nobody stopped me and said "Are you honest to God absolutely sure this is the ONLY path for you?!" To the contrary, the voices were all cheerfully supportive of my decision."

No one really challenged Dan at the time - possibly for fear of being labelled as a bigot or hater or whatever - and Dani later regretted the decision.

Again, somewhat off-topic, but finding people to really challenge you (in a supporting way) is hard to do.

Pathological skeptic here. Being critical, challenging ideas, and evaluating possibilities is something that makes people very uncomfortable and being honest can burn a lot of bridges, no matter how nice you are about it.

We live in a very lonely world, and most people would rather shut their mouth and damn the consequences that have a healthy argument. It's cold comfort knowing you're right when no one wants to listen.

We are born into a cruelly honest world. Children, before life beats them down, are cruelly honest. Somewhere around that first full time job and the first pregnancy scare, all of the piss is taken out of us. We don't want to be judged, so we don't judge others.

It's a very sugar-coated world to live in.

Pathological bridge-burner here. Agreed.

"We live in a very lonely world, and most people would rather shut their mouth and damn the consequences that have a healthy argument."

And most people would rather not listen to criticism and prefer sugar-coating so it doesn't hurt their feelings, aspirations, dreams, etc.

But the question stands in what a world one wants to live. In a world of sugarcoating, or in a world of truthful edges?

Me, I would love the edges. But that's for everyone to decide for themselves.

False dichotomy.

Ego gratifying false dichotomy.

>It's cold comfort knowing you're right when no one wants to listen.

This says it all. Being critical, challenging ideas and evaluating possibilities isn't about being right and letting people know it. The whole point of being critical, challenging ideas and constructive criticism in general is to do it for their benefit. To help the person see things they may have missed. It's not about ego tripping for your benefit by proving that you're a visionary who noticed all the negative things they didn't want to see.

How about this attempt to be nicely critical and help the guy out: http://matt-welsh.blogspot.co.uk/2009/02/how-i-almost-killed...

Whenever I go to someone for advice or an opinion on something I'm working on, I look for people who aren't afraid to tell me I've done something wrong, something looks bad, or the whole idea is just plain garbage. Instead, what you get is people half-heartedly telling you, "Oh, that's really something."

I'm not a baby, people. Tell me what you hate about it so I can make it better! You can't fix bugs if no one reports them.

Unfortunately, this mentality gets me into a lot of trouble with my girlfriend, who is a Graphic Designer. She'll show me something she's working on, and I tell her what I would want to hear: "That face looks funny", or "I don't like that colour". What she takes from it is, "I hate everything about what you just showed me."

sounds like asker/guesser striking again (<http://ask.metafilter.com/55153/Whats-the-middle-ground-betw...). i've had a job implode, and endless relationship friction, because i'm an asker all the way (as i expect are most people here).

are you and your gf (and the people you ask for advice) from different cultures at all? (could be america/canadia, new york/midwest, or just that you're a normal geek and she isn't.)

Same cultures, mostly. All people from Ontario, Canada (at varying latitudes). She's not quite as geeky as I am, but still much more so than most women I interact with.

It has caused some friction in our relationship, but I just try to remember to preface my "I don't like this part" comment with a "That looks great, but..."

While I agree in principal that people should have questioned Dani about his/her decision, it is hardly their responsibility to do so in this situation, and least of all the responsibility of the "medical folks" at any stage. The only exception would be a doctor you've asked for a consultation on whether it's a good idea medically, or a psychologist on whether it's a good idea psychologically (more relevant here).

I think one can assume that at the level of this type of irreversible decision, said decision maker has thought long and hard about whether to "reassign their gender" and come to the conclusion most suitable for their own lives. At this point, it's only appropriate for close friends and family to perform a last questioning of sorts before the decision is sought through. I mean, there is a point at which you must make the switch from being skeptical of a situation to being accepting of the situation, or you must exit the situation (burn the bridge, etc). The point of acceptance after healthy skepticism is due to the fact that everyone's life is different, and there is no one-size-fits-all solution to any problem. The real trick is figuring out when and how to make that switch.

it is hardly their responsibility to do so in this situation, and least of all the responsibility of the "medical folks" at any stage

It is always the responsibility of a doctor/nurse to ensure that a procedure is best for the recipient. That's the essence of the Hippocratic Oath.

