Texans debate Futile Care Law, - page 2
am i the only one who see's something REALLY wrong with that quote??... Read More
Apr 17, '09Jan,
You're my hero. I have never heard my beliefs about this issue expressed so eloquently and compassionately.
Apr 17, '09Quote from lamazeteacherAt the hospital that I work at, a ventilator step down unit was just recently put into place. That means that all of those trached, vented pts who have multiple system failure and who will not get better, and are not placeable anywhere else (because they are either too complex or are not only on a vent forever but on dialysis as well and are too expensive) sat in critical care units for months and months because that was the only place that was trained to care for pts on a vent. So now they sit in our step down unit, qualified for it solely on the basis of being on a vent, for months and months, and basically go back and forth between critical care and step down as their bodies break down, being resuscitated again and again, until they finally wear out. Granted, this isn't every single pt, but there are a good many of them, and besides just the dollars and cents issue, the prolonged agony I see in some of these pts breaks my heart. I see the flaws in this law, but I have to agree with jan, I think working with this pt population makes me, at least, understand the thinking behind it..
What puzzles me, is why patients who are moribund and require less active treatment are ensconced in ICUs, with nurses burning out around them. My recall of the long ago days I spent around that unit, is that only acutely ill patients were admitted there, whose death was unexpected, or might occur if they weren't there.
Apr 18, '09Interestingly (or oddly, perhaps) the one group of children we rarely see on our unit are the oncology patients. By and large when those children come to PICU, they're admitted for a specific, reversible problem such as tumor lysis or chemo-related right-sided heart failure; they're treated and transferred back out again in a few days. Only two of their kids have died on our unit in the last 6 1/2 years.
Apr 18, '09Quote from janfrnChange the venue to Canada where we already have universal health care and there is no bill presented to the family at the end of it all... In every ICU in the country there are patients at this very moment who have no possibility of recovering in any way, not just in a "meaningful" way. Patients who have no awareness of their surroundings, who have no awareness of the passage of time, no awareness of whose hands are turning, diapering, suctioning them or in many cases that these events are even happening. Their families have insisted they be kept "alive" for as long as science will allow, for reasons they aren't always willing to share. And the hospital staff provide mechanical ventilation, vasopressor support, artificial nutrition, dialysis, and any other litle thing that will keep the heart beating until it stops, then performs CPR for as long as physically possible before ceding the field to the opposition. Where is the dignity in that?
But you will never convince a certain portion of the population of that. One family member told me that if God had really wanted his son, then He wouldn't have allowed science to develop all the life-sustaining therapies we have today. And if we have all these wonderful tools at our disposal we darned well better use them on his son! The son has had more than a dozen prolonged cardiac arrests, numerous pneumonias and bouts of sepsis, prolonged apnea, decubitus ulcers, UTIs, diaper rashes, the whole gamut. He shows no evidence of being aware anyone is in the room with him. He used to cry when he was suctioned or had chest physio, though he hasn't been doing that any more for about 5 years. But he still has a heart beat.
I would argue that when you go beyond what is reasonable, into the realm of advanced intensive care, for a patient who will inevitably succumb to their illness, that we're in fact doing them a disservice. I can think of no worse torture than to be trached, ventilated, GT fed, turned, bathed and diapered by strangers, dialysed when my kidneys fail, my decubiti debrided daily causing great pain, sedated anytime I show any measure of displeasure at my plight. Especially if there's a part of me that knows I will die anyway.
In my world we already have that for every patient... they're called parents. But they are also not completely objective and will only hear what suits their construct of the situation.
Those are certainly worthy endeavors, but the largest portion of the health care dollar is spent in the first and last year of life... for advanced intensive care. An indefinable cost of this is the significant moral distress suffered by those who provide this care and the burnout that inexorably follows the demise of these patients. It might be difficult for those who do not work with this population to grasp that degree of distress, but I can tell you that a single recent patient situation on our unit caused six very experienced ICU nurses to leave for units where they would be insulated from having to live through anything like it again.
If you're excluding the Netherlands, Belgium, Switzerland and the state of Oregon from the list of civilized countires, then this statement is true. The Netherlands and Belgium allow euthanasia, while Switzerland and Oregon allow physician-assisted suicide. Despite the legality of euthanasia in Belgium, a recently published study suggests that it's used only very infrequently. The paper makes interesting reading. http://www.biomedcentral.com/1471-2458/9/79
You my friend can take care of me anytime. Your response was very insightful and impressive. Do you know AFM in OKC you two sound very much alike and I would have her take care of me in a heart beat. Thanks for your input it was fantastic but you will pardon me if I choose NOT to live in your state/country?
Apr 18, '09TuTonka, I live in Canada and I'm a career peds nurse... You wouldn't want me to look after you, but I'd gladly look after your children or grandchildren!
Apr 18, '09Quote from janfrnTuTonka, I live in Canada and I'm a career peds nurse... You wouldn't want me to look after you, but I'd gladly look after your children or grandchildren!
Awwwww come on where is your sense of adventure. LOLOL But yes I have two beautiful grandchildren and a great Grandchild and you can still take care of them LOLOL.