Hard Decision..but the decision isn't yours

[KCS911]

Had a conversation with an EMS buddy today. I needed help finding a topic to write about for a Proposal Essay for a college English class. MEDICAL VS ETHNICAL is the topic we came up with. There is alot of hard decisions that EMS make everyday but its really not their decision to make....its their duty and they have to do their job even when it is hard.Here is a couple topics....

* EMS respond to suicide. Terminal patient just took a bunch of pills...save them or respect their wishes..

* Some guy murders a family, gets shot by police...you want to let him die...but...

* Someone has massive spinal/cranial injuries to the point that if they survive, they will be vegetative or completely crippled...not breathing...save them or end the suffering before it begins...

WHAT CALL HAVE YOU CAME APON THAT YOU WISH YOU COULD HAVE LET THE PERSON DIE?

 

[jgmedic]

So not trying to be an a-hole, but it's ETHICAL and UPON, not ethnical and apon, since this is for a paper thought you should be sure. As far as your question goes, there have been a few times where I felt the patient didn't need to be worked up, a very elderly lady who choked and died, had a whole host of problems and did not have a high quality of life, and the family insisted on full resuscitative measures, and a little girl who had a near drowning, ended up severely compromised neurologically, and ended up being frequently transported with all those lovely complications of being bed-ridden.

 

[JPINFV]

Medical concerns and ethical concerns should be one in the same. For an interesting documentary on the terminal suicidal patient, watch the Frontline documentary "The Suicide Tourist." However, physician assisted suicide needs to be a process, and not something thought of on the spot.
http://www.pbs.org/wgbh/pages/frontline/suicidetourist/

For number 2, it's simply neither ethically or medically justified to let someone die because you beileve (regardless of how strongly or how correct you are, you are not a court of law or a jury of 1) they did something horrendous.

Similarly, with number 3, the decision of life or death (withdrawal of life support) should be up to the patient or the patient's representative, not you the provider.

 

[KCS911]

haha Wow.I know thats how it should be spelled.Just having a dumb moment.Hopefully this English class I'm taking helps. Thanks for the documentary and the input

 

[citizensoldierny]

Did a motorcycle accident this summer where the persons head and facial structure were totally blasted . I worked him and he is still alive and in a hospital in a coma, from what I heard he has something like 10% brain function. A miracle of sorts I guess, as the guy he hit head on while stunting/playing chicken died on the way to the hosp. and my patients injuries were just as severe. As for the ethical decision I didn't see any, he was still breathing though poorly when I got on scene so I did what I was trained to do.

 

[Veneficus]

Similarly, with number 3, the decision of life or death (withdrawal of life support) should be up to the patient or the patient's representative, not you the provider.

I respectfully disagree.

While it may seem as black and white as this, in real life it is often gray.

Often the patient has no predecided power of attorney, for medical or otherwise.

The decision to withdraw life support is often based on family education level, or lack of it.

There is also the problem when medicine cannot restore quality of life but can maintain the organism.

 

[firetender]

No offense meant!

Geez, for a minute I thought you were trying to decide whether it's okay to work up an Eskimo but leave Albanians to God!

I've been looking at this stuff from the rear-view mirror since I've not been active for quite some time, in part, coming to terms with the numbers of people who I brought back who were brain-dead and lingered for as long as, yes, YEARS, without regaining any semblance of consciousness, only retaining (supported, i.e. feeding) function.

I came to the conclusion that EMS's role is quite simple; if there's a chance, we bring them back. We pay attention to directives that say "don't bother" but WE of all medical personnel, don't deal with such moral/ethical conflicts.

Sometimes we do, however, see the results of our Gung-Ho's and it's pretty depressing, but on the scene, making the decision (except in cases of huge time lapses, etc., you get the picture) is NOT ours.

* EMS respond to suicide. Terminal patient just took a bunch of pills...save them or respect their wishes..

All you see in the moment is a human being down. Your job is to get them to the hospital, hopefully alive. There are no conflicts to be handled here.

* Some guy murders a family, gets shot by police...you want to let him die...but...

Here's the Dark side: Sure, sometimes we wish they would.

