A philosphical question bound to regress to name-calling and flames - page 2
Here's a discussion for you -- and bear in mind this does not reflect any particular personal belief: Does health care in general do any good for our species? By saving people from horrible... Read More
Dec 6, '02if it's wholistic, respecting the person and his/her dignity as well as wishes above others' egos and other impediments, then yes, it can and does do good. unfortunately politics, HMO's, and so many other things do get in the way of that. I just wish we would all move faster toward practice under a wholistic, respectful model that recognizes death is NOT AN OPTION ONLY BUT A REALITY and learn when to let GO!
Dec 6, '02When I was a nursing student, we were given our patient assignments the day before. A brief history, prognosis, medications, etc.
My assigned patient was on a vent, had been for 6 months, paralyzed from the neck down due to a progressive neuromuscular disease which eventually reverses itself (but it takes more than a year).
I thought, "Why is her family putting her through this? What a waste!"
But then I met her. One of the most totally alive people I have ever met. Flaming red hair (dyed), great attitude, constant visitors, smart...she had kept a journal since she was 16 and continued to journal (I recorded some of her thoughts for her). Brilliant mind, great writer...
what a waste to have let her go early! And she WANTED to live, wanted life, wanted to be with the people she loved (she got better and eventually went home, btw).
So, how would you ever pick who is expendable and who isn't? I wouldn't care to have that job and I can't think of anyone I know who'd be good at it...Last edit by researchrabbit on Dec 6, '02
Dec 6, '02Good thread. I have asked and answered myself many times on this topic. In a teaching hospital, I think a lot of the codes etc. were for training purposes, as were some of the surgical procedures done there. I doubt seriously that the "powers that be" would ever admit to this. So how else are they going to train Dr.s and nurses? Doesn't this thing perpetuate itself, i.e. train a doc to be good in a code situation, and he/she is going to save more people that shouldn't have been saved in the first place. It is truly a can of worms, and a question that needs much further exploration from ethics committees etc. No flames here, it is a question that needs an honest answer before the whole country is bankrupted trying to save those who don't even know they have been saved.
Dec 6, '02What a great thread!! Great posts!! Lots of food for thought. Loved the last one, made me think of my father. They decided to do surgery while he was in full blown septic shock, pressure barely maintained with Levophed (aka leave em dead). Why this torture??
So far, he's still around fighting with me. Fortuanately, it only took a month. Guess he wasn't ready to go. I wasn't ready for him to go either. Very hard judgement call.
He was in his seventies, had triple CABG the year before.
Answer to the original question? Nah. We can try but we're not that powerful.
Addendum: I posted at same time as someone else. "The last post" specifically referred to researchrabbit. Liked the new one too.
Great discussion. Thoughts without flames. Is this possible?Last edit by abrenrn on Dec 6, '02
Dec 6, '02I think in the U.S. anyway, it is survival of the wealthiest. If you have the money they won't stop. If you're poor and/or don't have health insurance, people are less likely to work with you. I think this is truly unfair. Don't flame me, please
Dec 6, '02Matt, I love you for this thread.
Emily, things are not always as they seem. Best pediatrician I ever met was in a local health department that gave free or reduced price care. She was tired of trying to keep parents happy in private practice by giving antibiotics for viral sore throats so she took a job in the health dept. The patients had nowhere else to go when she said no antibiotic unless the strep is positive. Yes, explaining is nice, lots of people don't want to hear.
You know who gets all there shots here? Kids on WIC. They need their shots to get their checks. Coercive? I suppose. On the other hand, they can so no to the checks.
Best HIV care I ever saw, Kings County Hospital and Downstate in Brooklyn. Lots of HIV, lots of poor people. And everybody knew the score, including the patients. If I want care, I have to be used as a learning tool. But, there were always good teachers in the background.
I'm not flaming, Kristy, I hope you know that. It's just that I saw what I saw. I wasn't surprised when I found the pediatrician at the Health Dept graduated from Harvard. I already knew she was that good.
Dec 6, '02I don't think universal healthcare is a right, but I think it would be barbaric not to offer universal pain control, not matter what.
If it was my Dad with the CABG and septic shock, etc I could never just give up, so I understand why family members choose to fight to the bitter end. Unfortunately by saving one man with a poor prognosis we have just upped insurance rates, denying care to several others. Or in the Canadian system, where you get X money for Y population one critical care patient means that 10 homecare visits were not available. (these aren't actual statistics, just an example)
You know I think that the universal healthcare fight is shortsighted and selfish(for the current generation). If we want to better the planet how about the right to free quality education. We'd better our current situation and improve the world sotuation for our children.
