How do you feel about the right to die? - page 3
I was just curious as to what other LTC nurses thought about the right to die? I am very supportive of someones rights to die with dignity. However I am quite uncomfortable with a current situation... Read More
Dec 27, '06I agree wholeheartedly with canoehead - show me a patient over 80 who has the cerebral and cardiac circulation to survive a cardiorespiratory arrest intact and I'll reconsider. Until then...
I've had to resus too many 80+ patients at 2AM, felt their frail ribs crack under the pressure of cardiac compressions, managed to get them half way back, only to have a consultant decide that ICU would be inappropriate. It feels like I'm grabbing onto them on their way to heaven, putting them through agony, for nothing. And the only thing that's changed in their condition is the arrest.
Survival stats haven't changed in 30 years. Around 50% of patient survive an arrest. Around 50% of those patients rearrest within 24 hours. One study showed 16.6% of patient surviving to discharge, and that was with pre-screening inappropriate patients out (Arch Intern Med -- Abstract: Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target, November 14, 1994, Ballew et al. 154 (21): 2426). Overall survival is around 5% (Medical College of Wisconsin - Researchers find ways to improve CPR survival) - and that's not "neurologically-intact survival". In one metastudy, "long term survival" was three months post discharge (Entrez PubMed)!
Meta-analysis reveals that the most significant negative predictors of survival from CPR are renal failure, cancer, and age more than 60 years, while AMI is a significant positive predictor. The PAM [pre-arrest morbidity] index is a useful method of stratifying probability of survival from CPR, especially for those patients with high PAM scores, who have essentially no chance of survival. Entrez PubMed4 percent of the patients (n = 10) were alive at the end of follow-up (mean, 22 months). None of the patients discharged alive had a significant new neurologic deficit, and all but one returned to their preadmission environment. The post-CPR hospital charges for each of the surviving patients was estimated at $63,000. Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. A prospective study -- Berger and Kelley 106 (3): 872 -- Chest
Dec 28, '06If they've made it well and healthy to their 80's or 90's, when something goes wrong, like a resusitation, it generally doesn't have a good outcome. Even if you DO get them back, you'll probably have broken ribs, they'll end up on a vent in ICU, where they will most likely end up with pneumonia related to the broken ribs.
Their last week or two will be miserable, and then they die - I've seen it happen time after time!!
There are a multitude of reasons why their families don't want to let them go - genuine love, guilt, etc. But the greatest heros in my book are the family members that say 'I don't want any more of this stuff done to my mother - or father - or whoever.'
Dec 28, '06I've heard opponents of right to die say that it will easily become a duty to die.
I still say let me have it. I don't want to burden anyone.
Dec 29, '06There's a really interesting ethics text called "Is there a duty to die?" that addresses why, is some situations, that would be the more ethical thing - heartbreaking story about the middle-aged daughter of an elderly woman.
Jan 3, '10How about someone who is in their early 40's, breaths on their own, gtube for ALL nutrition and meds, mentality of a less than 3 month old and a parent who insists on pt being a full code? I am so afraid of this person coding on my shift. We having starting fighting routine pneumonia and recent ilius.. This person has never had any quality of life, IMO. Just laying in bed or being pushed in a chair. Their only communication is occasional crying out when wet or discomfort. It's sad.