Who should decide?

chare · Dec 7, 2021

44 minutes ago, toomuchbaloney said:

[...]

These matters are ethically and morally difficult and rarely simple. I believe that a good measure of the cultural of death denial and eternal hope needs to be better countered by realistic assessments from the medical and nursing professionals EARLY in the game for fragile patients. It's more complicated with children, of course [emphasis added].

Absolutely. However, when have providers that don't seem to understand or reinforce thee concept that brain death is no different from cardiac death, how can we expect non-medically trained family members to do so?

subee, MSN, CRNA · Dec 8, 2021

On 5/16/2021 at 1:49 AM, JKL33 said:

Can you elaborate on this comment?

Yes. I also wonder how we can be dead and alive at the same time. Aren't hospitals still required to have ethics committees? Over the years I have seen several patients forced to leave a hospital after the patient is declared brain dead and the family can't accept it. That was one thing good about old timey Catholic nursing homes. They were the only facilities willing to take them.

yschon, BSN, EMT-B · Dec 8, 2021

15 hours ago, subee said:

What if it were a 96 year old instead of a toddler? Following your logic we should keep EVERYBODY ventilated and hydrated just because a family member wants that? Putting flowers on a grave is not an analogy for what is going on here, in fact it's ridiculous.

Yes, 96 or even 196 YO. I am not arguing that this is a good idea. When there is scientifically no hope, the family should definitely be made aware of the difficult reality. However, we respect all cultures whether or not we understand them.

Would you simply disrespect patients’ cultures whenever you don’t understand them? Would you disrespect Asian culture when it makes no sense to you? Would you disrespect LGBTQ people if you didn’t understand them? How about a culture that believes in keeping someone on a vent? Is that any different?

No one should be judged for sticking to their cultural beliefs.

subee, MSN, CRNA · Dec 8, 2021

2 hours ago, yschon said:

Yes, 96 or even 196 YO. I am not arguing that this is a good idea. When there is scientifically no hope, the family should definitely be made aware of the difficult reality. However, we respect all cultures whether or not we understand them.

Would you simply disrespect patients’ cultures whenever you don’t understand them? Would you disrespect Asian culture when it makes no sense to you? Would you disrespect LGBTQ people if you didn’t understand them? How about a culture that believes in keeping someone on a vent? Is that any different?

No one should be judged for sticking to their cultural beliefs.

Which cultures promotes ventilating dead bodies?

allnurses Guide · Dec 8, 2021

While debates over who decides about who lives or dies continue I doubt very much that this toddler, which by the way she's not as she has never toddled anywhere, would still be alive if her family were footing the bill. It is sometimes more compassionate to all concerned to face the fact that there is no hope of meaningful recovery and that resources need to be diverted to where they can do the most good. Thankfully I have never had to make these decisions except to honor my mother's request to be allowed to die with dignity. Still I think of all the millions of dollars spent on this one hopeless case and how many children with chances of brighter outcomes have possibly been denied care.

People say we don't have the right to play "God." and "He" will take her when it is time. However "He" has been trying to take her for years but mankind in his hubris keeps yanking her back, in effect playing God.

Hppy

toomuchbaloney · Dec 8, 2021

45 minutes ago, subee said:

Which cultures promotes ventilating dead bodies?

American culture?

allnurses Guide · Dec 8, 2021

4 minutes ago, toomuchbaloney said:

American culture?

Please cite your source - anecdotes not allowed.

toomuchbaloney · Dec 8, 2021

34 minutes ago, hppygr8ful said:

Please cite your source - anecdotes not allowed.

Read Gawande's work on end of life in the USA.

JKL33 · Dec 8, 2021

3 hours ago, yschon said:

No one should be judged for sticking to their cultural beliefs.

First, I apologize for not responding after you addressed the question I asked months ago; I didn't see your reply.

