Is it ethical to deny medical care to one person so the money can be used to help some one else?
Is it ethical to just go with the families wishes even if the patient is capable of making those decisions and by doing so increase the patients pain or hasten their demise?
Is it ethical for persons in the medical profession to be making those decisions?
Is it ethical to use a person against their will, disregard their safety and well being to help some one else?
Actually they are from different situations that I have encountered over the years and yes I put up a stink and even left jobs because of this. One case was an alert and oriented resident of a LTC facility signed for cpr if needed, doctor orders reflected this. I was told that we don't do cpr because the facility was a no code facility and the family didn't want it. They were just humoring the resident.
Another example: Social worker has a resident put onto hospice, order from the doctor was for social worker to have the family talk to him the doctor first. Hospice shows up at the facility and D/C's all meds.
Another example: Same social worker gets another resident put onto hospice after she has a tumor removed and chart indicates that the surgeon got it all. I point out to hospice nurse that there is no dx to support her being on hospice, so she talks to the doc and they come up with failure to thrive. Which was true prior to the surgery. The tumor was on her bowel. So now she had been treated and was on Hospice. I could go on with these cases, but I was looking more for support and agreement that some of this is unethical.
Does the word GOMER mean anything to you? You start doing CPR on some of these folks and they still wind up dead, eventually. Only now, you've spent $50,000. For what? Did you in any way improve their QOL? Did you ever have to look at the face of that old frail person on a vent, ngt, 3-L CVC, foley for 12 hours? Did you ever have to run multiple drips on them? One to bring up their BP the other to bring down their HR. Multiple antibiotics to turn them into petri dishes. Then antifungals because they are loaded with Candida? Don't even get me started on daily labs and x-rays. Personally, I think it's almost criminal what we subject some of our older citizens to. Yeah Iam, it's real easy to 911 that person but you never see what you have done to them.
I think you missed the point entirely. I don't think any one is talking about putting the tubes in. I am talking about pulling them out. I agree the decision should be the patients. and these decisions should be made prior to that stage. But if we are going to ignore the patients wishes then none of those Living Wills mean any thing. I would not want you in my corner. What hospital do you work in so I make sure I don't go there or any one else I know. I could come back with some names of my own for you like Jethro. I don't think he can read very well nor does he understand simple principles. I agree that it is traumatic for the elderly to go through that it is also traumatic to send them to the hospital just to treat pneumonias also. But untill some one can get the laws changed and allow nursing homes to either do more or make sure that nothing is to be done we are stuck with what we have. I don't want to be working along side a nurse that goes along with things just because everyone else is. I think this forum has a section for name calling post in there I don't bother reading those childish ones.
What this issue needs is a very large amount of patient/family education starting at or before age 18. The saddest cases I see are the young adults who have had a catastrophic event and the family wants everything done (no LW in place). Most turn into potatoes and have no QOL and little dignity (in the 18 months I've been in my unit, I could probably show you numerous ones of these).
Take some time and go visit an LTAC (or better yet, work in one for a while). You will see what a lack of a LW and education does.
Iam..to your questions:
1. No. It is not ethical to deny medical treatment to someone else simply to favor another, UNLESS it is a triage sort of situation where the recipient is deemed most likely to die despite treatment efforts. I don't necessarily mean triage on a battlefield here.
2. If a patient can speak or somehow answer in a decisional manner for him/herself then by all means the opinions of others should not override the patient. To do so otherwise when a patient is decisional is illegal, is it not?
3. No
4. No
I have never worked in ER did not know what GOMER meant also not getting the point here. But if you have no idea what is wrong with the pateint how can you make a decision not to treat some one? As far as number 2 goes I have run into that situation. and was curious to know how others would handle situation like that. To me it puts the nurse in a risky situation. With the order to do CPR and then don't family can come back and sue, if they do cpr family can come back and sue. I agree that we need to provide more education regarding what happens after a code is initiated. What are stats regarding outcomes. I have seen some that look promising for some and not so for others. I did a rotation in NICU and hace seen many babies revived and live a normal life. I cared for a 15 year old in a nursing home after she was in a coma for 3 weeks. I am sure it was expensive but she came back to normal. She was ventalated , trach the whole bit. I had a 96 year old lady in a nursing home that they were going to let go, she had pneumonia, family realy didn't want to let her go, so she changed doctors we started IV antibiatics 3 days later that woman opened her eyes and said " Boy, I thought I was a goner" she lived for 2 more years in this retirement community. This was a very tough lady, she enjoyed every minute of her life even in the nursing home. The problem here was that the family had to foot the bill for the ABT because medicare doesn't pay unless you go to the hospital for 3 days.
what I am seeing is people stealing even health care. Best part is the one that worked for it doesn't get it. This country is so infested with illegals that they will do any thing to any one. And us Americans just let it happen. They steal our jobs, they steal the food right out from our mouths. How about this one a 52 year old woman with health issues forced out of her profession, then gets kicked out onto the streets, no food, no money. She'll probably end up in your ER, dehydrated, condition twice as bad, then you will send her back out to go through this all over. Best part is that you will provide care for the illegal first. Why is that. Why can we not take care of our own. What if I told you this woman is an RN would that make any difference to you probably not. Which means that you do it to your own.
