Should doctors have to tell you they won't try CPR?

[The Floating Island of the Sleeping God]

Of course not. The use a term americans might be accustomed to. The customer is always right.

I would like to apologize on behalf of whoever the hell said that and clarify that, indeed, the customer is not always right. In fact, the customer's is sometimes a dumb asshole.

The customer is always right to get the hell out of my face and let me do my job.

[Communal Ecotopia]

I'm aware of that and not that long ago doctors here were able to quietly decide to let people die. It was only when the media exposed it that they retracted that.

First I've heard of it.

If you have access, look at David A. Asch, “The Role of Critical Care Nurses in Euthanasia and Assisted Suicide,” New England Journal of Medicine 334, no. 21 (May 23, 1996): 1374. Effectively, it says, "A 1996 mail survey, sent to 1600 ICU nurses who subscribed to Nursing Magazine, with responses from 852 full time nurses, revealed that “one out of five have hastened the death of critically ill patients at least once in their careers, occasionally without explicit permission (author’s italics) from patients, doctors, or family.”

[Ethel mermania]

lets see, dad goes to the hospital for a gallbladder operation, the operation is a sucess. while in recovery his chest fills with fluid, the pressure in his chest presses on his heart and it stops beating. the dnr will stop the meidical personal from trying to restart his heart or relieving the fluid in his lungs. simple enough for you?

His heart has stopped? So he is already dead. No-one "let" him die, that happened before the DNR came into force.

Try again if you like.

your kidding right? thats one of the stupids opinions i have read. you know nothing about the dying process. death occurs after the heart stops, minutes later in fact. we are done.

[Communal Ecotopia]

Not really, I can still discuss the merits even if I dont care about them. And this one sucks like major balls.

So you would force doctors to perform procedures they believe to be harmful based on the wishes of lay-persons?

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

[The Floating Island of the Sleeping God]

So you would force doctors to perform procedures they believe to be harmful based on the wishes of lay-persons?

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

What the doctor thinks is actually really fucking important. The doctor went to years and years of medical school before coming to that conclusion. The doctor knows way more than you, and the doctor is nearly always right.

[Fionnuala_Saoirse]

So you would force doctors to perform procedures they believe to be harmful based on the wishes of lay-persons?

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

Cost is a bad factor to consider when determining medical management?

[The Floating Island of the Sleeping God]

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

Cost is a bad factor to consider when determining medical management?

It won't be about cost. Doctors don't actually just do it for the money. You don't go through all that trouble of med school to be treated like crap if you're only in it for the money. They happen to like saving people.

[Fionnuala_Saoirse]

Cost is a bad factor to consider when determining medical management?

It won't be about cost. Doctors don't actually just do it for the money. You don't go through all that trouble of med school to be treated like crap if you're only in it for the money. They happen to like saving people.

I don't go into that whole "all docs are altruistic heroes" generalisation sorry.

Cost should be a factor in the decision making process of all medical staff.

[Fartsniffage]

His heart has stopped? So he is already dead. No-one "let" him die, that happened before the DNR came into force.

Try again if you like.

your kidding right? thats one of the stupids opinions i have read. you know nothing about the dying process. death occurs after the heart stops, minutes later in fact. we are done.

Really? So with a stopped heart dad can still get up a walk around? How about sweat to maintain homeostasis? Get an erection to reproduce? Metabolise the air they're no longer inhaling? Keep growing?

The brain death definition of death is useful simply because we now have the capabilities to restart stopped hearts, but if you're not going to use those methods then cardiac arrest is death. You're very unlikely to just get better.

[The Floating Island of the Sleeping God]

It won't be about cost. Doctors don't actually just do it for the money. You don't go through all that trouble of med school to be treated like crap if you're only in it for the money. They happen to like saving people.

I don't go into that whole "all docs are altruistic heroes" generalisation sorry.

Cost should be a factor in the decision making process of all medical staff.

Well, all the doctors I've met have been altruistic heroes. But hey, anecdotal evidence.
Cost should only matter to the insurance companies and the hospital administrators.

[Communal Ecotopia]

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

What the doctor thinks is actually really fucking important. The doctor went to years and years of medical school before coming to that conclusion. The doctor knows way more than you, and the doctor is nearly always right.

