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Frontline: Facing Death

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by MattiesMama MattiesMama (Member)

MattiesMama specializes in Community Health.

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This was one of the best documentaries I've ever seen on death, dying, and our healthcare system. It airs on Nov. 23rd but the full episode is available online here:

http://www.pbs.org/wgbh/pages/frontline/facing-death

How far would you go to sustain the life of someone you love, or your own? When the moment comes, and you're confronted with the prospect of "pulling the plug," do you know how you'll respond?

In Facing Death, FRONTLINE gains extraordinary access to The Mount Sinai Medical Center, one of New York's biggest hospitals, to take a closer measure of today's complicated end-of-life decisions. In this intimate, groundbreaking film, doctors, patients and families speak with remarkable candor about the increasingly difficult choices people are making at the end of life: when to remove a breathing tube in the ICU; when to continue treatment for patients with aggressive blood cancers; when to perform a surgery; and when to call for hospice.

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VanessaRN specializes in Cardiac Telemetry/PCU.

88 Posts; 4,722 Profile Views

This is a very powerful and moving documentary, shedding light on the challenges of critical, end-of-life care for patients, their loved ones, and healthcare providers alike. I really appreciate and was touched by this.

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Altra is a BSN, RN and specializes in Emergency & Trauma/Adult ICU.

6,255 Posts; 40,287 Profile Views

I watched the entire episode and overall it was excellent - thanks for sharing.

The underlying point needs to be heavily emphasized though -- all the advanced technology in the world is simply "support" for an individual's physiology to have the potential to overcome disease and debilitation. We as a culture need to think long and hard about the day in and day out use of technology that produces what one physician in this documentary called the "suspended animation" of trach & PEG, ventilators, pressors, sedation, etc.

I believe this to be especially true in the case of the elderly.

Maybe I'm just having a particularly bad stretch at work, but I am experiencing an increasing amount of personal emotional distress in dealing with families whose parents/grandparents are > age 80, who clearly have zero understanding that their loved ones are approaching the end of current human life expectancy, even without their current critical illness.

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PostOpPrincess is a BSN, RN and specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

2,211 Posts; 11,984 Profile Views

I watched the entire episode and overall it was excellent - thanks for sharing.

The underlying point needs to be heavily emphasized though -- all the advanced technology in the world is simply "support" for an individual's physiology to have the potential to overcome disease and debilitation. We as a culture need to think long and hard about the day in and day out use of technology that produces what one physician in this documentary called the "suspended animation" of trach & PEG, ventilators, pressors, sedation, etc.

I believe this to be especially true in the case of the elderly.

Maybe I'm just having a particularly bad stretch at work, but I am experiencing an increasing amount of personal emotional distress in dealing with families whose parents/grandparents are > age 80, who clearly have zero understanding that their loved ones are approaching the end of current human life expectancy, even without their current critical illness.

You're saying things very nicely. What you're talking about is that people need to get a reality grip. People expect their families to live to a thousand years old, I guess.

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219 Posts; 3,028 Profile Views

It doesn't help that medical advances that can sustain life have come to be seen as routine rather than the exception. Once, "playing God" meant maintaining life in circumstances where it otherwise could not exist, and was an expression of horror and disbelief used by the medical community and ethicists. Now the term is used by the lay community to scold us and call our humanity into question when we advise against artificial support. Is it playing God to allow someone to die with comfort and dignity?

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Altra is a BSN, RN and specializes in Emergency & Trauma/Adult ICU.

6,255 Posts; 40,287 Profile Views

You're saying things very nicely. What you're talking about is that people need to get a reality grip. People expect their families to live to a thousand years old, I guess.

It doesn't help that medical advances that can sustain life have come to be seen as routine rather than the exception. Once, "playing God" meant maintaining life in circumstances where it otherwise could not exist, and was an expression of horror and disbelief used by the medical community and ethicists. Now the term is used by the lay community to scold us and call our humanity into question when we advise against artificial support. Is it playing God to allow someone to die with comfort and dignity?

Yes, this is exactly what I'm saying.

