Ethics

how about the need for surgery on a cystic fibrosis pt and dnr status and their desire to not be mechanically ventilated after surgery.

or dnr status and surgery.

d

There was a patient that I took care of in the ICU who was brain dead. He was on a vent, and after his family met with a judge, he was scheduled to become an organ donor and be allowed to die. The nurses took this man (with vent, etc) to surgery. He was anesthetised to take away any pain he might sense (even though he was braindead). (I hope I am relaying this next part in the right order...)The surgeons extracted some of the abdominal organs. When the surgeon got to the heart, CRNA turned off the anesthesia machine. He left the room. The heart had stopped beating and he was finished with his job. The nurses and I were informed that the patient had passed. I wanted to write my experience to you, because it could definitely be examined from an ethical standpoint. I am curious as to if any CRNAs had to stop the anesthesia treatment while the surgeons continue their work...

you might google cases involving Jehovah's Witnesses and surgery...need for blood but won't accept blood transfusion, etc. also, plethera of info on persistent vegitative state (Terry Schiavo sp? in Florida). also a very famous ethical case concerning Dax Coward from Texas. he was in a terrible accident and was burned over 90% of his body, survived but wanted the right to die due to the insurmountable pain. doctors continued to treat him despite his pleas to be left alone to die. (still alive, I might add.) hope these ideas help. not so many cases involving anesthesia per se out there.

EA

I think you can approach this one of two ways - either look at a specific case and unpack the issues involved, or examine a particular aspect of anaesthesia/OR. Unless you already have a leaning, you might want to work out which approach you prefer, and start from there.

The Dax burns case, for example, has a lot of interesting aspects (he was adamant that he wanted treatment ceased, was overruled on the grounds that he was depressed, and is now glad he survived). However, while some of the conflict involved theatre (particularly for the staff who were conflicted about where their duty of care lay), it was not specifically situated in theatre. It seems to me that this will be the case with quite a few actual case scenarios - either some significant aspect of the issue occured pre- or post-op, or the issue/s involved have a broader applicability. On the other hand, case scenarios are more contextually thick and interesting than abstract examples or hypotheticals.

ether's suggestion of looking at brain death is interesting, and there's no shortage of literature. In particular I draw your attention to Gail van Norman's papers "A matter of life and death" and "Another matter of life and death"; there's also my thread in the neuro ICU section ("Talking to the brain dead") which discusses some interesting cases.

emergence's suggestion about surgery and Jehovah's Witnesses would allow you to look at resource allocation, paticularly in regards to trauma cases (as opposed to elective surgeries) - there was a case not long ago where a woman was pregnant, suffered a uterine rupture, and almost bled out; no transfusion, but full treatment, which involved continuous hyperbaric treatment (diving for eight hours at a time, only to change nurses and re-dive) and peritoneal dialysis to try to compensate for renal failure - but there might not be enough for the length of paper required.

I like gasspassah's suggestion about looking at DNR status and the specific issues it raises for OR staff, perhaps using CF as a specific example of the types of cases.

Whatever you decide it sounds like an interesting assignment.