Dec 6, '02I think emily is right in that the richest get the best care. That will moreso prove itself once we have the ability to genetically alter DNA so that disease and undesirable traits are removed before conception. At that point, those who are engineered to be totally unafflicted before they are even born would probably think that these developments are great for them...but as to whether that will be good for the species as a whole? That is the question!
Dec 6, '02Originally posted by mattcastens
By saving people from horrible illness and poor lifestyle choices, are we encouraging a weaker human species by going against natural selection processes?
If true, it would sure blow Darwin's theory to hades.
Dec 6, '02I agree with canoehead about the problem regarding the surgery with poor prognosis, even though it was my father.
It was an interesting situation and I got there after all decisions were made. When admitted he was already in shock and vomitting. They missed the diagnosis and did a lap - no problem.
My father is a physician, retired. The intensivist had worked with him and considered him his mentor. Basically, he said he could not let my father die on his watch. So, he spent hours grilling my father's wife. Finally she remembered what he said when he diagnosed his own problem (he's a pretty good doc) - in the middle of severe vomitting (which he dxed as e coli food poisoning in the car on the way to the hospital by quantity, color and volume), he said, "I'm having chest pain, it's not cardiac, take me to the emergency room."
Once the intensivist heard that, he called the cardio-thoracic surgeon and told him he had a patient with Boorhaave's syndrome. The surgeon was driving out of the garage, corrected pronunciation and asked who was the patient. When the intensivist told him the name, the surgeon slammed on his brakes and was there in three minutes.
The surgeon insisted on the surgery to my brothers, the intensivist was hoping to hold off. My brothers were a bit upset by all this, they did what the surgeon recommended. He also knew my father and couldn't let him die if there was anything he could do to prevent it.
I didn't get there till after the second surgery. I told my father, while he was pavolonized and on a vent, that if he was tired and wanted to let go, I, for one, wouldn't blame him. I guess he did not want to go.
Health care decisions sometimes make themseleves. When it is personal people do things they might not have done. IN this case, everyone who knew my father, knew he was strong enough to get through it, if they could get there jobs right.
Sorry for being so personal here. Sometimes health care is personal. The fact is, it is personal to everyone who gets sick and, ideally, the health care system would respond the way it did to my father. If they didn't know how strong he was, they never would have decided to do what they did. Fortunately, the surgeon knew how good he was.
Surgery was done twenty five hours after the tear happened (that's what Boorhaave's is, a tear in the esophagus, often brought on by severe vomitting). Every book I read said mortality is one hundred percent if surgery is not done in twenty four hours.
I think it helps everyone to learn that the textbooks are wrong sometimes.
I am tempted to feel guilty that my father got such good care when others don't. But, in the best environments, other patients benefit from what the caregivers teach themselves. Now the intensivist will be more open to that diagnosis. The surgeon knows the textbook is wrong. They experimented on my father because they loved him and did not want to let him go. He would have let them anyway, he knows they need practice.
Dec 6, '02All I can say, is that I have often thought that I personally would not want to have my life prolonged.........I mean, retiring in my 60's (probably my 70's by the time I get to that point)...fixed income, sure to develop at some point multiple maladies which can be cured by some miracle drug or whatnot, but which costs a frigging fortune. Who knows what kind of health programs will be around then...wil medicare still exist? and even so, it's not exactly the best, as it doesn't pay for those "frigging expensive drugs", and has so many limitations. So there I'll be living out a life that might never be quite my own again....people live into their 90's now, some longer, hell I want to be dead before then! I don't want to wear diapers or take 12 pills every morning, 6 at noon, and 8 at night. Maybe by then there will be more miracles, but unless they truly make quality of life better, then why bother? I don't want to live forever....or even close to it.
But hey, that's just me. Weaker human species? I have no clue. Seems we'd have some real major population problems though.
Dec 6, '02Healthcare (and Education) should be free in any country that wants ALL of its citizens to achieve the best that they can, which in turn, enriches that country. Needlessly prolonging a life which has no quality apart from continued existence is another thing.
I don't remember if it was a play or a documentary, it was a long time back, but the title stuck with me;
"Are you doing this for me, Doctor, or are you doing it for you?"
It's a question which should be put more often.