Not about my body. Look, I have spina bifida and cerebral palsy (more or less). I also have non-active Hepatitis C. I've had it for 30+ years (blood transfusion at age 2 or so, before they began screening). I also have a PhD, formerly a girlfriend (I hope again soon), an active social life, etc. My hepatologist was shocked that I would want to undergo treatment for my Hep C, given how "horrible my quality of life is" and that the treatment has a few nasty side effects like fatigue and nausea. Since my body isn't reacting to the Hep C virus, I'm lucky. I can wait a bit until these new non-PEG Interferon drugs get their kinks worked out. But, hell yes, I want them.

[Fionnuala_Saoirse]

I don't go into that whole "all docs are altruistic heroes" generalisation sorry.

Cost should be a factor in the decision making process of all medical staff.

Well, all the doctors I've met have been altruistic heroes. But hey, anecdotal evidence.
Cost should only matter to the insurance companies and the hospital administrators.

I'm pretty sure I have the bigger sample size for my anecdotal evidence.

So you would prefer doctors to ignore a key ethical principal?

[Fartsniffage]

What the doctor thinks is actually really fucking important. The doctor went to years and years of medical school before coming to that conclusion. The doctor knows way more than you, and the doctor is nearly always right.

Not about my body. Look, I have spina bifida and cerebral palsy (more or less). I also have non-active Hepatitis C. I've had it for 30+ years (blood transfusion at age 2 or so, before they began screening). I also have a PhD, formerly a girlfriend (I hope again soon), an active social life, etc. My hepatologist was shocked that I would want to undergo treatment for my Hep C, given how "horrible my quality of life is" and that the treatment has a few nasty side effects like fatigue and nausea. Since my body isn't reacting to the Hep C virus, I'm lucky. I can wait a bit until these new non-PEG Interferon drugs get their kinks worked out. But, hell yes, I want them.

The numbers here are pretty clear. Only about 1 in 5 people who need CPR in a hospital will survive to ever be discharged. If the patient has 3 or more risk factors associated with receiving CPR then only about 7% of those 1 in 5 will survive for 2 months. Only about 50% will make 2 months even with fewer risk factors.

Of these people who actually survive, only 3%-7% are ever able to return to their previous level of function.

Those are some pretty shitty odds right there.

[Communal Ecotopia]

Not about my body. Look, I have spina bifida and cerebral palsy (more or less). I also have non-active Hepatitis C. I've had it for 30+ years (blood transfusion at age 2 or so, before they began screening). I also have a PhD, formerly a girlfriend (I hope again soon), an active social life, etc. My hepatologist was shocked that I would want to undergo treatment for my Hep C, given how "horrible my quality of life is" and that the treatment has a few nasty side effects like fatigue and nausea. Since my body isn't reacting to the Hep C virus, I'm lucky. I can wait a bit until these new non-PEG Interferon drugs get their kinks worked out. But, hell yes, I want them.

The numbers here are pretty clear. Only about 1 in 5 people who need CPR in a hospital will survive to ever be discharged. If the patient has 3 or more risk factors associated with receiving CPR then only about 7% of those 1 in 5 will survive for 2 months. Only about 50% will make 2 months even with fewer risk factors.

Of these people who actually survive, only 3%-7% are ever able to return to their previous level of function.

Those are some pretty shitty odds right there.

Shitty odds, I agree. But what if the patient is willing to take that chance. I know, you're going to say "but they'll sue", but what if they don't? Along this same line of reasoning, this is partly why I think advance directives miss a key point. I don't have a solution, but what if you're a patient and you think paraplegia is the worst thing ever and you'd sooner kill yourself (nevermind that much of that reasoning is because society hasn't adapted the world to people with disabilities, but I digress), and then you find yourself a paraplegic. And you adjust. And you're okay. And you want to live.

[Tekania]

Certain medical conditions can preclude the use of CPR as a resuscitation mechanism by doctors. CPR is a fairly violent act and can result in severe injury or trauma, and so may not be used by doctors in a hospital in favor of other resuscitation meaures.

[Tekania]

Of course not. The use a term americans might be accustomed to. The customer is always right.

I would like to apologize on behalf of whoever the hell said that and clarify that, indeed, the customer is not always right. In fact, the customer's is sometimes a dumb asshole.

Working in the IT field for the last 15 years, I endorse this message.

[Allet Klar Chefs]

Shitty odds, I agree. But what if the patient is willing to take that chance. I know, you're going to say "but they'll sue", but what if they don't? Along this same line of reasoning, this is partly why I think advance directives miss a key point. I don't have a solution, but what if you're a patient and you think paraplegia is the worst thing ever and you'd sooner kill yourself (nevermind that much of that reasoning is because society hasn't adapted the world to people with disabilities, but I digress), and then you find yourself a paraplegic. And you adjust. And you're okay. And you want to live.

