A philosphical question bound to regress to name-calling and flames - page 4

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

  1. by   VickyRN
    I personally am very grateful for the system of health care that we all enjoy, whether in Canada, Europe, or the U.S. We are VERY FORTUNATE compared to the rest of the world. If you are poor and needy, say, in someplace like India, and suffer a fracture.... well, you just suffer with it for the rest of your life. In the continent of Africa, 1 in 16 women die needlessly from childbirth complications. A huge percentage of babies die before their first birthday. Life expectency in these countries is very low (age 35-40). I would venture to say that every one of us reading this post without exception, owe our lives to some sort of health care intervention at a desperate point in our lives, without which we not be here at this moment reading this thread!!!! I remember when I was deathly ill from anaphylactic shock and required emergency intervention. Probably wouldn't have made it without those "simple" timely interventions. Also remember when I was pregnant and suffering from hyperemesis gravidarum. My baby and I probably wouldn't have survived the pregnancy, had I not received timely medical intervention.
    We are blessed, incredibly blessed. I view myself as a nurse as an extension of God's hands of healing in this earth. All of us share this "ministry." The poor, the weak, the "least of these" among us, deserve compassionate care. This is a basic human right.
    That said, as a former ICU nurse, I witnessed the other side of the coin--unspeakable atrocities being perpetrated in the name of "health care." Sure, we saved many lives and for this I am SOOO grateful. I also saw elderly nursing-home-type patients (FULL CODE) with absolutely no quality of life (some in a vegetative state) being kept alive, enduring horrendous torments on the ventilator, multiple drips, painful procedures, etc. etc, only to die slow, painful, torturous deaths. This is so wrong.
    I would never want to be kept alive if my quality of life were that poor. I also believe the wishes of the patient in that situation should be respected, and if the patient is incompacitated, then the family should have free reign to make an informed decision. (Notice, I said, INFORMED DECISION--a lot of family members don't have a clue as to what "FULL CODE" really means and the busy doctors don't take time to educate.) We are facing a crisis right now in our family. My 76-year old father-in-law suffered a massive right-sided ischemic stroke and is totally flaccid and without sensation on his entire left side--very poor prognosis. The stroke is extending and he is non-responsive. We were QUICK to make him a DNR as we love him very much and he would not want to be kept alive under these circumstances. We told his doctor--NO HEROICS-- keep him comfortable, and let him die with dignity
    Last edit by VickyRN on Dec 7, '02
  2. by   Neon8
    "Good for our species"? Let me point out that all these old folks have already passed on their genes. How is prolonging their lives harmful to the species?
  3. by   flowerchild
    Originally posted by mattcastens
    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 illness and poor lifestyle choices, are we encouraging a weaker human species by going against natural selection processes?

    Discuss at will.
    I have discussed this with many nurses over the years. I work with children who have genetic, induced, and other disorders. When I worked at the hospital, we would take the children on our floor after NICU transfered them. When a FLK came up we sometimes wondered "WHY?" is this child being saved. What possible quality could come for this life? After many years of reflection and study, my views have changed a bit. I still sometimes wonder why but now realize that there is a reason for every life. Sure we save some and we lose some but is it really OUR power? Probably not IMO.
    We, as a medical profession are not encouraging a weaker human species when we save a MVA and adult other patients who will need extensive therapy. Saving those lives has nothing to do with a weakened human species. Saving the life of a newborn with a severe genetic disorder perhaps does in that if they have children, they will pass on the genetic makeup for the disorder thus increasing the number of people who will carry the gene.
    In researching genetic disorders; In general, genetic disorders occur in children when both partners carry the genetic makeup for the disorder. I have found that sexually speaking we pick partners who are "like" ourselves, Through history we trace our ancestors back and can find deaths and info regaurding newborn deaths, but the genes live on, and now more newborns live instead of die, but it really doesn't matter b/c the gene lives on anyway and is passed to other children and so on. In looking at society in general, there seems to be a shift in the natural selection process for life partners, especially amoung the young generations, people are no longer choosing partners who a like themselves, but choosing partners who are very different. The more diverse the genetic makeup of a couple who are having a child, the less chance of them both having the same genetic makeup and carrying a gene that causes the disorders.

    My thought is that the human population will continue to survive and will continue to strenthen as the gene disorders are diluted through a naturally occuring instinct in the human race for survival. The only involvement that the medical field plays in assisting with this whole situation is that perhaps we have hastened the diversity and strengthening of the human race.
  4. by   Jenny P
    Matt, I've never really thought about it this way before (weakening the species and fighting natural selection,etc.).

    I HAVE often thought how we seem to be playing God at times when we prolong death instead of saving lives....
  5. by   mario_ragucci
    Health care is not on the level of species, IMHO. Science has helped our species with stuff like small pox vaccines and penicillin. Since all people on earth are not considered in any health care system, a species perspective can not be considered. You know what I mean :-)
  6. by   rebelwaclause
    Originally posted by eltrip
    My goodness, what a great question! I'm going to have to think on this one for a while.
    Ha!

