ethical issues with aggressive treatments and end of life

[oramar]

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.

[mattsmom81]

I get 80 yr old CABG's too...and the surgeon has used 'he's a young active 85 yo' as justification to push for the CABG. Sure, he survives the surgery itself....but too often we see the poor man succumb later to complications...which we all know are more common as we age....

My British trained RN friend says this would never happen in GB due to their healthcare system and I agree its the $$$ grab here that encourages this 'go for it' mindset over a rational, more thoughtful approach.

I recently had a 50'ish bedridden chronic renal failure female too...she was also COPD and CHF...morbidly obese.....and finally the doctors were honest with her and talked about her prognosis. it was difficult for her family but we finally were able to sift through everything and do what the patient wanted...which was to not prolong her misery. The age thing is a bid deal, as the old saying is 'docs worry about who will be around later to sue them' after the patient is gone. Family wishes do play into this a lot.

[CCL"Babe", BSN, RN]

Our family had real issues with this subject recently.

Family member with end stage cancer. Mets everywhere, and I mean every organ of her body. Several near code situations requiring entubation and chemical resusitation. She refused to be made a DNR.

Finally we all asked her to reconsider her position. She refused. Her doctor came in after repeated requests on the family's part.

He was great. He gave her permission to die and she did , less than 24 hours later. Peacefully, finally at home.

It is very hard to "know" medically what is "right" and what a patient feels is right. I our family member gave up when she was first told to, she probably would have died years before. She had a good, if not different quality of life. For her cancer was a chronic illness- I'm talking a total of 37 years with some form of cancer. She survived two other cancers.

I/we had many a hard time accepting her decisions, but they were hers to make.