Published Jul 13, 2002
A very multifaceted question. With many answers even as I ask it. Speaking personally.........medical technology rocks....or I would not even be alive('nother story')
But beyond the micro world.....
does our care and medical care of our patients sometimes extend beyond the beyond.....
like when is enough enough......
in the case of a multiple end-stage organ failure dx patient.....
.........carcinomas.....beyond the point of no return.........
because someone other than the patient cannot let go......., even though the patient is saying let me go.................
Is it $$$
Is it the oath that "we" all take ...........
What is it.........
Sometimes.....I have just seen enough is enough.....and it is so sad..............
there is always at least two sides to a story..........
micro is just chillin today...........
I would have to agree with what you are talking about. Sometimes it seems that we keep them alive for strictly selfish reason.......whether it be selfishness of the family, the doctor, the medical staff in general. I guess it is where the quality of life issues come from.
We have quite a few docs who purposely mislead patients or families. Out of one side of their mouth they paint a bleak picture but then sum it up by saying "let's give it some more time and see what happens". Well what kind of false hope does that message send?!?!?!?!? Also with the internet generation who read miracle stories of the brain dead coming back to life....
I have had a few patients over the past few years with terminal conditions. These people would go from one doc to the next until they heard what they wanted to hear: "You will be just fine." If you look long enough you will find someone who will take your money and tell you what you want to hear. These are the oncologists who tell the family when the patient does finally die that "he didn't die from the cancer." What crap! If he didn't have CA, he wouldn't have been septic and just cause there was no cancer in the bone marrow doesn't mean they were cancer free. It means they were aplastic, a little fact the doc forgot to mention to the family.
Ethics is lightyears behind our technology. It desparately needs to catch up!!
Nurse Ratched, RN
Good question, Micro. Ask any Hospice nurse who more and more finds that the "new" patient she/he is admitting is in MSOF and will probably be dead within 24 hours because no one wanted to admit that the person was dying. Or the floor nurse who has someone circling the drain who is a full code who's got the remaining life expectancy of a fruit fly no matter how long I pound on his chest or how many drugs I push, but no one wanted to acknowledge that.
I'm all for raging against the dying of the light, but I hope I know when enough is enough and I should just fade out. More importantly, I hope my family knows.
I agree. No matter what high technology devices that are used and brand new drugs, everyone will eventaully die. This will happen to EVERYONE, regardless. I think our most important intervention for terminally ill people is to keep them comfortable, not see how long we can prolong their misery.
I agree micro, we have yet to let our ETHICAL ADVANCES catch up to OUR TECHNOLOGICAL advances in medicine. The gap widens all the time. I am truly frightened for our future if the trend continues unabated. we all should be.
The reason TECHNOLOGICAL ADVANCES are such a wide gap from ETHICAL ADVANCES is d/t the various Beliefs regarding Ethical choices/Morals/Faith-Based Beliefs/Religions that tend to signify when to let go of a life or put it in suspension until all else fails.
With all of the advancements made in the technological world, Scientist...who mostly believe that they can cure or sustain just about anything that they have tried and tested a drug or procedure on...keep plugging away giving people false hope at times, so doctors.....being attached to the hip of most scientists...add to that drama by using a life at the end of an individual's life to keep on experimenting...letting medical students partake of the opportunity to experiment and learn from those human lives barely holding on by a thread.
Once a patient reaches a point in his/her life that strongly states "death is imminent" that is when I wish family members would simply take their loved one home and love on them until he/she passes on to another chapter in his/her life...whatever that particular family's Belief may be.
Death is what needs to be addressed in a light of necessity when it comes to healthcare. Many patients suffer needlessly because of all the gadgets and drugs that can sustain what resembles "life" in a body, but why??? The fear is often with our ability to NOT let go...understandable...but what do we do?
If a patient is taken off of a ventilator, and dies...to me...it was meant for that person to die that day at that particular time just like my Auntie who suffered with Breast Cancer, but did NOT die of Breast Cancer, she died from a slip in the bathroom after taking a bath one day a couple months ago.
I do NOT want my BODY...not my life...sustained on some machine. If God means to call me home to Him...then so be it...I'll be gone no matter what science does to me. If He doesn't want me home at that particular time...I will be breathing until He does. And that's my faith. :kiss
the gap is surely there...........
the use of patients in experimentation and $$$.........
"Death is what needs to be addressed in the light of necessity of health care."
thx for letting me quote you Renee......
well written and thanks for your elegant reply.......
tough subject to discuss even as nurses.....that have seen it all...........
but it is a necessity.............
brings up many more ??? and issues..............
micro and out....for now
I have to agree with many of the other posters that we are very disparate when it comes to the technological abilities we have vis-a-vis where we are ethically.
It is my personal belief that we should practice by the Hippocratic oath, one of the tenets of which is "Primum est non nocere", or "First of all, do no harm". If we are less than honest with patients, families and even ourselves about the extent to which we can prolong life in a meaningful way--i.e.: coding a patient who will have absolutely no chance of survival regardless of the interventions we do--is that not causing harm?
Just a thought.......
l really respect the MD that knows when to call a code LR
NRSKarenRN, BSN, RN
By Stacey Burling
Inquirer Staff Writer
It has been eight months since James "Butch" Quinn's ailing heart was replaced with a machine, and he has spent all but three weeks of it in Hahnemann University Hospital.
Doctors said that without the artificial heart he almost certainly would have died months ago. Yet because of all that time away from his home in West Philadelphia and disappointing quality of life, Quinn now questions his decision last year to become one of the first humans to test a new type of fully implantable mechanical heart.
"I don't believe I would do it again simply because it's too much afterwards, you know," Quinn said in a soft, raspy voice from his ICU bed last week.
.....But last week, in his first interview done without medical staff present, Quinn said he had changed his mind. He has received good treatment, he said, but has been away from home too long.....
.....Irene Quinn said she did not realize just how experimental the AbioCor heart was. And, while she was aware that many serious complications were possible, she said she thought her husband either would die quickly or return home in better shape than before the surgery. She never imagined months of isolation in the hospital....
......E. Haavi Morreim, a professor in the department of human values and ethics at the University of Tennessee who chairs Abiomed's patient advocacy program, said the advocates discovered that most patients have entered the process with their minds already made up.
"They come to get the heart," she said. The advocates have done their best to help patients understand everything that could go wrong. (The Quinns dismissed their original advocate and have since chosen a medical anthropologist and ethicist who is independent of Morreim's group.)
But because this is brand-new technology, it's difficult to tell people what to expect. "What we have is the very cutting edge here and there isn't anything typical yet," Morreim said......
Full interesting story:
Wishing Mr. Quinn well. Was hoping for him to be able to return home as our agency often cares for Hahnemann tranplant patients living in our service area. Don't think I could be such a pioneer. Karen
It bothers me when quality of life is overshadowed by docs and their hi tech egos.....and lets not forget their fear of litigation (do all you can)....and their love of money...and the hospital's love of money....$$$$$$$$
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