ethical issues with aggressive treatments and end of life

oramar · Apr 25, 2004

Last night I had patient for the first time who is in her late 50s. She has already been resusitated once(just barely) due to serious arrthymias. She has been a renal dialysis patient for several years and has a deadly lung condition which is killing her slowly. The woman had a automatic implantible defib. device inserted shortly after the recent resusitation. As you all know these things are very expensive to buy and insert. But let's not consider the money here, let's talk about the patient. She is alert and oriented a very nice person even though she has been through hell. However, the thought popped into my mind that they cheated her out of a quick relatively painless death only to have her die a slow death of suffocation and kindney failure. Would you believe I am not passing any judgement here, just wondering about our healthcare system and the way people seem to be offered the expensive aggressive treatment. She said the doctor told her she had to have this thing inserted or she would die. Well everyone is going to die. If I were in her shoes knowing what I know I would have declined having the device inserted but most people don't know what I know. Also, I just think I would decline to have device inserted. I don't really know what I would do in that situation. I guess with her age and everything the situation is very borderline.

leslie :-D · Apr 25, 2004

do you have any idea on how the pt. feels? obviously she must be a full code....just wondering. if it's something the patient wants then she needs to make herself a dnr, in other words, it's her call. it really doesn't matter what we think. now it would be another matter if she did not want to be resuscitated and they did it anyway.

leslie :-D · Apr 25, 2004

do you have any idea on how the pt. feels? obviously she must be a full code....just wondering. if it's something the patient wants then she needs to make herself a dnr, in other words, it's her call. it really doesn't matter what we think. now it would be another matter if she did not want to be resuscitated and they did it anyway.

Stitchie · Apr 25, 2004

This sounds to me like a classic case of the physician not explaining all of the available options to her, one of which is a gentle death.

My philosophy is 'just because we can doesn't mean we should'. You're right, everyone is going to die someday, and if her condition has now caused her to become a cardiac cripple, or endure a lifetime of dialysis, is this really what she wanted?

Is she still a patient on your unit? Can you talk to her about end of life issues? It's difficult, but sometimes the best thing to do is talk about her options, such as hospice and DNR status. Sometimes the greatest advocate you can be for your patient is to give them options for a gentle sendoff. None of us are promised endless tomorrows.

As someone posted in another thread, it's all about the $$$, and if there's a big fancy 'operation' that will keep her alive the last thing anyone talks to the patient about is quality of life!

Stitchie · Apr 25, 2004

This sounds to me like a classic case of the physician not explaining all of the available options to her, one of which is a gentle death.

My philosophy is 'just because we can doesn't mean we should'. You're right, everyone is going to die someday, and if her condition has now caused her to become a cardiac cripple, or endure a lifetime of dialysis, is this really what she wanted?

Is she still a patient on your unit? Can you talk to her about end of life issues? It's difficult, but sometimes the best thing to do is talk about her options, such as hospice and DNR status. Sometimes the greatest advocate you can be for your patient is to give them options for a gentle sendoff. None of us are promised endless tomorrows.

As someone posted in another thread, it's all about the $$$, and if there's a big fancy 'operation' that will keep her alive the last thing anyone talks to the patient about is quality of life!

oramar · Apr 25, 2004

She has been on my unit several days and has just made herself a DNR for first time. She obviously was not a DNR when she was resently revived and had the device inserted. At the urging of the nurses on the floor our medical director talked to her about end of life issues and options. It probably was the first time she heard that approach. However, she was transfered to us from a high, high tech institutions where they always seem to do the most expensive intervention first and talk later. My sleeply little hospital is like a refuge from the storm for people like her.

oramar · Apr 25, 2004

She has been on my unit several days and has just made herself a DNR for first time. She obviously was not a DNR when she was resently revived and had the device inserted. At the urging of the nurses on the floor our medical director talked to her about end of life issues and options. It probably was the first time she heard that approach. However, she was transfered to us from a high, high tech institutions where they always seem to do the most expensive intervention first and talk later. My sleeply little hospital is like a refuge from the storm for people like her.

gwenith, BSN, RN · Apr 25, 2004

Hate to push the "free" vs "pay" medical system but it has been my experience that high tech interventions that are not truely in the patient's best interests are less commonly offered under a "free" system. They are discussed but they are very darefully discussed so that the patient knows exactly what they are getting into,

I know that ethically there are arguments both ways but this is the observed reality. I keep thinking of my Aunt - Bronchiolitis Obliterans - had a severe brain damage from cardiac arrest prior to intubation in a private hospital and they did a trachy 2 days before they switched off the ventilator due to brain damage - I was not able to be near her so I do not know the whole story but it always sounded strange to me - if she had been in a public system they would have continued with intubation rather than the expense of a trachy if we had any suspicion that there was irreversable brain damage.

gwenith, BSN, RN · Apr 25, 2004

Hate to push the "free" vs "pay" medical system but it has been my experience that high tech interventions that are not truely in the patient's best interests are less commonly offered under a "free" system. They are discussed but they are very darefully discussed so that the patient knows exactly what they are getting into,

I know that ethically there are arguments both ways but this is the observed reality. I keep thinking of my Aunt - Bronchiolitis Obliterans - had a severe brain damage from cardiac arrest prior to intubation in a private hospital and they did a trachy 2 days before they switched off the ventilator due to brain damage - I was not able to be near her so I do not know the whole story but it always sounded strange to me - if she had been in a public system they would have continued with intubation rather than the expense of a trachy if we had any suspicion that there was irreversable brain damage.

jemb · Apr 25, 2004

Many times I believe that our technology has overcome our humanity.

jemb · Apr 25, 2004

Many times I believe that our technology has overcome our humanity.