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11,191 Posts; 53,691 Profile Views

You're saying things very nicely. What you're talking about is that people need to get a reality grip. People expect their families to live to a thousand years old, I guess.

while that's true, it is near impossible for many, to dismiss the once-vital picture of their loved one...no matter how old.

it is also near-impossible to believe that their loved one WON'T be the exception...and that they'll eventually recover and even thrive.

this is what makes us human, our emotions.

and no matter how frustrated i feel w/some families, i inevitably allow them their 'fallibility' of being too involved.

that was an extraordinary documentary.

i esp appreciated dr's admitting their mistakes, i.e., perhaps being too gung ho/caught up in the moment.

it just goes to show you that despite how many feel about themselves, dr's are the furthest thing from being God...

that their decisions to pursue/encourage futile, painful txs, often resulted in bad deaths.

now, let's see who learns what, from this...if anything at all.

leslie

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tewdles is a RN and specializes in PICU, NICU, L&D, Public Health, Hospice.

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I honestly believe that as fewer and fewer nurses work in the primary physician office setting patients and families get less and less education about their health and diseases. They have fewer conversations about behaviors, plans, and goals. As technology continues to advance, those same people with too little information are required to make increasingly difficult and nuanced choices about their care and the care of those they love.

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tyvin is a BSN, RN and specializes in Hospice / Psych / RNAC.

1,620 Posts; 17,734 Profile Views

It was rather chilling when the doctor was talking about the federal governments waste factor, that all medical care in the ICU has 20 or 30% waste and how are the docs suppose to deal with that coming from the federal government. Also when the other female doctor was talking about vent care and it's cost......whewww. Basically what the feds are saying is fix it or we will come in and do it. That means cutting payments and reimbursements to hospitals etc... I surely hope it never actually comes to that.

I believe that with our docs and nurses now days we get the majority of the population to fill out living wills, assign POA etc... It's imperative that people are prepared and have had "the conversation" about end of life options and decisions.

Standing over them in the ICU is not the time to make a decision about pulling the plug. When that happens emotions are far too high and the wrong decision for the patient is usually made as we saw with the examples on the documentary.

That one french lady with dementia that is on a trach for over a year now; what kind of life does she have laying in that bed day after day just looking up. Well the Alzheimer's is a God send in this case because it takes her away from the reality of her situation. Is it worth her quality of life as it is so that the daughters may have her hand to hold? The daughter who was the R.N. was the only one who was making any sense to let her go but it was the other daughters (one being a doctor!) that voted for her to have the track there fore extending her life on a vent; tragic IMO.

Yes I did feel warm tears out of the corner of my eye when they voted to not let her go; I could see that the women needed to go but as one person said earlier.......some patients are trapped in their bodies without the ability to communicate and say what they really want.

Ohhh that was so scary when that one black lady cried and said that she's never heard her brother say he just wanted to go and not have any tubes. I take it it was the wife who was telling her that he told her he didn't want to stay alive on tubes but the sister didn't want to hear it. I have been witness to this conversation more then once when one family member will not let go because they have not heard the person actually say that's what they wanted.

"The conversation"; it's needed no matter what age you are.

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AllSmiles225 specializes in Trauma & Emergency.

213 Posts; 4,617 Profile Views

I watched the entire documentary and I really thought it was excellent. Many times we see death so often that we just don't understand a lot of the decisions that people make. Of course we cannot impose our beliefs on others but this documentary allowed me to take a step back and look at what many families are really thinking & the decision they are being faced with. It also reminded me of the importance of having someone you trust appointed to carry out your wishes for you, should you not be in a state to do so yourself. Many of the cases expressed throughout this documentary expressed in one way or another that they were not one hundred percent sure what their family member wanted. This obviously leaves someone a huge decision to make and is burdensome. Overall I think it was an excellent special. Thank you so much for sharing.

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341 Posts; 7,204 Profile Views

this is heartbreaking, and it's a must to see for many people. i posted the link on facebook so my family can voice their concerns now just in case.....

my first job was a vent unit rehab., and it was very sad! i had patients with advance dementia with trachs. yup, yup, a few pulled out their trachs....."these are the broken people who survive..."

and when there is trachs, there is gtubes, and sometimes there is supra pubic tubes or f/caths..... and eventually results in pain from infectious process, and lastly, it would lead to poor quality of life!

as a nurse there is only so much we can teach or refer md's to consult with families, but far often a few don't get.... : (

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