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.

[jnette, ASN, EMT-I]

You know, nine times out of ten I would agree with you on this one, Oramar... but something here with this case doesn't seem to fit in with my usual feelings on this.

Late fifties... I'm headed that way. In a couple months I turn 56. Hey, I am NO where ready to push up daisies ! I feel like I still have a whole lifetime ahead of me ! And as far as dialysis, if that was helping me to live right now, hook me up !

MOST of our dialysis patients live relatively healthy and productive lives.... they enjoy their families, grandchildren, go on vacations, travel, and I can't conceive of them saying.. "nah, think I'd rather just lay down and die right now".

Yes, there are a few who have numerous comorbidities, and in combination with their advanced age (eighties and up), they might be more ready.

But if this lady is not suffering, is in no real PAIN (I don't know what her lung condition is, nor how it currently affects her quality of life, or if she is in pain...), then I'd have to agree with Earle 58 on this one.

Does SHE want to live? If she wants this device and it gives her hope and assurance, then by all means she should have it.

If her life is so deteriorated, however, that she cannot enjoy or live painfree, then it might be a different story. Guess I just don't know enough about her condition to say one way or another.

I'm just trying to put myself in her shoes here. If it was merely a matter of "age" and a lung condition which will eventually kill her...? Well, what's eventually? And does it cause her daily pain? We're all going to die of SOME condition... even those on dialysis will die of a renal condition eventually, some might have another condition to go along with it. But how is she living NOW, and is she content with her life as it is? Is it satisfactory enough for her to want to prolong it?

Guess that would be my question.

[jnette, ASN, EMT-I]

You know, nine times out of ten I would agree with you on this one, Oramar... but something here with this case doesn't seem to fit in with my usual feelings on this.

Late fifties... I'm headed that way. In a couple months I turn 56. Hey, I am NO where ready to push up daisies ! I feel like I still have a whole lifetime ahead of me ! And as far as dialysis, if that was helping me to live right now, hook me up !

MOST of our dialysis patients live relatively healthy and productive lives.... they enjoy their families, grandchildren, go on vacations, travel, and I can't conceive of them saying.. "nah, think I'd rather just lay down and die right now".

Yes, there are a few who have numerous comorbidities, and in combination with their advanced age (eighties and up), they might be more ready.

But if this lady is not suffering, is in no real PAIN (I don't know what her lung condition is, nor how it currently affects her quality of life, or if she is in pain...), then I'd have to agree with Earle 58 on this one.

Does SHE want to live? If she wants this device and it gives her hope and assurance, then by all means she should have it.

If her life is so deteriorated, however, that she cannot enjoy or live painfree, then it might be a different story. Guess I just don't know enough about her condition to say one way or another.

I'm just trying to put myself in her shoes here. If it was merely a matter of "age" and a lung condition which will eventually kill her...? Well, what's eventually? And does it cause her daily pain? We're all going to die of SOME condition... even those on dialysis will die of a renal condition eventually, some might have another condition to go along with it. But how is she living NOW, and is she content with her life as it is? Is it satisfactory enough for her to want to prolong it?

Guess that would be my question.

[nialloh, RN]

It seems to be a case of all reasonable care Vs all possible care. Just because you can do something, doesn't mean you have to.

I have seen terrible things done to keep people alive a few more days, even when that person was as good as brain dead.

One woman was on a vent and coded. Her kidneys had shut down and she was too weak for hemo. She was so bloated from fluid retention (she was on TPN), we had to change 6 pads an hour because of weeping edema. She passed when her heart gave out, not because the vent was turned off. :angryfire

Another man was only being kept alive because of meds/vent/hemo. The family only made him a DNR when his legs started rotting off him. His arm turned black 2-3 weeks before. This man had been totally non-responsive for 2 months. He lasted 2 more weeks (still on meds/vent/hemo). :angryfire

So do I think that too much is done at times, YES I DO. Are there times when we should let them go with dignity and respect, again, YES.

I'm not saying for a second that we should turn off all machines on old people, or not supply care to the frail, but sometimes enough is enough.

I care for all my patents, and it upsets me greatly when they are abused to make family feel better.

Sorry for the vent, but as much as I love nursing, I hate this...

[nialloh, RN]

It seems to be a case of all reasonable care Vs all possible care. Just because you can do something, doesn't mean you have to.

I have seen terrible things done to keep people alive a few more days, even when that person was as good as brain dead.

One woman was on a vent and coded. Her kidneys had shut down and she was too weak for hemo. She was so bloated from fluid retention (she was on TPN), we had to change 6 pads an hour because of weeping edema. She passed when her heart gave out, not because the vent was turned off. :angryfire

Another man was only being kept alive because of meds/vent/hemo. The family only made him a DNR when his legs started rotting off him. His arm turned black 2-3 weeks before. This man had been totally non-responsive for 2 months. He lasted 2 more weeks (still on meds/vent/hemo). :angryfire

So do I think that too much is done at times, YES I DO. Are there times when we should let them go with dignity and respect, again, YES.

I'm not saying for a second that we should turn off all machines on old people, or not supply care to the frail, but sometimes enough is enough.

