All too often people in the medical field find themselves dealing with the medical dilemma of the Full Code versus Do Not Resuscitate order. One article in particular that I came across details a nurses personal struggle when placed in that situation.
She had been taking care of an 80 year old man with bone cancer. He had gone into surgery to have his leg amputated, but during surgery he stopped breathing. The medical team was able to resuscitate him, but he had been without oxygen for too long and suffered anoxic brain damage. This left him confused and with limited mobility. (which is often the case when a patient is left without oxygen for a period of time) The patient, a once active man, was aware of his confusion and had become depressed. He often would state that he'd rather just die. His family thought the confusion was temporary and that he'd recover and be sent home. (again common in these situations) Unfortunately the patient declined and began to develop Cheyne-Stokes respirations. (often called the "death rattle" it's a common breathing pattern occurs when a patient is very close to dying) The nurse was in a tough situation because the doctors wanted the man to be resuscitated if he were to arrest to deter a law suit, but she felt it cruel to resuscitate a person in this condition.
The article goes on to explain that the main issue this nurse was faced with was whether or not to hold her obligation to the doctors or to the patient. In nursing school you are taught that you are there for your patients and that you must do whatever is in the patients best interest. Unfortunately the law keeps nurses from doing this at all times. The article continues to debate the sanctity-of-life principle (which states that all life is sacred and that to let life end is unethical) versus the quality-of-life principle (which focuses on quality of the patients life).
The article concludes that in order to make a decision that best benefits the patient, the medical team must consult the family and discuss what they believe the patient would want. Whether he would agree with the sanctity of life or quality of life and what he may feel is normative of a quality life.
Reference
Davis, Anne J. "To Make Live or Let Die." American Journal of Nursing. 1981. p 582. JSTOR. 13 February 2007.
Saturday, February 17, 2007
Tuesday, February 13, 2007
Peer Review, Reviewed
February 8th, Thursday was one of our classes first peer review sessions. My group consisted of Danielle, Lindsay, Cody, and myself. I read Cody's paper first. He had written about Ben Franklin. I let him know that though he had very good information and facts, and a great introduction he needed to organize the paper Danielle's paper was about a man that had made it big in tobacco, yet sold out tobacco companies by exposing the health hazards of tobacco. Other then a few minor punctuation mistakes, the paper was very well written, well organized, informative and very close to being a final draft. Lindsay's paper about founding figures of Chinese acupuncture was very factual and interesting. I let her know to not only organize her ideas but to also give laymen definations of some of the terms she used. I pointed out a few minor spelling and punctuation errors that she warned us about before reading it. Lastly, the group reviewed my paper. I let them know ahead time that it was definatly a work in progress, and that I hadn't fully expanded on all my ideas. Cody asked me to explain my topic a bit more in detail, so I was sure to add that in my final paper. After reading my paper the some of the responses I got were to make the paper longer and to introduce Dr. Saunders full name in the beginning of the paper. These comments were taken into consideration when I wrote the final draft for this particular assignment. Overall peer review went well, and it was not only helpful to get my classmates opinion of my paper, but also to see how they wrote their papers.
Sunday, February 11, 2007
Altered States of Consciousness
In many situations, the decision to take a patient off life support or stop life sustaining treatment co-insides with not only the patients expected quality of life, but also their level of consciousness. Altered states of consciousness often are the result of either a traumatic head injury or an underlying illness such as diabetes, infection, stroke, or brain tumor. There are a few different levels of state of consciousness.
A patient being described as in a stupor is generally unresponsive, yet they may arouse briefly to painful stimuli.
A patient in a vegetative state is unconscious and unaware of their surroundings. Sleep/wake cycles are noted and the patient may appear alert (eyes open), make noises, and have random movements, but remain unresponsive to stimuli and fail to follow any commands. A patient may come out of either a stupor or vegetative state within a few weeks.
A persistent vegetative state is defined as a patient who is in a vegetative state for greater then thirty days. The likelihood of recovery is poor and greatly depends on the severity of the cause brain damage and age. The younger a patient is the more likely they may recover.
Another altered state of consciousness is locked in syndrome. The patient is one hundred percent awake and aware but is unable to move due to complete paralysis.
Brain death results when there is no sign of brain function. The test generally run to show signs of brain death is an EEG (electroencephalograph).
Coma is a state of prolonged unconsciousness in which the brain functions at its lowest level. The patient is unable to be awakened and shows no purposeful response to physical or verbal stimuli. It differs from vegetative states in that a patient in a coma has no notable sleep/wake cycles. Recovery depends on severity of injury and illness and rarely lasts longer then two weeks.
It is difficult for doctors and medical professionals to give families a 100% prognosis in determining if their loved ones will recover. This often leads to families to have to make a difficult decision. Should they hold on hope for a full recovery if any recovery can be made, or should they let them go?
