Medicine: Have we gone too far? And, is our system ethical as a whole?

  1. Sometimes I disagree with some of the things that I do in my job. I'm sure we've all felt this, such as a 95 year old full code on a vent, or other such scenarios.

    Personally, I feel like medicine often goes too far, especially in prolonging end of life. People view it as their salvation from death, in almost a religious way. Meanwhile, some people don't even have access to clinic care because of their lack of insurence.

    Medicine will spend 1 million + for organ transplants to save one life, then some clerk at 7/11 can't even be followed by a primary doc because they don't have insurence.

    I had a pt last night, a man on his last leg, who should have been a no code, but we're spending a small fortune on him. As a side note, he brought his health problems on himself entirely due to his terrible health habits. How about drug and ETOH addicts that then cry out for liver transplants! Where's the justice in that while some kid in South America just needs clean water?
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  2. 78 Comments

  3. by   Mission
    :yeahthat:

    I remember seeing some patients during my med-surg rotation and telling my friend if that if I was ever like that I would want her to put a pillow over my face. Just let me say goodbye to my family, give me a morphine drip and let me die in peace. What is the point of prolonging a life when there is no quality to it?

    I think a course and maybe even a clinical rotation in palliative care needs to be to be mandatory for nursing and medical school. If we can't talk about death, how can we talk to our patients about it?
  4. by   TazziRN
    I agree. We recently coded a liver recipient who lost his original liver to alcohol abuse. After the transplant he started drinking again and lost the second one, eventually dying from liver failure. And even then he was a full code.
  5. by   GardenDove
    I just feel that there is a huge ethical imbalance in our healthcare system. Also, there is still a very poor addressing of end of life problems. I also think that the public expects new expensive technologies to be their saviours. Plus, our distribution of health resources is so out of whack in the United States, it's unreal.

    Another thing is that people aren't taking responsiblity for their own healthcare enough. And we're all paying for it! Our system is so wasteful, and we're hemmoraghing money to extend the lives of dying people in unreal amounts.
  6. by   nurse4theplanet
    The healthcare system is becoming harder and harder for patients to access. I agree.

    I don't necessarily believe that medicine is going to far...in terms of treatments and new procedures. Yes, it can be abused, but for the most part it is improving and saving lives by leaps and bounds. I think views on this vary based on which areas of medicine you see on a daily basis. For example, those who work for cancer research hospitals, transplant organizations, children's hospitals, etc. would probably see a greater amount of good being done with new medical capabilities. On the other hand, when you work in areas that have a large population of elderly pts coupled with a high death rate (LTCs/ICUS), or areas like home health, public health, and plastic surgery clinics...you may feel that innovations in medicine are being abused, used in vain, or not reaching the populations that need it most.

    An overhaul on the system is indeed in order. But where do you even start? Government policies, insurance companies, hospitals, doctors...where are the failures in the system and how do we fix them?
  7. by   traumaRUs
    There are huge ethical dilemmas in our health care system. Have you considered sitting on your hospital's ethics committee? What about getting involved with social services or pastoral care or whoever discusses end of life care with families?
  8. by   Agnus
    Don't get me going on on the immorality of the current health care industry. I could go write volumes.
  9. by   casi
    It seems that the issues with death and dying have more to do with the fact that people just don't understand death until they experience a loved one dying. Even then I question how much they understand is going on. I was talking to a friend the other day about a resident that I had just lost. I was just venting because I was stressed and mentioned that it was hard to watch someone just waste away because they weren't eating or getting fluids, and bluntly just starving to death. He thought I was cruel! It took me awhile to try and explain that it was rather normal, and just apart of the dying process. If someone's body is ready to go isn't it more cruel to start hooking them up to IVs and tubes to prolong their life instead of providing comfort?

    If people knew more about death and were allowed to get comfortable with the idea of death and the dying process maybe it'd be easier to step back from the glamorous world of technological health care. Most people get their medical knowledge from medical shows and if you notice on medical shows people only die after the Doctors make every gallant attempt to save someone's life. When was the last time you saw hospice care on House or Grey's Anatomy? Heck, when was the last time you saw a nurse caring for a patient on those shows?
  10. by   SCRN1
    I understand what you're saying and agree to a point. Personally, I wouldn't want to continue to "live" if there was no quality of life left either. But we were always told in nursing school that it isn't up to us (doctors included), no matter if that patient has no chance whatsoever to recouperate, to decide if they should continue with life saving measures. To some people, they do not want to die no matter what. So, I just try to deal with it when I know that the patient would be better off not living. There have been so many full codes who should be no codes but the family just will not allow it. It's sad.
  11. by   GardenDove
    I probably would find satisfaction from participating in an ethics committee, not sure if they get openings often.

    As far as death and dying, you seem to have extremes in the media. You have your right to life, don't withdraw care otherwise it's Euthanasia group, and on the other side you have the Kevorkian types. Where's the balance?

    I think they should have a mandatory class in death and dying to graduate high school.

    The reason, though, that people don't address it is fear. People are afraid of death, pure and simple. Even devout religious people are.
  12. by   GardenDove
    As far as someone's right to drain the healthcare system because they are in denial about death, isn't there some sort of communal responsiblity here? Do we have a right to a million dollars in futile care just because we're scared to die? What about the basics for everyone? That's where I think our system is out of whack. We don't have infinate resources, as much as we would like to pretend.
  13. by   SCRN1
    There are lots of things I don't agree with but happen anyway.

    - We had a patient who was homeless and admitted. They did surgery and later found the name he gave didn't match his SS#. For some reason, they couldn't release him because of that and because of him not having any place to go. He remained in the hospital for a year getting dialysis.

    - Another hospital, another homeless person. He got a private room while there were some who work and have insurance having to share semi-private rooms. Private rooms cost more. But he got the private one because he has a tendency to hit someone if they touch him while asleep.

    - When working Labor & Delivery and Mother/Baby, I realized there were more patients there on Medicare than private insurance. The ones with Medicare got the same treatment, including all the freebies as anyone else. Who pays for all this? Taxpayers. These were people who fully able to work but refused so they could get free housing, free medical care, free groceries, etc and not have to leave home to work for it.

    - It doesn't stop with the young "women" either with people living off the system. There are so many people who can work but don't who wind up in the hospital at one point or another and get all the same treatment as those who work and have insurance. What really burns me up is there are so many who know how to play the system and get what they want while there are those who really can't work and can't get help or either it takes them years to get it.
  14. by   CrownHunter
    The problem with this line of thinking is that who would be the one to choose who gets extencive measures to save their life? Doctors take Hippocratic Oaths after they graduate. (Its an oath that says they will do everything in their power to save a life regardless of income or circumstance.)
    I think if the quality of life is bad and we are otherwise unable to help then it is time to discuss DNR orders. Until then I would fight like hell to save a life, (especially mine if it were the case)
    Futhermore why would it stop at the old and feeble, I dont like the Idea that I have to pay taxes so that some petifile in prison for raping youg girls can have medical insurence. Now Im sure that he just might have had a change of heart and when he gets out he'll give back to the community, but I doubt it.

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