[Suesquatch]

One reason I left the bedside was being sick of keeping the dead alive.

[vashtee]

To play the devil's advocate, I think the problem was that this guy was intubated in the first place. There IS a difference between allowing someone to die and hastening their death. Since the ventilator is already in place, to remove it would be to hasten death (at least in some circles).

[Dr.Nurse2b]

Originally Posted by natania

To play the devil's advocate, I think the problem was that this guy was intubated in the first place. There IS a difference between allowing someone to die and hastening their death. Since the ventilator is already in place, to remove it would be to hasten death (at least in some circles).

Define "Life" and "Living"...

My understanding of life support, i.e.: intubation/ventilator -- support is initiated for the purpose of sustaining basic fuctions to allow for the body to heal itself and eventually return to self regulation.

If during the course of treatment it is determined the body will never return to normal or self regulating function then what are we supporting? Cellular respiration? Where is the justification to continue life support? Who are we to disrupt the natural order of things? Death comes for all of us.

Which is the lesser of the two evils?? Hastening death or prolonging suffering? I believe in this life pain is inevitable, however suffering is an option. If this man were able to make choices would he choose to be on life support until his body turned to mush hanging on tubing? I would not want that for myself. Would you chose this path?

And the reality of "Do no harm"... OK, if care is withdrawn then the patient dies...hastening death? He was dying before the docs got to him...we're all dying. In this case medicine is just delaying the inevitable. It's not like anyone can argue here..."Yeah, he might recover and go on to win the US Open. It's not our place to decide...only God knows." Not likely! At best this man's outcome goal will be "able to tolerate et tube for undetermined period of time"

When a person is walking down the street and BANG their life is cut short by an unitended injury, or an MI, or a stoke...then healthcare steps in and delays death...this is the magic of medicine...OK dude...you're heart stopped, your kidneys failed and your brain is bleeding but I've gotta some tape and a pill that will get you up and running in no time...thats medicine.

Medicine is not...OK man...you've been around for 100 years but I've got a set of tools that will keep you around for another few. You won't know you're here or remember any of the pain or that you were ever here for that matter...but we're gonna do it because we can...and its the "right thing to do"

So "Do no harm" and the patient dies of renal failure, or a HAI, or drowns in his own secretions...because the doctor ordered the continuation of care. Who is responsible for death now? The Doc...and the nurses and ancillary staff are accessories.

The docs were trimming necrotic tissue from the patient's wounds on a daily basis. His body is dying around him and all yet because the heart is still beating, as a result of mechanical measures, someone has redefined life.

Life is now " The process in which groups of living cells, tissues, organs and organ systems work together in order to acheive a mechanically assisted level of existence evidenced by the presence of a measureable blood pressure, heart rate, and tidal volume."

Look at it this way...if you could stand at your own bedside and look down on yourself in a similar state...would you allow care to continue?

To end my rant...the problem here is not a question of playing God. Humans, our society play God everyday. We attempt to manipulate our environment and control what cannot be controlled. We create illusions which quell our fears...the reality that we are not in control of anything.

...The problem here is not "Playing God"...the problem is knowing when to stop...and let life continue as it should...in a natural order.


If I ever get to this point the orders will be as follows:

1. 1000CC Quervo Gold Margarita with lime, no salt ATC
2. Open window

And don't forget the little cray paper umbrella...I like the yellow ones.

[leemacaz]

Originally Posted by Michigan RN

In other countries this wouldn't happen, so why are we doing this to the people here. It's disgusting. I think doctors should be able to make the determination when it's time to withdraw care and even override a family's decision in situations that would be otherwise futile. It's just awful that people do this to their family members. I had a patient who was 100 years old, on a vent, peg tube, decubs to the bone and the daughter (who can't even take care of herself by the way) is yelling in his ear,"five more years dad". Sometimes I just want to throw down my charts and scream "this is torture not healthcare"

And I'm gonna say this and its gonna **** some people off and I don't care. But these patients, the ones who are vented for life with no chance of a quality of life, need to be let go. Do you realize how much medicare/medicaid is being used to pay for the care of these patients. It burns me to think that a patient with no quality of life is being kept alive with my tax dollars.

For myself, I do not want to be kept "alive" at all costs....I have health care directives that I have written out (it is allowed in my state, although it seems docotrs and or family can override) that state very plainly I do not view being tortured as "taking care of my health care and my best interests. When I no longer have a quality of life I want to be allowed to die. My standards as to what qualifies as quality of life is different than the medical communities....I already know there is a good chance I will be kept going beyond where I want to and the thought of enduring what I have seen some of my own relatives go through makes me hope I will wind up with a doctor who will say enough is enough. AND with health care costing soooo much now and so many unable to afford it it just does not make sense to expend resources keeping someone in a living hell they are never going to recover from it seems wrong. Spend the money giving someone who has a future a chance not on torturing those who have none. I am not a nurse....and it is not all about the money..it is about decency and mercy ( you care about me..let me go),

[inthesky]

This is the reason I cried during much of my ICU rotation. It also didn't help that I kept getting images of my 94 year old grandmother on the vent. Thankfully, my aunt eventually relented.