References
Mayo Clinic Staff. Coma. Mayo Clinic.com. 17 May 2006. <http://www.mayoclinic.com/health/coma/DS00724/DSECTION=1>. 11 February 2007.
A patient being described as in a stupor is generally unresponsive, yet they may arouse briefly to painful stimuli.
A patient in a vegetative state is unconscious and unaware of their surroundings. Sleep/wake cycles are noted and the patient may appear alert (eyes open), make noises, and have random movements, but remain unresponsive to stimuli and fail to follow any commands. A patient may come out of either a stupor or vegetative state within a few weeks.
A persistent vegetative state is defined as a patient who is in a vegetative state for greater then thirty days. The likelihood of recovery is poor and greatly depends on the severity of the cause brain damage and age. The younger a patient is the more likely they may recover.
Another altered state of consciousness is locked in syndrome. The patient is one hundred percent awake and aware but is unable to move due to complete paralysis.
Brain death results when there is no sign of brain function. The test generally run to show signs of brain death is an EEG (electroencephalograph).
Coma is a state of prolonged unconsciousness in which the brain functions at its lowest level. The patient is unable to be awakened and shows no purposeful response to physical or verbal stimuli. It differs from vegetative states in that a patient in a coma has no notable sleep/wake cycles. Recovery depends on severity of injury and illness and rarely lasts longer then two weeks.
It is difficult for doctors and medical professionals to give families a 100% prognosis in determining if their loved ones will recover. This often leads to families to have to make a difficult decision. Should they hold on hope for a full recovery if any recovery can be made, or should they let them go?
References
Mayo Clinic Staff. Coma. Mayo Clinic.com. 17 May 2006. <http://www.mayoclinic.com/health/coma/DS00724/DSECTION=1>. 11 February 2007.
Picture from:
Thursday, February 8, 2007
Progress
Fortunatly I have picked a research topic that I am not only familar with, but also contains a great deal of information. I have yet to run into any snags in finding information about end of life ethics. Though I deal with with this topic on a day to day basis, like anything in this world, I don't know EVERYTHING about the subject, so I am definatly learning quite a bit along the way. The only major problem I'm dealing with at the moment is deciding how to narrow my reasearch down and focus on just a few key points. For example, do I want to focus on the legal aspects of death such as advanced directives, living wills, and all the grey areas inbetween, or should I focus more on topics such as euthanasia and hospice care? I realize I can write about all these subjects, and I'll touch on all of them a bit, but it may end up being a 14 page paper rather than the 8 we are assigned.
Another issue I am having is attempting to remain objective. Since I have been in situations through my work dealing with end of life topics I do tend to be a bit biased. Though my thoughts and feelings on the subject are entirely circumstantial. I've seen 16 year old comatose kids on ventilators recover and walk out of the hospital. (which is one of the most gratifying experiences in my life, just one of the many reasons being a nurse is great) I've also seen 16 year old kids with gun shot wounds remain paralyzed and comatose with machines running their lifeless bodies, because a parent will never give up hope. Nursing is a double edged sword. I want to save lives, but in some cases I want nothing more then for that person to be allowed to rest in true peace, not on machines.
I intend to continue my research in all subjects dealing with end of life ethics, and I'm sure when I sit down to write the final paper it will all come together.
Another issue I am having is attempting to remain objective. Since I have been in situations through my work dealing with end of life topics I do tend to be a bit biased. Though my thoughts and feelings on the subject are entirely circumstantial. I've seen 16 year old comatose kids on ventilators recover and walk out of the hospital. (which is one of the most gratifying experiences in my life, just one of the many reasons being a nurse is great) I've also seen 16 year old kids with gun shot wounds remain paralyzed and comatose with machines running their lifeless bodies, because a parent will never give up hope. Nursing is a double edged sword. I want to save lives, but in some cases I want nothing more then for that person to be allowed to rest in true peace, not on machines.
I intend to continue my research in all subjects dealing with end of life ethics, and I'm sure when I sit down to write the final paper it will all come together.
Thursday, February 1, 2007
Euthanasia
Euthanasia, or mercy killing, is the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability. It can be divided into two subgroups, passive and active euthanasia.
Passive euthanasia occurs when a person is allowed to die by withholding treatment, such as withdrawing a life-sustaining device. This could involve turning off a respirator or heart-lung machine. Technological advances in life-support devices raise the issue of quality of life. Should patients be kept alive in hopeless states? Passive euthanasia has become acceptable in cases of terminally ill patients. The argument that once equated this practice with suicide is rarely heard today. Although experts do not entirely agree on the precise boundaries of what treatment decisions should be made. For example, can a comatose patients life support be disconnected when the patient has left no written instructions, or does the family have the right to over rule a physicians order to continue life support? These questions have no clear cut answers.