But to pick up where the conversation is now--

I feel you are really using some emotional language against the responses here. There is a difference between the negative connotation associated with "judging" someone and a practical discussion about what something is or isn't. There's a reason that trained ethicists porifice these issues very carefully from many different angles, and it isn't because I or that guy over there feel(s) judgy about the matter. Being judgy is for whether or not someone should have tattoos. (They should if they want to and if I don't like the look of it that is solely my problem because it is a personal matter that isn't hurting a soul. If I treat a person poorly because of an inconsequential personal decision that has nothing to do with me, that would be wrong and I would be the one being judgy). But judging an issue (which is in effect what ethicists do) is a different matter.

I really dislike when this judging word is weaponized such that logic and careful, practical thinking about an issue is reduced to "judging."

The same goes for the disrespect verbiage. Disrespect is a matter of the heart, so-to-speak; it has to do with the intention and motivation of the one giving the opinion or taking an action.

I agree with an above poster that your flowers-at-gravesite analogy is not appropriate. If people were actually bringing the flowers for the deceased to see and smell, that is indeed illogical--but that is not why people typically place flowers at a gravesite. They place them there as part of their own grieving (or remembrance) process. They do not demand that people give them money so that they can take flowers for the deceased to smell.

What if someone's tradition was to preserve the body and keep it around the house indefinitely for companionship? Is that okay? What if they prefer that it be treated just like any other person and wanted fellow citizens to pay for the equipment that would be necessary to take it shopping and out to restaurants, etc?

These are deep and serious matters we are discussing. They go right to the core of what makes us human. I believe that those in this conversation know that and are not being flippant, judgy or disrespectful. At the same time this matter is also a serious with regard to the one(s) grieving. I think they are experiencing a severely altered grieving process that is not really a far cry from the analogy I gave in the paragraph directly above. They are keeping someone around for their own comfort and inability to let go. I actually do not think people have the right to demand that others pay for such alternate reality experiences, but I want to emphasize that even more than that I think this represents a serious spiritual and mental health issue that deserves regard for its own sake. I think it is a concerning matter regardless who pays for it. Making the charge that this is just a matter of (our) inappropriate judgment and disrespect of another culture is inappropriate.

Hannahbanana, BSN, MSN · Dec 8, 2021

20 hours ago, subee said:

Teach the mother how to care for the girl at home. Everybody wins. Taxpayers have rights as well as dead children being artifically kept alive.

You might be surprised at how much home care costs (obviously you can’t require a parent to be on duty 24/7/365); if she’s on Medicaid the taxpayers are paying anyway.
If the parent dies or becomes disabled the taxpayers would get her too.

subee, MSN, CRNA · Dec 8, 2021

1 hour ago, Hannahbanana said:

You might be surprised at how much home care costs (obviously you can’t require a parent to be on duty 24/7/365); if she’s on Medicaid the taxpayers are paying anyway.
If the parent dies or becomes disabled the taxpayers would get her too.

I am well aware of home care costs - couldn't afford to allow my mother to stay at home. But it's not the costs that is the lesson here. It's in the hope that the parents would come to a different understanding about the quality of her life if they had to do a large chunk of the work themselves instead of depending on the generosity of others, be it the state or the actual caretakers. Maybe when they don't have the time or the energy to put the big barettes on and lay out the baloon, they would get a better grasp of reality.

Hannahbanana, BSN, MSN · Dec 8, 2021

6 minutes ago, subee said:

I am well aware of home care costs - couldn't afford to allow my mother to stay at home. But it's not the costs that is the lesson here. It's in the hope that the parents would come to a different understanding about the quality of her life if they had to do a large chunk of the work themselves instead of depending on the generosity of others, be it the state or the actual caretakers. Maybe when they don't have the time or the energy to put the big barettes on and lay out the baloon, they would get a better grasp of reality.

I wish that were true. Reality has nothing to do c it. Alas, I have seen firsthand how many families keep biological specimens alive for years when the human spirit has long since left the bed. Denial and wishful thinking can have horrific outcomes that are very long in coming.