I care for all my patents, and it upsets me greatly when they are abused to make family feel better.

Sorry for the vent, but as much as I love nursing, I hate this...

[jnette, ASN, EMT-I]

It seems to be a case of all reasonable care Vs all possible care. Just because you can do something, doesn't mean you have to.

I have seen terrible things done to keep people alive a few more days, even when that person was as good as brain dead.

One woman was on a vent and coded. Her kidneys had shut down and she was too weak for hemo. She was so bloated from fluid retention (she was on TPN), we had to change 6 pads an hour because of weeping edema. She passed when her heart gave out, not because the vent was turned off. :angryfire

Another man was only being kept alive because of meds/vent/hemo. The family only made him a DNR when his legs started rotting off him. His arm turned black 2-3 weeks before. This man had been totally non-responsive for 2 months. He lasted 2 more weeks (still on meds/vent/hemo). :angryfire

So do I think that too much is done at times, YES I DO. Are there times when we should let them go with dignity and respect, again, YES.

I'm not saying for a second that we should turn off all machines on old people, or not supply care to the frail, but sometimes enough is enough.

I care for all my patents, and it upsets me greatly when they are abused to make family feel better.

Sorry for the vent, but as much as I love nursing, I hate this...

I can agree with all of the above cases... most definately. As I stated, more than not, I do take this stand myself.

It was just this one particualr case Oramar described which threw me off a bit. But, as said, I'm not familiar with ALL aspectsof her condition, either.

But yes, for these cases here, I agree 100%.

[jnette, ASN, EMT-I]

It seems to be a case of all reasonable care Vs all possible care. Just because you can do something, doesn't mean you have to.

I have seen terrible things done to keep people alive a few more days, even when that person was as good as brain dead.

One woman was on a vent and coded. Her kidneys had shut down and she was too weak for hemo. She was so bloated from fluid retention (she was on TPN), we had to change 6 pads an hour because of weeping edema. She passed when her heart gave out, not because the vent was turned off. :angryfire

Another man was only being kept alive because of meds/vent/hemo. The family only made him a DNR when his legs started rotting off him. His arm turned black 2-3 weeks before. This man had been totally non-responsive for 2 months. He lasted 2 more weeks (still on meds/vent/hemo). :angryfire

So do I think that too much is done at times, YES I DO. Are there times when we should let them go with dignity and respect, again, YES.

I'm not saying for a second that we should turn off all machines on old people, or not supply care to the frail, but sometimes enough is enough.

I care for all my patents, and it upsets me greatly when they are abused to make family feel better.

Sorry for the vent, but as much as I love nursing, I hate this...

I can agree with all of the above cases... most definately. As I stated, more than not, I do take this stand myself.

It was just this one particualr case Oramar described which threw me off a bit. But, as said, I'm not familiar with ALL aspectsof her condition, either.

But yes, for these cases here, I agree 100%.

[oramar]

I guess with her age and everything the situation is very borderline.

Did you notice the last line on my original post in this thread? I have mixed feelings about this one and that is why I felt the need to post. One of the people who responded to this post said, "what does the patient want". That about sizes it up does it not.

[oramar]

I guess with her age and everything the situation is very borderline.

Did you notice the last line on my original post in this thread? I have mixed feelings about this one and that is why I felt the need to post. One of the people who responded to this post said, "what does the patient want". That about sizes it up does it not.

[jnette, ASN, EMT-I]

Did you notice the last line on my original post in this thread? I have mixed feelings about this one and that is why I felt the need to post. One of the people who responded to this post said, "what does the patient want". That about sizes it up does it not.

Exactly, Oramar. That's really what it boils down to. What does SHE want?

As far as you last line in the original thread, I must have taken it the wrong way... thinking you were thinking late fifties was "old"........ :uhoh21:

Heh... sorry ! :kiss

[jnette, ASN, EMT-I]

Did you notice the last line on my original post in this thread? I have mixed feelings about this one and that is why I felt the need to post. One of the people who responded to this post said, "what does the patient want". That about sizes it up does it not.

Exactly, Oramar. That's really what it boils down to. What does SHE want?

As far as you last line in the original thread, I must have taken it the wrong way... thinking you were thinking late fifties was "old"........ :uhoh21:

Heh... sorry ! :kiss

[oramar]

... thinking you were thinking late fifties was "old"........ :uhoh21:

Heh... sorry ! :kiss

Well if she is old then I am old because we are the same age. What exactly is the source of my discomfort in this case? I say I am happy with the patient being in control of what is done or not done so why do I feel conflicted. I strongly suspect that the proceedure was presented in a way that played up the benefits of having it done and played down the negative aspects. Why do I suspect that? Because I used to work on the unit that she came from and I know what goes on over there. It is all go, go, go, do, do, do!!! These expensive proceedures are money makers all around for the healthcare industry and where the situations is border line they will always do as opposed to not do. Most of the nurses that post here know exactly what I am talking about because they have seen it also.

[nialloh, RN]

Most of the nurses that post here know exactly what I am talking about because they have seen it also.

Sad to say, it is seen all too often.