You're trading a 0.6% (0.6%!) chance of happy survival for anyone who has something happen to them which requires CPR in return for the wellbeing of all of the hospital staff involved who are going to see 99.4% of their work effectively go to waste. It's not really their fault you're going to die. But if you make it their fault, it's going to crush morale, even aside from cost considerations and the family's wellbeing.

[Ashmoria]

Yay death panels.

yup

it can be much better to let a dead person stay dead than to bring them back to suffer for a few weeks or months then die.

[Communal Ecotopia]

Shitty odds, I agree. But what if the patient is willing to take that chance. I know, you're going to say "but they'll sue", but what if they don't? Along this same line of reasoning, this is partly why I think advance directives miss a key point. I don't have a solution, but what if you're a patient and you think paraplegia is the worst thing ever and you'd sooner kill yourself (nevermind that much of that reasoning is because society hasn't adapted the world to people with disabilities, but I digress), and then you find yourself a paraplegic. And you adjust. And you're okay. And you want to live.

You're trading a 0.6% (0.6%!) chance of happy survival for anyone who has something happen to them which requires CPR in return for the wellbeing of all of the hospital staff involved who are going to see 99.4% of their work effectively go to waste. It's not really their fault you're going to die. But if you make it their fault, it's going to crush morale, even aside from cost considerations and the family's wellbeing.

Perhaps. But I'm really not trying to be that specific. I'm trying to generalize out of the OPs issue and show why a vast misunderstanding of what people with impairment live like can really hamper the medical profession and why things like advanced directives may not be the Godsend we think.

[Vamtrl]

Yay death panels.

yup

it can be much better to let a dead person stay dead than to bring them back to suffer for a few weeks or months then die.

I am sure the families feel the same way about their loved ones. I mean they are going to die anyway!

[Tekania]

So you would force doctors to perform procedures they believe to be harmful based on the wishes of lay-persons?

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

With some conditions CPR has a very low rate of success compared to other resuscitation measures and as an added "Bonus" subjects the patient to additional bodily trauma in the process. No CPR =/= DNR... it just means that CPR is not to be used, and instead other measure should be used by staff for resuscitation in the case of the patient coding.

[Napkiraly]

yup

it can be much better to let a dead person stay dead than to bring them back to suffer for a few weeks or months then die.

I am sure the families feel the same way about their loved ones. I mean they are going to die anyway!

I'd rather my mother died with as little pain as possible. If "saving" her is going to negatively impact her quality of life for just a short while I'd rather she didn't have to go through that. In fact I know she wouldn't because she's told me, my sister, and my step-dad that and has it written into her will.

Then again, she's a doctor so she has quite a bit of knowledge about this stuff.

[Fionnuala_Saoirse]

If it's simply a matter of cost or of what the doctor thinks the patient's quality of life will be, yes.

With some conditions CPR has a very low rate of success compared to other resuscitation measures and as an added "Bonus" subjects the patient to additional bodily trauma in the process. No CPR =/= DNR... it just means that CPR is not to be used, and instead other measure should be used by staff for resuscitation in the case of the patient coding.

What are these other measures?

[Communal Ecotopia]

I am sure the families feel the same way about their loved ones. I mean they are going to die anyway!

I'd rather my mother died with as little pain as possible. If "saving" her is going to negatively impact her quality of life for just a short while I'd rather she didn't have to go through that. In fact I know she wouldn't because she's told me, my sister, and my step-dad that and has it written into her will.

Then again, she's a doctor so she has quite a bit of knowledge about this stuff.

I think here's a different story than I'm arguing. If she isn't in economic need, if she has a family support structure, is competent, and not in pain, and she doesn't want to be in huge amounts of pain, that should, of course, be her choice. What I am opposed to is people (philosophers like Peter Singer, some, but by no means all, doctors, etc.) thinking they know what my life is like and then being shocked when told otherwise.

[Tekania]

With some conditions CPR has a very low rate of success compared to other resuscitation measures and as an added "Bonus" subjects the patient to additional bodily trauma in the process. No CPR =/= DNR... it just means that CPR is not to be used, and instead other measure should be used by staff for resuscitation in the case of the patient coding.

What are these other measures?

Defibrillators, ambu bags, Leyerdahl masks, medications (such as antihistamines and adrenaline), oxygen tanks, oximeters, etc.

There is literally a whole army of less traumatizing resuscitation measures then pounding on someones chest hard enough to crack ribs and blowing into them that can be undertaken by a staffed and equipped hospital.