[ QUOTE ] lam said:
I have never worked in ER did not know what GOMER meant also not getting the point here.
[/ QUOTE ]
The point is ER personnel are overworked and understaffed. They don't mind busting their a$$ for a patient that can be salvaged and returned home. But after a couple of hundred sepsis/dehydration, resp failure/pneumonia(MRSA) NH specials, you kinda know how the story will play out. They will be good soldiers and treat but they are not happy. I guess calling the patient a GOMER helps them cope.
They usually come to the nursing home with MRSA, That's what I was talking about I don't see why we couldn't treat them at the nursing home and not even send them out. usually the dehydration is associated with an infection like UTI. I know what you mean, I had a lady with pneumonia, came to us with severe malnutrition, weight 67 lbs. developed pneumonia, had o2 all the time took mask off sats dropped to <80, so I put the o2 back on sats came up to 90% doc wanted her sent out to er to be eval. so I called to transport her. DON gets upset because I didn't call 911 and have all the sirens etc. pt. was 99 years old, she said we could have saved her if I sent her out quicker. She died a couple of days later at the hospital. She was a full code. I felt she was living on borrowed time as it was. She was not in resp. distress when she left the facility. would say a half hour made that much difference? "99 Years old"
Guess I wasn't making myself very clear. When I said LTAC, I was referring to 'Long Term ACUTE Care,' not 'Long Term Care.' IMO, 2 very different animals! The difference in the patients is the LTAC patients don't need ICU care but are still to complicated for the regular floor. They are usually long term vent depentant patients. These patients usually end up in a NH when they are finally weaned from the vents.
Sorry I had a Jethro moment, had to go back and reread your post. I have worked in LTAC some vents, but I didn't have any. Then I am shocked that the DON let that slip. These patients are not stable any so many things can alter their diabetes. Actually I liked working at that hospital.
No,no,no and no again.However i have another food for thought.................
1-Is it ethical for the superior to instruct a male nurse to bed shower a female patient(girl's and young women)?
2-Is it ethical for the male nurse to give bed shower to the female patient even if against their will?
3-Is is ethical to instruct a male nurse to give bed shower to a female client without seeking full consent from her spouse or family?
4- Is it ethical for some male nurse posting humiliating joke's in the forum boasting of giving shower to a stripped female patient?
[ QUOTE ] 1-Is it ethical for the superior to instruct a male nurse to bed shower a female patient(girl's and young women)?
2-Is it ethical for the male nurse to give bed shower to the female patient even if against their will?
3-Is is ethical to instruct a male nurse to give bed shower to a female client without seeking full consent from her spouse or family?
4- Is it ethical for some male nurse posting humiliating joke's in the forum boasting of giving shower to a stripped female patient?
[/ QUOTE ]
I'll take this on the Male Nurse Forum since you posted it there also.
I have only worked in one place where they made the males tend to females against their will. I know that I wouldn't want a male bathing me. There are too many issues to deal with. As far as I know the patient has the right to refuse if they do not want a male doing them, and usually they can be accomomdated as there are many more females in the profession. To deny that request would be self centered and not in the best interest of the patient.
With very few exceptions, it certainly isn't ethical to force ANY patient to do anything against their will.
Do female nurses have to get permission to bathe male patients? No. It's just assumed that if you need a bed bath, and your nurse is female, it will be she giving you one.
Why make such a stink over males bathing females? If the patient or family specifically requests not to be bathed by a specific nurse, gender irrivelant, the request should be honored.
We have patients come to our ER requesting a "male" or "female" doctor. We have one doctor in our ER at all times, so if the patient wants to be seen, they have to be seen by who is on that day. I have never had any refuse to see the doctor, once it was explained that, that is the only doctor present.
Our male nurses do not "get permission" to put foley caths in female patients. Nor do they need permission to change an incontinent female patient. UNLESS the patient requests otherwise, which I have found to be a very rare occurance.
I am no more interested sexually in the male patients I place foleys in or bathe, than the males are interested in the females they attend to. This is what this issue boils down to. If a person behaves professionally, and treats patients with respect and dignity, they are behaving ethically.
I really don't think being sexually interested in the patient is the issue. the doctor isn't usually the one doing any thing to the patient other than the usual listen to heart etc. If the patient has problems with a male taking care of them then that should be honored if at all possible.
then I guess it's the same argument if the male has a problem with the female taking care of them then they should get the male nurse. Depends on what the pt is in the ER for as to what the doctor is doing. Pelvics are done in the ER. It wasn't too many years ago (about 10) we had male orderlies that did all male caths and male baths. We have women who go to female OB's but when the time comes if that MD isn't oncall they get who they get. OK sure if someone is totally against one gender or another taking care of them honor those wishes but also make it be known that they might not get the bath etc that day ..beggers can't be choosers.
I agree, if a patient has a problem with ANY nurse caring for them, every effort should be made to accomidate the patient request. With that said, however, the issue of males bathing females or females bathing males, etc... is just rediculess. It should only be an issue if the patient has an issue with it.
