Thursday, May 27, 2010

After Reading Through Ch. 17 (and beyond)


This one's a bit tough - Dr. Nolen describes treating terminally ill patients and that "a surgeon is reluctant to 'pull the plug'? As recently as 2005 with the "Terry Schiavo" case, how to address the dying is something most of us are reluctant to deal with. If you were the attending surgeon would you be comfortable "playing God"? If you were a family member of a terminally ill patient, what would you do?

26 comments:

  1. I think that it this issue is always tough to have a definitive opinion on. Personally, I think that if I were a surgeon/doctor I would leave the decision up to the family members, because it doesn't take too much of my own effort to keep the patient on life support, whereas it takes a lot of invested time and emotions on the part of the family members. If I had a terminally ill relative I would probably try to do everything to keep them alive even if it meant keeping them on life support. After a long time passed, however, I would eventually take them off of life support to have final closure and accept the situation. But it is always hard to make a clear decision.

    ReplyDelete
  2. As the attending surgeion I would definitely not feel comfortable "playing God." I think that decision lies in the hands of the family. I don't think that the surgeon has any right to pull the plug, because even though they were "entrusted with the patient's health," I think that as families must agree to surgery, families must also be the ones to decide when the plug gets pulled. I see the argument that the surgeon has been put in charge of the patient's health and so any decision they make for the better of their "health" is a good one, but I just don't think they have a right to make a decision when it comes to pulling the plug.

    ReplyDelete
  3. This year, my grandmother suffered from major stroke and was diagnosed as being in a persistent vegetative state. Instead of allowing her to "live" with a food tube, her sons decided to let her die naturally under hospice nursing. I don't consider this "playing God." After witnessing the experience first hand, I think it was the most compassionate and merciful thing to do. Instead of prolonging the pain and lack of awareness, they allowed her to pass in a painless, safe environment. So, I don't think a doctor can decide to "pull the plug" or not, but I think, under the right circumstances, the individual can choose if their condition is not going to get better.

    ReplyDelete
  4. If I were the attending surgeon, I (like Dr. Nolen) "could never assume the responsibility of imposing death upon(someone). I couldn't play God" (200). I think that even surgeons with all their intelligence and long years of training cannot possibly be 100% sure of an inescapable and imminent death. I most definitely would hesitate before pulling the plug because although the decision is theoretically and logically sound when you think of the resources saved, the consequences are frighteningly permanent.

    If I were a family member of a terminally ill patient, I think I would probably be one to read all the inspirational medical success stories ever published and cling to any slim chance, even if it was 10 billion to one, of a miracle. At least at first; I suppose eventually I would get so tired of the waiting and worrying that I would permit the hospital to pull life support.

    ReplyDelete
  5. If I were a doctor in the role of "playing God" I would never be able to give up and let them die and I don't think it is the role of surgeons or doctors to make that choice. It is definitely hard to constantly care for a patient that has barely any hope left and will soon die, but as Dr. Nolen mentions, there is always hope and in even the worst situations a patient can survive seemingly miraculously. For this reason it is important to work to the last moment to help a patient. The only exception is if the patient himself or the patient's family is ready for their relative to go. From experience I know how hard it is to watch a family member progressively deteriorate, and at some point I think the family has the right to ask the doctor's to take the patient off life support and finally put the patient to rest.

    ReplyDelete
  6. I feel that as a doctor I could never make the decision for anyone about a patients life or death. Though I believe that since its part of my job and I have an obligation to do so, that I would explain the situation to the family. This would most likely include a suggestion of letting go of their close family member. So I do not think would feel comfortable “playing God”. I also feel that if I were part of a family in this situation I would have a great deal of trouble making the decision, myself, to end someones life. I imagine my thinking in that situation would be quite torn, and only if my family member could not bare the pain of living, would I be able to let go.

    ReplyDelete
  7. I don't think that I could ever bring myself to play God as an attending surgeon (another reason why I don't think I'll ever be a surgeon!). Were I to have the consent of either the patient or a family member - someone who really loved this person - then, reluctantly, I would probably "pull the plug," but if it were my decision, I would definitely do everything in my power to keep the person alive.

    If I were a family member however, the decision, I think, would be much harder. I think that it is fine for a family member to ask the doctor to let a patient die, but actually making that decision would be extremely hard, I'm sure. The logical way to look at this issue is to try to access weather or not the possibility of recovery is great enough to outweigh the suffering that the person is going through. After a point, keeping a person alive after they are too far gone is just a waste of time, effort, emotion and pain, but I don't know if I could ever make that decision...