    Actually, the first thing that comes to mind (for me), is the thought that healthcare isn't really a right. Its a need and necessity - But not a right. If you are speaking in terms of "Everyone has a right to healthcare", then yes, this is a true statement. In a general term like this...sure.

    Interesting, I caught an old episode of Hopkins 24/7. There was an MD who was really upset that an MRI he had ordered for a patient of his had to go through an authorization process before being approved. The Dr stated that his patients prognosis would have been better, had she been given the diagnostic earlier, but since it was delayed because of "waiting for a high-school secretary to approve the MRI", her treatment was expanded.

    What the MD didn't explain, was that the patient's medical plan was actually covered through her fathers employer (the patient was a young girl, teen-aged). What was further not explained is that companies go into bargaining about what benefits they want included for their employees and what they don't want to pay additional within the employer-health insurance contract. Something as basic as a MRI should be covered without a doubt, especially if ordered by a specialist with back up history included with the diagnostic request. But often times a delay in authorizing a request for treatment comes from PRIMARY CARE doctor's not following specific guidelines that are in place by the insurance company. Some insurance companies want a SPECIALIST to consult with the patient and primary care MD for a more accurate plan of care (Not thinking of an MRI, but more elaborate tests of diagnostic value).

    And who makes these guidelines? A PEER doctor who is the medical director over the insurance company. Most guidelines and protocols aren't just born immediately. The guideline was consulted by many MD's - Argued, drafted, changed, revised, redone, revised again and finally passed by the MD Medical Director AND a group of board elected MD peers. The "High-school diploma secretary" was only doing her job by approving a request for authorization based on guidelines or forwarding it on for Medical Director review - Who is the only person who can deny a request for authorization. (In California at least).

    And don't get me started on the secretary at the MD's office who didn't fill out the authorization request correctly in the first place. If vital information is missing from the initiating MD's office...This will delay an authorization request, PERIOD. And they tell patients "Oh..your insurance company hasn't approved it yet - They are being lazy or just don't want to approve it". WRONG! What that nice little secretary DIDN'T say was that "I didn't include a reason for the request, I didn't check to see if this is something I even NEEDED authorization for and I didn't return the insurance company telephone call to explain what the hell I even wrote, because who can read my handwriting anyway?

    Grrrrrrr.....I haven't even started on infertility benefits. Should an employer be held financially responsible to get someone preggers? I've been yelled at because someone thought infertility is cheap and free. Hmmm......

    Is healthcare suppose to cover everything? Should employers pay for a "everything included" benefit contract? Should patients ever have to pay anything?

    Grrrrr.

    Thanks for letting me vent.
    Last edit by rebelwaclause on Dec 9, '02
  7. by   Stargazer
    Well, I just checked in with this thread for the first time in several days and I must say I'm bitterly disappointed there's been no name-calling or flaming yet. Geeze. Promises, promises.
  8. by   mattcastens
    Originally posted by Stargazer
    Well, I just checked in with this thread for the first time in several days and I must say I'm bitterly disappointed there's been no name-calling or flaming yet. Geeze. Promises, promises.
    I know! What happened to AllNurses? Has everyone gotten civil? It must be just to impress Santa.

    Actually, I've been really enjoying what people have written. Since I started the whole thing, I should probably clarify that I don't belive the premise that I introduced, but I think it's an interesting question.
  9. by   KaroSnowQueen
    I think all this technology is a double edged sword. In some cases all this is wonderful, the young person dreadfully injured, brought back from death's door to be back with their families for fifty more years in a basically good condition.
    On the other hand, as in a case in my own family:
    70+ woman, chronic non complicant COPD'er. Smoked long after told to quit. On O2 at home for years. Chronic, chronic, chronic. Non compliant, non compliant, non compliant. Finally had an episode in April. Never fully recovered. Kept IN THE HOSPITAL, NOT EVER EVER EVER TRANSFERRED TO A NURSING HOME, BUT IN THE HOSPITAL, ON AND OFF THE UNIT FROM APRIL TIL DAY AFTER CHRISTMAS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!
    Poor woman was coded at her husband's insistence NINE times. The day after Christmas was the ninth, maybe the tenth, I've forgotten, they finally give up, the husband stands at the door yelling at them to go back in and get her back. He could not, would not face the fact that not only had "God called", God was jumping up and down yelling for her!!!
    The woman's siblings were against this coding. The children although all over 30 were with the dad in this. NONE of them could face reality. All they did was make this poor woman miserable for eight months to save themselves having to face her eventual departure.
    This was over ten years ago. Her husband died September 2001. He told his family NOT to code him under any circumstances and they didn't. It made me MAD! How could he do that to her and then not want it for himself?
    So in this case technology was IMHO, wasted to save the family some unavoidable heartache. I think if the patient, who was fairly well out of it from June on, had her opinion known, it would have been to let her go.
    Sorry to rant. But technology is not always the best thing for every case.
  10. by   BellaTerra2002
    I have seen many situations in which technology has overridden our humanity.