The second form of euthanasia is active euthanasia. Active euthanasia occurs when death is deliberately induced, as when a lethal dose of a drug is administered to a patient. The most widely publicized cases of active euthanasia involve "assisted suicide." Jack Kevorkian, a Michigan physician, has assisted many terminally ill patients to end their lives. Kevorkian was convicted of second-degree murder and given a long prison sentence, after a controversial trial. Active euthanasia is a crime in most countries, and in all US states except Oregon. In 1994, Oregon passed the Death with Dignity Act. This act allows active euthanasia of individuals diagnosed with a terminal illness who are not expected to live more than six months.
While active euthanasia sounds acceptable in theory, the potential for abuse is substantial. If active euthanasia were to become acceptable, it's likely that depressed and suicidal individuals would use this method to legally kill themselves.
Reference:
Santrock, John. Life-Span Development: Tenth Edition. Ed. Emily Barrosse. New York: McGraw-Hill, 2006. 635-36.
Passive euthanasia occurs when a person is allowed to die by withholding treatment, such as withdrawing a life-sustaining device. This could involve turning off a respirator or heart-lung machine. Technological advances in life-support devices raise the issue of quality of life. Should patients be kept alive in hopeless states? Passive euthanasia has become acceptable in cases of terminally ill patients. The argument that once equated this practice with suicide is rarely heard today. Although experts do not entirely agree on the precise boundaries of what treatment decisions should be made. For example, can a comatose patients life support be disconnected when the patient has left no written instructions, or does the family have the right to over rule a physicians order to continue life support? These questions have no clear cut answers.
The second form of euthanasia is active euthanasia. Active euthanasia occurs when death is deliberately induced, as when a lethal dose of a drug is administered to a patient. The most widely publicized cases of active euthanasia involve "assisted suicide." Jack Kevorkian, a Michigan physician, has assisted many terminally ill patients to end their lives. Kevorkian was convicted of second-degree murder and given a long prison sentence, after a controversial trial. Active euthanasia is a crime in most countries, and in all US states except Oregon. In 1994, Oregon passed the Death with Dignity Act. This act allows active euthanasia of individuals diagnosed with a terminal illness who are not expected to live more than six months.
While active euthanasia sounds acceptable in theory, the potential for abuse is substantial. If active euthanasia were to become acceptable, it's likely that depressed and suicidal individuals would use this method to legally kill themselves.
Reference:
Santrock, John. Life-Span Development: Tenth Edition. Ed. Emily Barrosse. New York: McGraw-Hill, 2006. 635-36.
Medical Pioneer
"You matter because you are you, and you matter to the last moment of your life." Words spoken from Dr. Cicely Saunders, the founder of hospice.Dr. Saunders (June 22, 1918-July 14, 2005) began her university schooling in 1938 at Oxford University in England. Due to World War II, Saunders diverted her college career to become a nurse. (Nursing was an "on the job" learned trade back then). Through her work as a nurse, Saunders became a social worker (another career that didn't require a formal education back then).
In 1948 when she was working as a social worker she met a Polish man by the name David Tasma. Tasma was dying from inoperable cancer. Through her conversations and visits with Tasma, Saunders realized the need for a great change in the way dying patients were cared for. Because dying patients were considered beyond help, they were often left alone, much of the time in great physical, spiritual, psychological, and social pain. When Tasma passed away, he left 500 pounds to Cicley Saunders. With his gift Saunders realized her mission was to better the quality of life for dying patients. She would set out to establish better pain management and encourage holistic care.
Saunders was advised that if she was truly compelled to care for the terminally ill that she should become a doctor because no one would listen to a nurse. Following her friends advice she enrolled in medical school at the age of 33. She earned her medical degree in 1957 and became the first doctor to devote thier career to dying patients. Soon after recieving her doctorate she got right to work on devising better pain manangement methods. Through her work she learned to adminster morphine before a patient appeared in pain and to continue with timed doses as a way to "stay ahead of the pain." This method is used by most doctors today.
In 1967, Dr. Saunders opened the first hospice center in a suberb of London, St. Christopher's Hospice. This soon launched a worldwide movement to provide compassionate care for the dying. The first US hospice was opened in 1971 in Conneticut. There are currently 3,200 hospices helping 900,000 patients in the US alone.
Dr. Cicely Saunders died at St. Christopher's Hospice in 2005. Her legacy lives on throughout the thousands of hospices worldwide. Her life has impacted not only the medical world, but also thousands of patients and families. She is a medical pioneer and a compassionate hero.
Reference:
Field, Barbara. "Science Hero: Dame Cicely Saunders." Myhero.com. 23 June 2006. 1 February 2007. < http://www.myhero.com/myhero/hero.asp?hero=Cicely_Saunders_06>.
Original photo obtained at <http://www.cicelysaundersfoundation.org/>.
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