    ReplyDelete
  8. I think that it's always very difficult for both the doctors and family members in this kind of a situation. I do believe that the family members should make the decision on when it's time to pull the plug, not the doctor. If I were a family member, I would want the doctors to do everything possible to keep my loved one alive. It's always easier for the family to want to keep fighting for the life of their loved one, but sometimes the patient would rather not be in pain anymore. I think that there are cases when the family realizes it's time to let go and that's ok. It's best to make a decision that the family has peace about.

    ReplyDelete
  9. This one's a bit tough indeed. To me, the ethics behind pulling the plug depend completely on the specifics of the case. If the patient is terminally ill, actively dying, but can communicate, it should be solely their decision whether to wait and die naturally or end it quickly. If the patient is not in good enough condition to make the decision personally, it gets trickier. On the one hand, asking the doctor to do it puts a lot of extra stress and responsibility on their shoulders that they definitely do not want to deal with (almost all doctors, including Dr. Nolen, do not feel comfortable making this decision for their patients—even if referring to it as “playing god” is, frankly, a bit melodramatic), and has a lot of potential legal issues for the hospital. But on the other hand, the doctor is much more qualified to make this decision well. The patient’s family members, in addition to probably not fully understanding the disease, are too biased to choose what’s truly best for the patient. The best way to deal with this issue is to have the doctor decide whether or not to pull the plug, but require consent from the patient’s family—give them the final say.

    ReplyDelete
  10. I think I would only feel comfortable ending a person's life in one of two circumstances:

    A. If the patient asked for it and was clearly both terminally ill and living in constant agony.

    B. If a person was obviously brain-dead and it was clear that that would never be able to enjoy life again. (though this is problematic)

    I do agree with Nolen's assertion that a surgeon should not "play God", meaning that they should never take a patient's life into their own hands, most of the time. I believe it is a doctor's duty to keep a patient alive as long as possible and as healthy as she can make them. I also don't think the doctor should interfere with a patient's conviction to live, even if her case seems hopeless to the doctor. As Nolen notes, on occasion a person given no chance of survival will pull through, and thus the doctor should usually honor that sliver of possibility.

    But I think a doctor should respect the wishes of a patient who has no hope for herself, for if that patient herself has chosen to remove any hope in that "sliver" there is no reason to keep her in agony.

    Going to the second part of the question,if I were the family member of a terminally ill patient, I would do everything I could to support them and would respect their decisions. I would hope that I would not be inclined to "play god" with a relativee; but if my relative was brain dead, I would probably consent to having their support shut off instead of keeping them alive in a coma.

    ReplyDelete
  11. I think it is definitely a difficult decision to make and as an attending surgeon it would be almost impossible to decide whether or not to "pull the plug". As the doctor you dont have the same ties that family members do and therefore you dont have the same emotional involvement as a family member would. If I was a family member, i could see how I wouldnt want to pull the plug even if i knew it was the best option for my family member just because I wouldnt want to go through the extra emotional stress. It would be easier to just refuse to believe the person is not going to come back to normal than to accept it and pull the plug. As an outsider on the issue I would say I think it is usually best to let the person go and accept they arent coming back though if i were emotionally involved it would be much harder to stick to this opinion and I would probably keep the person on life support hoping they would somehow return to normal.

    ReplyDelete
  12. Dealing with a patient with a terminal illness is never easy for the attending surgeon. Personally I would not be comfortable with "playing God." It would be very difficult to determine when to pull the plug. Although the person is already terminal, the actual action of dying is a hard concept to face, and having the power to end someone's life is hard to deal with. I would follow the wishes of the family, I would keep the patient alive until the family had closure with the situation and felt comfortable enough to say goodbye. As a family member of a terminally ill patient, I would not want my family member to be sustained on life support. I do not think that a person on life support is actually alive, merely a body. To honor my family member I would want them to die peacefully for their sake and so I could move on as well.

    ReplyDelete
  13. If I were the surgeon, I'd never want to be the one who would choose whether or not to pull the plug. I don't really think it's the doctor's place to decide. A decision like that should be made by family members or friends.