    JEMB: I agree with you. And this is why I want to do Hospice nursing. The patient is terminal and has accepted, more or less, that he/she is going to do so. At that point, all that needs to be done is to make the patient as comfortable as possible. Much more 'humanity' than 'technology', although certainly both are needed.

    I absolutely disagree with taking any type of extraordinary measures, including dialysis, to keep anyone over the age of 50 alive (and that includes me, since I'm over the age of 50).

    And as for spending a million or two to keep any one person alive, no matter what the medical problem -- I don't get it. There are only so many healthcare dollars to go around, and I think that those dollars should be concentrated on men and women between the ages of 18 and 50 (and child geniuses), particularly those who have minor children still to raise, who can be reasonably helped.

    I have a GF in her middle 60s who has been fighting breast cancer now for over a year. I know I will never do that because I've thought about it long and hard. She's had a good, long life (and so have I). Neither she (nor I) are making contributions to society that society can't live without. Perhaps it's time to 'move on' and make room for someone younger.

    When we stop seeing death (well, first we'd have to take a look at death and so many average Americans are in complete denial that death even exists) in this country as a personal and medical 'failure', things will change. But this is the US, and all we have to do is read the morning newspapers to know that we don't admit to failure in ANY area in this country.

    I am SO GRATEFUL I will never have to make a decision as to whether someone lives or dies. I keep hearing on this board that nurses don't have a lot of autonomy. At least when it comes to this, I AM GRATEFUL. I had a friend who was in Admin of a local hospital. The hospital took an anonymous poll of the doctors to find out who had committed a mercy killing. 38% of the doctors admitted to it. (That was 15 years ago. And, like she said, that 38% didn't include the doctors who didn't admit to it out of fear that, although the poll was anonymous, they'd still be found out somehow.) The doctors said that it had been a horrendous decision for them and that they still had some problems with the fact that they had done it. Although I'm grateful to them for doing what they thought was right (and probably was right all or most of the time), I am MORE grateful that all I will have to do is follow the doctors' orders.

    Anyway, until we see and accept death as part of of life (even in illness and accident and not just old age), we're going to have a lot more 'technology' than humanity.
  11. by   kimberle
    Some people don't want to be "responsible" in making decisions to "pull the plug", or for whatever reasons, I've seen very selfish decision making on the part of family members and/or significant others that makes me angry. All I can do it educate, educate, educate, and try to make patients as comfortable as I can. We've had to report cases to risk management/ethics committees to obtain humane care for patients that family members were not allowing. Also, on our unit, I would love to see family members pay a nominal "fee" for their family member on this ventilator unit - just something like $50.00 a month. I think we would see a little more family participation and evaluation. For example, we have a handful of people who are brain dead or barely above brain dead for a variety of reasons, who are full codes, and the family members never visit, or the rare times they do they are demanding and unreasonable. I think even such a little fee like that (which is barely above what some are paying for their cable TV) would make people think a little about what they are requesting. I tell you, we are really good at keeping people alive on our unit, if that's what you want, and it's not a very exciting picture at the end.
    Technology can get kind of crazy, but I guess we all have different ideas of what living is.
    (I work in a hospital on a assisted breathing center, where everyone is at some level of dependency on ventilators either partially or fully.)
  12. by   researchrabbit
    Why make 50 the cutoff point? There are many people who don't really hit their stride until then.

    There are 20 year olds who have less to offer than some 70 year olds.
  13. by   Stargazer
    Originally posted by BellaTerra2002
    I absolutely disagree with taking any type of extraordinary measures, including dialysis, to keep anyone over the age of 50 alive (and that includes me, since I'm over the age of 50).

    And as for spending a million or two to keep any one person alive, no matter what the medical problem -- I don't get it. There are only so many healthcare dollars to go around, and I think that those dollars should be concentrated on men and women between the ages of 18 and 50 (and child geniuses), particularly those who have minor children still to raise, who can be reasonably helped.
    Well, here we go, Matt--flame on. I find this both bizarre and completely arbitrary. So you're actually for witholding lifesaving treatment for children under 18? I believe that there are some childhood cancer survivors on this very board who might disagree with you.

    And what qualifies as "extrordinary measures" and where do you draw the line? Not trying to be argumentative here-- I'd honestly like to know how you propose to quantify some of these things. If an otherwise healthy 51-year old has appendicitis, are you going to deny the appendectomy he needs and let him die of peritonitis? What about folks who only need dialysis temporarily, or even ONCE, because of a drug reaction or a kidney infection? Are they refused also? Are pacemakers and AICDs extraordinary measures? How about insulin pumps?

    Believe me, as a former ICU nurse I am not someone who thinks everybody should be kept alive at all costs.--I completely agree with KaroSnowQueen's entire post. But I think your ideas swing a little too far in the opposite direction.

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