And then again, we're not paid to be Executioners, are we? That's what it would be and we have laws to cover that and Specialists whose job it is to pull the plug. No moral decision to be made; that one is legal.

* Someone has massive spinal/cranial injuries to the point that if they survive, they will be vegetative or completely crippled...not breathing...save them or end the suffering before it begins...

Should I come across a Biker Down and you are there with your ambulance and I see you put down your drug box and take out a crystal ball, you'll have other ethnical dillemas to resolve, like, how do you explain some ex-medic stole your ambulance and patient and ran your call?

 

[JPINFV]

While that is true, when it comes down to a situation where medicine can do no more and the patient's family, or lack there of, is unable to make the decision, it isn't going to be up to any single or any two providers, and definitely not a decision to make in the back of the ambulance.

 

[CAOX3]

Had a conversation with an EMS buddy today. I needed help finding a topic to write about for a Proposal Essay for a college English class. MEDICAL VS ETHNICAL is the topic we came up with. There is alot of hard decisions that EMS make everyday but its really not their decision to make....its their duty and they have to do their job even when it is hard.Here is a couple topics....

* EMS respond to suicide. Terminal patient just took a bunch of pills...save them or respect their wishes..

How do you know their wishes, maybe it was accidental.

* Some guy murders a family, gets shot by police...you want to let him die...but.....

As a professional I can seperate emotion from my decisions.

* * Someone has massive spinal/cranial injuries to the point that if they survive, they will be vegetative or completely crippled...not breathing...save them or end the suffering before it begins........

Is that really your call? Who are we to determine what quality of life is acceptible.

WHAT CALL HAVE YOU CAME APON THAT YOU WISH YOU COULD HAVE LET THE PERSON DIE?

I look forward not backwards, I have a job to do and thats what I do.

 

[iamjeff171]

im in agreement with what pretty much everyone else has had to say, our job is to treat the patients and get em to the hospital.

as for the suicide: quite often people change their mind. in my experience those who truly intend to kill themselves do it in such a way that not treating is a no brainer (no pun intended). and also, accidental overdoses do happen, especially in those chronically ill patient with lots of narcotics for pain.

as for the murderer: what exactly would you call yourself for letting them die? i dont think i would want that on my conscience for the rest of my life.

for the patient with the TBI: there is no way you could possibly predict the extent of his deficits and or/quality of life in the future. in addition, you dont know who could benefit from the viable organs that person could potentially donate.

i dont know if this is bad or not, but when i am working a critically ill person (multisystem trauma, cardiac arrest, etc) i dont see a person as much as i see a patient.

-Jeff

 

[EMSLaw]

The second situation is the most ethically clear cut. It is not up to the medical provider to make a moral judgment as to whether that person deserves to live. It is for the state to make that decision after trial and conviction, a process that isn't governed by passions.

Terminally ill patients present their own challenges. If the patient is THAT sick, and their wish is a peaceful death, we have a process for obtaining a DNR. Again, where the consequence is ultimately final - death - then it is better to err on the side of caution than make a decision that can't be reversed.

I've had calls with patients of very advanced age (90+) where the decision was made to intubate. While EMS providers, myself included, might want the patient to peacefully "walk to the light" that simply isn't our decision to make. One of my few CPR "saves" was an otherwise healthy 40-something who had a cerebral hemorrhage. In hindsight, it might have been better if we'd not succeeded. But even if we KNEW the cause of the arrest, it would still be our responsibility to save his life.

These are decisions in the category risk managers label with "NDT". No discretionary time. High-risk, low-frequency, NDT situations are the most prone to go pear-shaped with dramatically bad outcomes. So, work the call, and let the important decisions be made upon sober reflection.

 

[silver]

I've had a long interest in medical ethics, and have taken a few classes on it. I can see why you chose emergency situations, but they are some of the more difficult situations to come up with a moral decision (that has some foundation to it). I would consider a dilemma that doesn't have an emergency aspect to it to write a paper on.

And that being said, without knowing any social, familial, and medical backgrounds of the patients in those 2 topics (the second one is just not a decision for you to make), I wouldn't make a decision...


(As a caveat, you should obviously be providing the best care possible as an EMT, and not be making these decisions. Call med control or let the ED deal with it.)