Sunday, July 15, 2012

The Dying Patient

The Daily Telegraph, a UK paper has this health article posted on their website.  The title is Hospitals "letting patients die to save money" It should not surprise me since euthanasia seems to be a desirable option now-a-days for people in more developed countries who does not want to suffer from a debilitating or terminal illness.  But still, news like this continue to surprise me simply because I believe in the sanctity of life and no one, absolutely no one has a right to take it away. 

The article talks about "The Liverpool Care Pathway, so called because it was developed at the Royal Liverpool Hospital in the 1990s, aims to ensure that patients who are close to death can die without being subjected to unnecessary interference by staff. In addition to the withdrawal of fluid and medication, patients can be placed on sedation until they die".  Supporters of  this say it is the kindest way of letting dying patients slip away.  But there are some UK doctors who suspect that this is not the only reason, but also the fact that prolonged care for dying patients stretches hospital budgets, and so when these patients die earlier, money can be saved.  When money and not comfort becomes the motivating factor, then the process becomes unethical and immoral.

Although I would agree that dying patients or those who are terminally ill and who would no longer benefit from any kind of treatment should not be subjected to further medical interventions, I would draw the line from removing supportive care like food and fluids. When our patients or their families sign a DNR (do not resuscitate), it does not mean that they are asking us to stop giving them comfort, care and attention. This care includes giving them food and water when they want it. Withholding these will not make them comfortable, rather add more distress.  We are still their doctors and nurses till the end. 

"God only knows"

When I was a medical clerk, at times when we had difficult cases, we would jokingly say that the diagnosis was GOK or "God only knows". Today I say that to families of dying patients when I am asked by them how much time their loved ones have...only God knows.  One of the things I remember from some of our consultants was their predilection of giving a time frame as to when a patient may die.  They would tell us that this or that patient has 3 or 6 months to live and we, students would knowingly nod our heads. But more often than not, they were wrong.  My grandmother was diagnosed with stage 4 Breast CA in November 1988 and was "given" 3-6 months more to live. She called all her family to place everything in order.  Almost two years later, she was still alive, in spite of not having undergone any treatment for her cancer, and so realizing she was not going to die anytime soon, she decided to move back to the province together with her handicapped daughter (my aunt), building a small house besides us.  During the last 2 weeks of her life, my grandmother continued to eat when she wanted to and she agreed to a feeding tube when she became too weak to swallow. She was asleep most of the time but during moments when she was awake, she was coherent and would even joke about me losing weight by the time she dies. She had vivid dreams of my grandfather (who passed away in 1964) and would sometimes impatiently ask God to take her already.  After spending four of the happiest months in her life (that is what she told me), she passed away peacefully in October 1990.

If there was one important thing I learned from all these, it is that no human can predict death and that we should never be afraid of it. But when the time comes, God will be there to take us home with Him.


26 comments:

  1. Every one should have the chance to decide for themselves as long as it won't hurt other people and that goes to anyone who is dying. Financially wise, I believe it is just fair to those who are left behind.

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  2. This had been an ongoing issue in the healthcare field that until today still bothers a lot of people. In the end, the decision must be weighed properly for its pros and cons.

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  3. I agree with Rojae.. decision must vary on the pros and cons.. it sure be a hard one.. but will surely passs

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  4. for the past years of practicing my profession as a nurse, I have seen a lot of cases where the family members opted to "remove the tube", some could not bear the feeling of seeing their loved ones suffer but sadly, some could not just sustain the finances. I really hope, that we will be blinded by the so-called conventional way of thinking when dealing with life. I agree that even the doctors who give a certain time a patient lives, this will still not have a guarantee that they are 100% correct.

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  5. In cases of terminally ill patient, I guess they should decide how they'd live their remaining years or month as this would make them happy.

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  6. I remember writing about euthanasia when I was in college. It's a hard decision. No one knows the day or the hour really.

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  7. I definitely agree with you. The story about your grandmother just proves that even terminally ill patients can have a chance for a longer life. It's not ours to simply take away.

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  8. we were just talking about this yesterday.. i agree that dying patients should still be given care and comfort.. :)

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  9. As for euthanasia, it is, I believe, a decision where prayer and study involve. We are not to decide when life has to end, because miracle happens in a lease unexpected time.

    On the other hand, seeing dying for me is traumatic. I don't want to remember how my grandfather die, even though I know he's in a better place.

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  10. Euthanasia! This is really a serious matter that need a lot of talks between relatives and concern love ones. Life is something we should cherish and respect.

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  11. It has been an issue for the past years and until now. No matter what the decision is, they should consider first the patient and the immediate family. It's only God knows our time.

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  12. common saying "when there is pulse there is hope". Euthanasia can be an answer yet saving life must be the prime concern of every doctor and medical practitioners

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  13. Only God has the ability to take one's life. I know euthanasia is being practiced in some countries but I think not here.

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  14. Euthanasia is a hard subject but I'm confused why religious people are against it. If a patient is only alive because of a machine, isn't removing the machine basically allowing "God's will" to be done?

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  15. I guess we should consider both sides regarding this sensitive matter.

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  16. It bothers me too, this is really hard to decide on. The issue remains to be talked carefully as to patients has the right still.

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  17. Pros and cons should be weighed with regards to this issue and I may go with letting people live their lives to the fullest but I still do think that in some cases such as if patient's life only depends on life support system then I guess ending it is the only answer.

    I know I'm not God but really they also need to rest.

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  18. I recently talked to a client who came from US and she said that when her husband was hospitalized, she signed a DNR. It was hard for her to let go of her husband but she didn't want her husband to suffer. I think that it would be best to just let the patient expire and not resuscitate than to intentionally cut of his life support.

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  19. My father refused any more dialysis sessions after two years of undergoing it because he said it was already becoming too painful for him. There was nothing we could say that could make him change his mind. He actually requested us to let him go reminding us that he has already surpassed the 6-month death forecast given by the doctors. It was so difficult to let go.

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  20. Being a nurse, I also had a dilemma if euthanasia is an evil or a good action to do. Yes, I believe that we should take care of life as long as we can, but prolonging the life, with pain and suffering.. Does it benefit the patient? Or we are just trying to comfort the relatives who are mourning for the possible death of the patient?

    Same article here: http://goo.gl/cSDRh

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  21. No human can predict death..
    certainly not medical professionals..
    This presumptions is preposterous.
    If you ask my opinion on it,
    I agree with Euthanasia..
    But as much as possible, in an ethical and moral way.

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  22. hmmm... my grandfather chose to die in his home.. he told his children to get him off the hospital and in days he did not ate.. even though they would not let him to go home.. but he insisted and after several days they found him dead in his bed.

    he chose it for he knows the hardship of paying the medical bills and the hardship of taking care of him..

    now my grandmother is still healthy and enjoying himself...

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  23. While we cannot predict when it is our time to leave this earth, I believe that some times we have to factor in a lot of things before coming to a decision such as euthanasia. If a person is terminally ill, wouldn't you want that loved one to not suffer any longer? Let nature take its course? As much as we want to prolong life, wouldn't that be going against God's plan as well with the use of medicine? I sound like I'm rambling but I guess my point is, before making such drastic decisions, we should still ask God's guidance and pray that he leads us to the right decision. :D

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  24. Every issue of letting go is really difficult but when it comes to issue about life and survival I am in favor to respect the will of God not the will of anyone around me if I am the subject of euthanasia.

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  25. I'm okay with letting go of the machines that support the heart when the brain is dead.

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  26. agree.. only He knows when He will get back the gift He lent us which is life.

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Thank you for your comments.