Our Death-Defying, Death-Denying Society - page 2

The following is a psychic reading that will eventually prove accurate with every single person in existence today: we're all going to die. The fact is that life will end, and how Americans... Read More

  1. Visit  Asystole RN profile page
    3
    Quote from Cold Stethoscope
    The...
    For clarity I am going to respond outside of the quote tree.

    As to your first point, the extraordinary measures in the face of insurmountable odds are what many would call keeping hope alive. I personally do not feel that keeping someone on a vent for years who is brain dead is exactly what I would do for my family but those decisions are for the patient/family to decide. As for family overriding the patient’s wishes, that is an issue for the court.

    As to the second point, I think this is a valid topic but I believe that the decision of providing life supporting care is something that is personal and the decision is driven by one’s culture, religion, and personal beliefs.

    I have personally found that western culture is not the predominant culture that pushes to extended life preservation but rather those of Native American or foreign origin.

    I personally do not believe that the 3rd party reimbursement system is the most effective system. I do not think that the system fosters the competition and quality of care. Medicare is unsustainable due to the fact that a larger population is/will be utilizing the system compared to the population that supports it. There are many serious problems with Medicare but I will leave that for another thread…
    Aurora77, lindarn, and Susie2310 like this.
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  3. Visit  Asystole RN profile page
    2
    To clarify my position;

    I do not think that providing social workers, councilors, or case managers to educate patients on the end of life process is such a bad thing. Some families may indeed push for extended end of life care due to a lack of education but I am willing to bet that many know exactly what they are doing, in my experience. Where I draw the line is in forcing someone against their wishes.

    I see this issue like I do abortion and the right to die issues. I do not agree with the decisions many make concerning their bodies but I firmly believe that when it comes to issues regarding someone's body that the decision should firmly lay with the individual and not the government.
    TJ'sMOM and lindarn like this.
  4. Visit  That Guy profile page
    11
    Quote from Asystole RN
    As to the second point, I think this is a valid topic but I believe that the decision of providing life supporting care is something that is personal and the decision is driven by one’s culture, religion, and personal beliefs.
    To this I would like to add a lack of education. People think that when we do these surgeries/codes/treatments that people will just get better. I dont think people fully understand the implications or potential outcomes or lack thereof for what we do sometimes. You can point the finger wherever you want to on this. You can point to faith, hope, culture, heck even media plays a part in it. People think that extreme measures always yield positive results. It doesnt.

    I live my life by the mantra of "Today is a good day to die, but a better day to live". Once I cant say the second part I want to go. I dont want to live here if I cant actually live.
    ProfRN4, TJ'sMOM, Aurora77, and 8 others like this.
  5. Visit  Tarabara profile page
    5
    I could not agree with you more OP. While I do think every patient/family has the right to decide on their treatment and when to say enough is enough I also believe there needs to be more discussion about what exactly these treatments entail. I've seen many people well into their 70s or 80s offered chemo, radiation, etc for their cancer when they have a very poor prognosis and just feel miserable with the treatment. Just as with the discussion of DNR/DNI, I think most patients and families dont understand that it has a low success rate and people dont just wake up back to their old selves like on tv.
    TJ'sMOM, lindarn, pomegranate, and 2 others like this.
  6. Visit  Asystole RN profile page
    3
    Quote from That Guy
    To this I would like to add a lack of education. People think that when we do these surgeries/codes/treatments that people will just get better. I dont think people fully understand the implications or potential outcomes or lack thereof for what we do sometimes. You can point the finger wherever you want to on this. You can point to faith, hope, culture, heck even media plays a part in it. People think that extreme measures always yield positive results. It doesnt.

    I live my life by the mantra of "Today is a good day to die, but a better day to live". Once I cant say the second part I want to go. I dont want to live here if I cant actually live.
    I would agree that education plays a significant part in the decision but I would be careful in assuming that a decision by a patient or the family that is counter to your own beliefs is founded upon a lack of education.

    While I worked at a SNF I had a patient who was on a vent for the last three years, brain dead, who was coded and revived several times (hence the brain death) who's POA was a cardiologist. They kept him going for strictly the patient's wishes and religious reasons.
    lindarn, microtutor, and Susie2310 like this.
  7. Visit  That Guy profile page
    1
    Quote from Asystole RN
    I would agree that education plays a significant part in the decision but I would be careful in assuming that a decision by a patient or the family that is counter to your own beliefs is founded upon a lack of education.