I had one patient with severe foot drop and leaking edema soaking the bed. One patient kept coughing the vent out. This poor nursing student had a close heart attack when the vent pulled out for the first time and no one else was in the room. The son told me about his father and what a great man and father he was; it melted my heart. I had one patient who was not given enough anxiety meds and would cry when she was suctioned and would bite down on the tube. We had to suction her anyway because the tube was getting blocked with mucus. After a month, they finally placed a trach. She would eventually get better, but making her cry made me want to cry.

needless to say, I'm not an ICU nurse.
=P

[Dr.Nurse2b]

Originally Posted by inthesky

This is the reason I cried during much of my ICU rotation. It also didn't help that I kept getting images of my 94 year old grandmother on the vent. Thankfully, my aunt eventually relented.

I had one patient with severe foot drop and leaking edema soaking the bed. One patient kept coughing the vent out. This poor nursing student had a close heart attack when the vent pulled out for the first time and no one else was in the room. The son told me about his father and what a great man and father he was; it melted my heart. I had one patient who was not given enough anxiety meds and would cry when she was suctioned and would bite down on the tube. We had to suction her anyway because the tube was getting blocked with mucus. After a month, they finally placed a trach. She would eventually get better, but making her cry made me want to cry.

needless to say, I'm not an ICU nurse.
=P

The one thing I am pretty certain of is if Diprivan is involved the patient won't remember a thing...at least thats what I have been told by the patients I meet for the first time...after caring for them for 5 days.

And since you mentioned cost...

True story...an elderly woman ends up in the hospital at the ripe old age of 102 or something like that...She required extensive care and was kept alive long after the docs started removing parts of her limbs. Transfer from LTC to ICU and back again, and again.

The family is blue collar, worked for everything they had. The state took the womans entire savings, retirement, and home to pay for healthcare. After all if you have the money no way medicare is going to pick up the tab...The family could do nothing because grandma's assets were not "protected"...and so one woman's entire legacy, instead of being passed onto the surviving daughters, was absorbed by the state to pay for 9 months of "CARE". The woman owned her own home before going in...the family had to borrow money to pay for the funeral.

If I am going to blow my entire life's savings then let it be on a girl named Helga from Amsterdam who of course knows how to mix perfect margaritas!

[CHATSDALE]

if the patient has no living will/advanced instructions then this should be discussed on admission, most people will not want to live like this and will sign
it is important for everyone, patient, family, helath care providers that
DEATH IS NOT THE ENEMY, THE REAL ENEMY IS NO QUALITY OF LIFE
AND NO HOPE FOR CHANGE

[vashtee]

Originally Posted by Dr.Nurse2b

Define "Life" and "Living"...

It seems in this case, my opinion of what constitutes life doesn't matter, and you need not rant to me. I already said I was playing the devil's advocate, and yes, there IS another position on the matter, even if I don't care for it personally.

[Michigan RN]

Oh everybody just chill out.

[marachne]

OK, I haven't read all the comments, so if I'm repeating something, please forgive me.

Here's the thing: while I do not agree with the way things are playing out in this case, part of the issue is that he is an orthodox Jew, and in Jewish law, once you have started treatment, if the patient is still alive you can't stop it -- it's murder. We have had a few cases like this and had to deal with this. I believe in Israel they have timers on the vents so that they can reevaluate and if continuation is futile, they can just let the vent "go off." Then it is not an active action but allowing things to happen "naturally" (not that there's anything natural about being on a vent). Here's some things to flesh out what just paraphrased:


From Bioethics for clinicians: 22. Jewish bioethics
Gary Goldsand, Zahava R.S. Rosenberg, Michael Gordon
CMAJ • JAN. 23, 2001; 164 (2)
3 main principles: “human life has infinite value; aging, illness and death
are a natural part of life; and improvement of the patient’s quality of life is a constant commitment.”22 Other important principles are that human beings are to act as responsible stewards in preserving their bodies, which actually belong to God, and that they are duty bound to violate any other law in order to save human life (short of committing murder, incest or public idolatry)...In general, traditional Judaism prohibits suicide, euthanasia, withholding or withdrawal of treatment, abortion when the mother’s life or health is not at risk and many of the traditional “rights” associated with a strong concept of autonomy. For example, an observant Jew would not consider it his or her right to seek physician-assisted suicide as a way to avoid present or future suffering from metastatic carcinoma. Exceptions to these prohibitions are sometimes made in extreme circumstances...challenge is determining the moment when hope for continued life is lost and the process of death has begun. Jewish law is relatively clear that life is not to be taken before its time. It is equally clear that one is not to impede or hinder the death process once it has begun.

Basically, in cases like this you need to consult a Rabbi -- or two, or three. They will bring their understanding of Halacha (Jewish law) and the circumstances to provide guidance. You may not like what they say, but as long as we let religion trump secular ethical stances, it's a matter of respecting the belief system of the family.

The irony is that this is being discussed at the same time that the death of two young people b/c they belonged to a faith healing sect.

One last note: this approach is not common among all Jews -- only SOME Orthodox Jews follow this approach. It's like any culturally competent/sensitive/humble care -- one size doesn't fit all within a cultural group