    If someone in my family was in that situation, I have no idea what I'd do. I've never been in a situation anything like that, so I really don't know if I'd cling to any chance, however slim, of recovery, or if I'd want to end the suffering and stop ife support. I can't even guess what I'd do in that situation.

    ReplyDelete
  14. "Playing God" would probably make anyone uncomfortable, especially when the life of a loved one is at stake. However, with a case of a terminally ill patient on life support, the decision falls to the family members. I really wouldn't feel comfortable "playing God" here because I'd feel it's simply not my call. Just as doctors have to get consent from patients or their relatives before performing risky operations, doctors aren't in a position to decide to pull the plug. Though a doctor might have a more realistic understanding of the nature of the patient's condition before surgery or before pulling the plug, they do not have free reign to do whatever they see fit. Aside from my personal aversion to "playing God," I would leave this sort of decision up to the patient/family because I don't think it's within my authority.

    ReplyDelete
  15. Though i understand that a patient may be suffering, i would not feel comfortable pulling the plug on a patient. If the family members all unanimously agreed that letting the patient die was the best option, i would not try to convince them to change their minds but i would have to ask another doctor to actually perform the act. Even if the patient had previously stated that they didn't want to stay on life support, I would not be able to pull the plug. I thought it was terrible in the Terri Schiavo case that both her parents wanted her to stay alive but she was taken off life support because her husband decided to allow it for his own personal reasons. I do believe that pulling the plug should be limited if the patient was completely brain dead, with no hope of any recovery, or if the patient is terminally ill and in pain. I would feel a little too personally responsible for letting them die. If one of my family members was terminally ill, i would let them decide what they wanted to do, without trying to convince them either.

    ReplyDelete
  16. It is definitely the family's decision as to whether or not the plug should be pulled, but personally I would feel comfortable with whatever the family asked to do. I would feel fine pulling the plug and ending the person's life, as that is what I would want someone to do for me under certain circumstances. I think that it is completely ethical to end someones life if they are in certain conditions and there is no chance of the patient improving, and i think it unnatural and wrong to let it go on. However, if i believed that the patient had a reasonable chance of surviving, i think it would be very wrong to pull the plug. I would be comfortable "playing God," but i would take the family's ideas into account and be very careful with my decision.

    ReplyDelete
  17. As the attending surgeon I would not be comfortable with “playing God” because I think the decision to “pull the plug” should be made by the family. If a relative of mine was terminally ill I would probably want to do everything in my power to keep them alive. But if he/she had been on life support for a long time and there were no signs that he/she would get better, then I would probably take them off life support. I think that “pulling the plug” is just one of those decisions that will be hard to make no matter what.

    ReplyDelete
  18. The idea of 'playing God' is an interesting one. As a surgeon, you are almost entirely responsible for the life on which you are operating, which is a very intimidating realization. As mere mortals, we aren't used to being the decider's of life and death for other people. As for terminally ill patients, I believe that it is mostly up to the family (if there is one) whether or not to 'pull the plug' on a patient. However, it is my personal opinion that, despite the immense difficulty in the decision, pulling the plug of a patient reliant on life support would be the economically sound, and realistic thing to do. You can keep them "alive" as long as you want with the hope that someday they might wake up, but more likely than not, their body will just be a drain on resources.

    ReplyDelete
  19. I this is a tough topic for young people to think about. If I were the attending surgeon, I would not be comfortable with “playing God”. I would leave the decision entirely up to the family. If I were a family member of a terminally ill patient, I would have to discuss with the rest of my family so that we can make the decision together. We would probably decide to do everything in our power to keep our family member alive.

    ReplyDelete
  20. If I were the attending surgeon, I would not feel comfortable "playing God." I think the choice to "pull the plug" should be made solely by the family, considering that it is their family member on the line. Depending on whether or not the patient has a chance of survival and recovery, perhaps I would try to influence the family's decision, but in the end, it is up to them, and not to me. Letting a loved one die must be one of the hardest decisions, and for that reason, it should be made by the people who truly care about the person. I support "pulling the plug" if there is no chance of survival or recovery, but I cannot make such a difficult decision for someone.