    While I worked at a SNF I had a patient who was on a vent for the last three years, brain dead, who was coded and revived several times (hence the brain death) who's POA was a cardiologist. They kept him going for strictly the patient's wishes and religious reasons.
    Oh I was not implying this at all. Im sorry if it came across that way. I know many people do not share my beliefs/thoughts and it is how it is. This is one of the reasons I get along well with my patients, that even when we disagree on things, I can still provide the care that they need and deserve.
    TJ'sMOM likes this.
  8. Visit  Been there,done that profile page
    3
    "Countless procedures, medications, treatments, and consults that are ordered during the immediate time frame prior to the end of life end up being futile. Also, many patients and family members want everything humanly possible done to fight off death despite having received a terminal prognosis."

    Billions of dollars are spent at the end of life , in a fruitless effort to prevent the inevitable. Many more than the dollars spent at the beginning of life.
    The only answer is teaching at the doctorate level. Future physicians need to be TAUGHT that their role is not to prolong life.. but to enhance the quality of life of every patient they care for.
    TJ'sMOM, LaughingRN, and SoldierNurse22 like this.
  9. Visit  Mulan profile page
    2
    Quote from Asystole RN

    While I worked at a SNF I had a patient who was on a vent for the last three years, brain dead, who was coded and revived several times (hence the brain death) who's POA was a cardiologist. They kept him going for strictly the patient's wishes and religious reasons.
    Keeping dead bodies "going".............maybe that is when someone else should step in, if only for ethical reasons.
    lindarn and tewdles like this.
  10. Visit  Asystole RN profile page
    3
    Quote from Mulan
    Keeping dead bodies "going".............maybe that is when someone else should step in, if only for ethical reasons.
    Who's ethics? Are your beliefs somehow more valid, more important, and the "correct" beliefs? Not everyone sees the human spirit in terms of electrical brain activity.

    As nurses we see terrible things and we know first hand that we all are going to die, most likely not well either. I think that many of us have lost hope, something that many outside of healthcare still retain.

    I certainly would not choose the path that many of my patients take but I certainly do not begrudge them for making a choice, a very difficult choice, that is contrary to my own beliefs.
    lindarn, Aurora77, and Susie2310 like this.
  11. Visit  Mulan profile page
    5
    Quote from Asystole RN
    Who's ethics? Are your beliefs somehow more valid, more important, and the "correct" beliefs? Not everyone sees the human spirit in terms of electrical brain activity.

    As nurses we see terrible things and we know first hand that we all are going to die, most likely not well either. I think that many of us have lost hope, something that many outside of healthcare still retain.

    I certainly would not choose the path that many of my patients take but I certainly do not begrudge them for making a choice, a very difficult choice, that is contrary to my own beliefs.
    Dead is dead.

    Who is paying for all that futile care by the way?
  12. Visit  Asystole RN profile page
    4
    I can see two rationales for refusing life saving measures in the face of terminal illness, one is an ethical concern and the other is a fiscal. I do not hold any stock in anyone making ethical (the nurse's ethics) decisions contrary to the patient's/families wishes, which would in fact be unethical by it's nature.

    The fiscal rationale I can understand but there are far greater and easier ways to save money. Why not cut services to illegal immigrants, prisoners, and those who refuse drug/alcohol rehab? Even better, why not cut services to those who ride motorcycles and refuse to wear a helmet? What about smokers, we all know that COPD is one of the most expensive diagnosis to treat?

    By the way, instead of cutting service to those who want life saving treatment, why not allow those who do wish to die with dignity do so instead of lingering on and utilizing healthcare resources? I would think that the right-to-die group should be the first group addressed if someone was concerned about fiscal savings.
    TJ'sMOM, lindarn, Jessy_RN, and 1 other like this.
  13. Visit  Cold Stethoscope profile page
    4
    Asystole, I'll say it again. No one here is arguing that patients should be forced to die, regardless of their condition. No one here is saying that the government should choose who lives and who dies. (That is the job of the insurance carriers.) The point is that people are choosing to go through proceedures that are more of a detriment than a benefit to their remaining life.

    You and I both agree that there are times that it's absurd to sustain life (e.g., after the complete cessation of brain waves). The question we are trying to explore here is: Why do people choose to try to hang on? Why do proxies for the patient so often choose to vainly extend life, even in violation of the patients written instructions? (If a family member decides that the patient will remain on the ventilator, then the patient's living will means little — that is the reality.)

    I've yet to see addressed here the question of why so many Americans, many of whom are so religious, have such a great fear of death, and such an unrealistic idea if what modern medicine can do to extend life, or at least, life that the patient would want to live.

    To really drive the point home: The issue is not death panels or taking people's rights away. It's like pondering why so many people smoke. While we shouldn't take their cigarettes away, and neither should the government, it's a valid question that even the most hardcore libertarian can ponder.
    TJ'sMOM, lindarn, Jessy_RN, and 1 other like this.
  14. Visit  Mulan profile page
    1
    Who's talking about the nurse's ethics? Most places have an ethics committee.
    tewdles likes this.


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