"Gender reassignment" is an elective surgery. For a physician who performs such a surgery, how does she choose whether it's a good idea or a bad idea for a certain patient? And keep in mind this particular patient had no negative physical side effects. She only regretted it. This leads me to believe that a physician who performs such a surgery will unquestioningly perform it for all who ask, unless there are serious medical concerns, which there were not in this case.

Also, the Hippocratic Oath says nothing of elective surgery. For a normal surgery, sure, the onus is on the physician to decide whether it's best. For elective surgery, the physician's duty is to decide whether it's medically OK. Otherwise, we'd have physicians picking and choosing who gets what elective surgery for reasons unknown.

And note, I'm personally against elective surgery, but it exists and it's legal. Someone who wants it should be able to get it without being told NO by a physician who performs such surgeries because they don't think it's a good idea for that particular patient (unless, as I said, it's a medical concern). Leave the psychology to the psychologists.

> "Gender reassignment" is an elective surgery

Both the AMA and APA consider it medically indicated in certain cases. In these cases, the patient has the choice of whether or not to pursue these options as part of their treatment, but it is not considered an elective surgery for giggles, but rather a treatment option for medical reasons.

For liability reasons, most doctors do not perform the surgery on a walk in and have it happen basis. There's a set of guidelines that have been promulgated that are used by internationally by most doctors in their professional practice. These guidelines aren't binding on anyone, but have become accepted enough that most medical professionals working with people in this situation view them as standard practice for this procedure and follow them.

> Also, the Hippocratic Oath says nothing of elective surgery

There is no distinction as far as the Hippocratic Oath is concerned. Elective or not, a surgery is a doctor performing services as a doctor and I would find it odd to assume their oaths suddenly wouldn't apply.

> Leave the psychology to the psychologists.

Current practice mostly does, in that doctors generally only do these procedures after they've been recommended by a set of psychologists or psychiatrists after evaluation. (Usually two are required, at least one must be a doctoral level practitioner.) Almost every doctor also does their own brief check and conversation just to make sure they come to a similar conclusion and add their own confirmation.

Very interesting, thanks for the feedback/corrections. I find it especially interesting that gender reassignment surgery isn't always considered elective, but having your wisdom teeth removed is. Any links to information on how the decision, of whether it is considered elective or not for any given situation, is made?

> isn't always considered elective, but having your wisdom teeth removed is

Wisdom teeth removal isn't always considered elective either. Wisdom teeth removal is considered a medically necessary procedure by my insurance company and is covered.

> Any links to information on how the decision, of whether it is considered elective or not for any given situation, is made?

In the US system, generally each insurance company has their own policies on how they judge things and what they cover. Often depending on how your plan is written, slightly different sets of policies will kick in.

Insurance coverage in the US doesn't always directly correlate with what medical professionals in that field would declare as elective or not.

It is, of course, also extremely common for insurance companies to declare that genital reassignment surgery is elective, despite AMA and APA resolutions which declare otherwise.

It's important to look at the relative upside and downside for different parties.

If you are the voice of uncomfortable truth for someone you have the possibility of a big win (e.g. say out loud that the emperor's butt naked) but are probably viewed as a big meanie and may burn bridges in most typical cases.

If you are the voice of sugar coating and go with the crowd, or whatever you think the other person wants, you are unlikely to have a big win, but at least you are considered "nice" most of the time.

In practice, no one is all one or all the other. It also depends on who is risking what. In the Dan/Dani case, the surgeons and doctors didn't have to deal with the consequences of a mistaken decision, but they did have to deal with the possibility that someone might label them anti-trans bigots. When nothing is really at stake for you, personally, why not be blandly, gently "nice" to someone and avoid hurting their feelings?

On the other hand, if $1M of my own money is on the table (e.g. investing it in a startup), even though I want to maintain good working relations I will ask the hard questions, because there's big downside risk for me if I don't.

Is it up to the doctors involved to question your decision? I don't think it is. I don't understand someone who would rely on that.

I had multiple doctors refuse to perform an elective surgery on me because I was "too young" (over 18, then later over 21). That was beyond "questioning my decision" - that was refusing service for their own beliefs.

You're right, that is really off-topic.

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