[gwenith]

Think on this - I recently found a research article that said that 1 in 5 deaths in the USA occur in ICU. That is not 1 in 5 ICU patients die that is 1 in 5 patients in the population die in ICU. What happened to natural death???

[Blackcat99]

Originally Posted by gwenith

Think on this - I recently found a research article that said that 1 in 5 deaths in the USA occur in ICU. That is not 1 in 5 ICU patients die that is 1 in 5 patients in the population die in ICU. What happened to natural death???

Yes natural death is no longer allowed. In the 1970's it seemed that the doctors would allow old people at the LTC's to die a natural death. Not anymore. Now it seems we are always sending people to the hospital or they are always receiving very aggressive treatment to keep them alive.

[devi]

This thread reminded me of something one of my instructors recently told our class.

She told us that even if someone is DNR, we should do our best to resuscitate them if their family is there and insists, despite the patient's wishes. That if the patient does not die, the patient is less likely to sue you for going against their wishes than the family is to sue you for not trying.

I have a real problem with this. Has anyone else been taught to do this?

[Trauma-tizedRN]

Originally Posted by devi

This thread reminded me of something one of my instructors recently told our class.

She told us that even if someone is DNR, we should do our best to resuscitate them if their family is there and insists, despite the patient's wishes. That if the patient does not die, the patient is less likely to sue you for going against their wishes than the family is to sue you for not trying.

I have a real problem with this. Has anyone else been taught to do this?

Haven't been taught this...it's just the way it seems to work...

[nursemary9]

Hi,

I really think the only way we can get a handle on this is by EDUCATION!!

We need to educate the public. I don't care how old people are, I don't care how young they are, if they are of legal age, people need to be educated on there CHOICES!

They need thorough teaching on Advanced Directives. they need to be talking about this in an informed way.

I have started to do this with EVERYONE in my family. I am tired of hearing--"Oh we don't talk about that"!! Well, you need to!!! You need to tell as many people as possible what you're wishes are. It's never too soon.

People need to start taking some responsibility for what happens to them.
I now know what every member of my immediate family wishes, as do the rest of the family, because we TALK about these things.
The people in my family have been getting everything in writing, and keeping copies with them. Also, people in my family are giving copies of AD to people they have made Powers of Attorney for Health Care, so in case something happens, I or someone, will have legal proof that I am power of Attorney!

We,as nurses are in a unique position to educate--our patients, there families, and our own families. We need to be out there talking about quality of life, quantity of life.

We also need to let go & be supportive of people who want everything done. They have that right.

I just think that so often people keep there families alive out of guilt!! It's so sad.

I have worked oncology for 30 yrs. i've seen it all; prolonging life until I can barely stand it & feel guilty doing these things to pat's. and letting people go peacefully. I'll take the later any day!!

[gwenith]

No we need to educate the public and in particular the relatives so that ICU is not seen as the drama queen's dream - think on all the soap operas. Days of our Lives and Muma Mia has just been admitted to ICU - there she is still in immaculate make-up and hair styling lying oh so tragically on the bed while the family gather round and express regret for every harsh word they have ever said.

Sadly for many people this view of ICU is the only one they have encountered so "life at any cost" becomes an easy ideology. It is too easy to deny that the person you love is going through hell when they do not see it. I am not sure about America but here we usually make sure the patient looks their best before letting the family in. We try not to do things to the patient that will upset the family while they are there. Perhaps this is wrong. Somehow we must break through the stereotypes implanted by the media to bring truth and acceptance.

[reprise]

One thing which was quite common 10 years ago was selective adherence to advance directives - so while only palliative care would be given for the underlying, terminal condition, doctors would actively treat any opportunistic infections or other complications likely to cause death as they arose (and they would present such treatment as being to make people more comfortable while either not mentioning or minimising the fact that it was also life-prolonging). I'm not sure how common such a practise is now. My partner had an advance directive in place and I held a medical power of attorney, but the doctors still tended to ignore both when they wanted to.

A neighbour of ours was on a ventilator last week and the doctors seemed to be working hard to try to convince the family to spare him the ordeal of a tracheotomy (he has emphysema and a host of other respiratory problems and has been "pulling through" for a year at the cost of appalling reductions in his quality of life each time). On that very issue, I made the rather difficult decision to allow my 13 year old to visit him in ICU last week and I don't regret that decision. I was concerned that she would find the experience distressing, but in fact it gave her a much greater understanding of just how sick he is (he's also experiencing multiple organ failure and had passed less than an ounce of urine in the previous 24 hours, so he was blown up like a balloon) and how interventions tend to cascade. We spent a couple of hours after the visit discussing why he was sedated and why his not weeing was such an issue and the fact that decisions made about his treatment do not affect whether or not this man will soon die but to a large extent they do determine how.

[mattsmom81]

Gwenith you are so right...natural death sems unacceptable here now...and equated to giving up or being weak, giving up the fight by some. They don't see the lost dignity. Also seems like in our hospital system, if someone dies it must be somebody's fault...and there's always a lawyer around every corner to grab a grieving family member and run with it. This is behind a lot of our futile care IMO.

One of my best friends is a nurse trained in Britain and she says it was not that way there. I don't know how things compare there now, but she was amazed to come to the US and see what goes on.

My mother was dx with inoperable cancer w mets to the liver...one massive dose of chemo ruptured something internally; and she went into a coma. My family looked to me for a decision what to do. It was easy for me...what are we saving her for I told them. if we intubate her and take her to surgery, we wil likely only prolong her misery, she may never wake up to anything and if she does it will be a life of pain and wasting away. Let her go. One of my sisters still accuses me of 'giving up' on Mama.

The public DOES live in this soap opera drama where doctors are Gods and can save everybody...(they watch ER and General Hospital right) so its hard to counter these fairy tales. Education and honest conversations will turn this around but its frequently up to nurses...as doctors can be the worst offenders. I've heard doctors tell families "I could have saved her but she gave up on me'. The God complex at its worst.

[earle58]

Originally Posted by mattsmom81

.

...as doctors can be the worst offenders. I've heard doctors tell families "I could have saved her but she gave up on me'. The God complex at its worst.

ditto ditto ditto
one of my biggest pet peeves...
i see so much needless suffering because of this God complex.

sometimes i would like to have them as a critical patient for one week.

[Energizer Bunny]

When my grandmother was dying, my grandfather only waited long enough for us to get there (about 12 hours.flying cross country) and then we made the decision to pull the plug. We never could have let it go on....we even had other family members on the way and we didn't wait for them. It just wouldn't have been right.