    ReplyDelete
  21. It's interesting to note that in a sense, the entire role of a surgeon is to aid the patient in extending their life in circumstances that they may not be able to deal with on their own. This form of helping them extend their well being, and oftentimes their lifespan is a form of playing God. Yet it is not up to the surgeon to make these decisions as to whether or not to treat the patient, the patient or their family must first approach the hospital or the doctor. This shows that the responsibility of the decision of the patient to either "pull the plug"or continue to live off of life support is not of the surgeon's. It is up to the family or the guardian of the patient, providing that the patient cannot provide for themselves. Of course, the surgeon should offer accurate facts and perhaps their own opinion, and a second opinion should be consulted as well, but it should not be the responsibility of the surgeon to decide whether or not the patient should live.

    Besides, think of the awful lawsuits someone could launch at the hospital if they decided to argue that the patient could have eventually recovered, or that the surgeon "murdered" their loved one.

    ReplyDelete
  22. If I was a family member of a terminally ill patient, I would pull the plug if they were suffering a lot or if they said they were ready to die. I know that if I were actually faced with this situation I would not come to this decision as easily and would probably be very reluctant. But, I do think that it is selfish to keep someone alive beyond his/her will. (For example: the mother in My Sister’s Keeper).

    If I was the attending surgeon of a terminally ill patient I would be just as reluctant to pull the plug because I wouldn’t have any relations to the patient. I would not want to suffer the wrath of the family, however again if the patient needed to die then I’d kill him… as terrible as that sounds.

    ReplyDelete
  23. This one's a bit tough - Dr. Nolen describes treating terminally ill patients and that "a surgeon is reluctant to 'pull the plug'? As recently as 2005 with the "Terry Schiavo" case, how to address the dying is something most of us are reluctant to deal with. If you were the attending surgeon would you be comfortable "playing God"? If you were a family member of a terminally ill patient, what would you do?

    I always hate to be put in really complicated moral situations, especially ones that involve someone else's life. If I were a surgeon operating on a terminally ill patient, I would not want to be the person to determine whether or not he/she will continue living, as I do not really know the patients. Rather, I would have the patient's family decide. It's them who have an emotional connection with the patient, not me.

    Recently my grandmother died. One day she just didn't wake up. I know that my family could have rushed her to a hospital and maybe could have given her a few extra days, but my family and I decided against it. My grandmother, although she died earlier, died very peacefully without any pain. My grandfather on the other hand, was rushed to the hospital and suffered for a few extra days with a tube down into his lung. It was only until the doctors told my family that there was nothing left to do did my grandfather die. My grandfather died in pain. So, if I were a family member of a terminally ill patient, I would let that family member go as long as he/she would have a painless, peaceful death.

    ReplyDelete
  24. If I were a surgeon, I don't know how comfortable I'd be in this situation. Of course, surgeons do play God for a living (by operating to prolong someone's life, they are playing God), but this situation is different. If I were the doctor of a terminally ill patient, I would tell my patient their options and let the patient and their family decide. If my patient were brain dead, I would (tactfully) tell the family that I did not think that there was a chance that their loved one would wake up, and would let them decide. It's not my place to tell someone to let their family member die, after all.

    All of my family members that I've spoken to about this subject have told me that they do not want to be kept on life support. Of course, when you're actually in that situation, I'm sure it's impossible to decide to let your loved one go. . . But I would like to think that I would be able to let them go. I wouldn't want them to be kept alive and in pain.

    ReplyDelete
  25. As a surgeon, I would always hesitate before pulling the plug on any patient, even if I was sure that they would have no chance for recovery. If the patient was capable of making decisions, I would pose the option to them and follow their wishes. However, if they were not in any capable state, I think that if I were sure it was the best option, I would pull the plug. However, I would have to get consent from the family members before doing anything; ultimately I could only advise them, but they make the final decision.
    If I were a family member of a terminally ill patient, I think that theoretically I would let them go - however, in the actual situation, I have no idea what I would do. I hope that I would still be able to put them off life support in order to save them the pain of an inescapable death.

    ReplyDelete
  26. I mean, as a surgeon, I'd beyond "hesitate" to pull the plug. I couldn't. I wouldn't. I'd refuse. It's not my place. It's the family's decision/right to choose the time and situation of their loved one's passing. It's really not the hospital's choice at all. Even if I thought it was the best option, no way could I infringe on people's rights like that.
    On the other hand, as the family of a terminally ill patient, I'd be in control and I would have the right to make that decision. Fortunately, I know what most of my family members want to be done in certain situations. It's a really important conversation to have no matter what, because you don't want to ever be in a position where you have to choose the fate of a loved one. Even if you just have to be the messenger, at least you know that they would have wanted it that way.

    ReplyDelete