Nobby!!! work related question!Follow

Just off the phone to my dear 'ol mom, and she was telling me about one of her friends.

Basicly she has a serious heart condition (She has an extra Aorta which is back filling into her heart and reducing the bloodflow to the rest of her body), the doctors have told her that if she has a fourth heart attack that they will not place her into intensive care and continue treatment.

Is this ethical? Is it legal? and can she fight it?

For me it seems that we constantly hear about the human rights of the scum of the earth but whenever someone who has paid taxes their entire life askes for their human rights to be observed (be it continued treatment l;ike this or the right to euthanisia) they get told Unlucky.

Is she following all fo the doctor's advice and not helping a 4th heart attack along? I know in Canada, we had a few years where some doctor's refused to take care fo people who had heart issues and smoked.

After three heart attacks and a serious condition for which (presumably) a surgical fix is not an option, I suppose they have had to do some triage and determine how much time, money and expertise they can afford to spare in her case.

Nobby can tell us more about how these determinations are made, if he will.

Yeah, Nobby is the one to ask on this. My own completely hazy inexpert guess is that private systems and public systems have two different criteria by which they will try and keep you alive. As far as I know private systems will try to keep you alive at all costs if they think your insurance will pay out on your treatment, but won't try to keep you alive at all costs if they think your insurance won't pay out, or you can't cough up the money in another way.

It's not out of heartlessness, it's out of sheer empirical ability. If they can't pay the staff and the bills, they can't keep the hospital running and open. Insurance won't pay out forever on hopeless cases, the companies would go broke, and that wouldn't be good at all for the people who paid their cover all those years.

Public patients and public hospitals have the luxury of General Revenue to pull on to keep the staff and bills paid. But they have to let people die in the end. There's no cure for mortality. So there's a medical formula for when they put people on the "no resuscitation" list. It has most to do with how frail/ill the body is, in combination with how old the person is. So someone on the brink of total organ failure who is 30 they might try to save if they have a heart attack, whereas they won't try to save someone who is on the brink of total organ failure and who has a heart attack who is 90.

If someone has metastasized cancer throughout their body, and the cancer WILL kill them shortly, they aren't going to try saving them if they have a heart attack or stroke. Not for another few days or a week or two of pain-wracked life in a hospital bed, no matter how old the patient is.

So my question is, how frail and old is your mother's friend? Is she dying of the reduced blood flow she is experiencing? If this was happening in Australia, and she was talking to public system doctors, I would have every confidence that your friend's mother was in serious medical breakdown, her body deteriorating badly and rapidly, and death inevitable in a fairly short amount of time. No society has the money yet to put every person on life-support who is just dead.

Edited, Sep 19th 2008 1:35pm by Aripyanfar

From what my mum discribed, she does have two Aorta's, one of which basicly loops back into the heart, so only half the blood being pumped actually gets around the body, they can operate and will do "when the patient is healthy enough to survive major heart surgery" but if she has another heart attack in the mean time and flatlines, she will not be resusitated.

She has been given six months to live.

It doesn't effect me so much, i've never met the woman nor will i but it's not nice having your mum crying on the other end of the phone.

If thats the case, then I stand corrected. never heard of anyone with 2 aortas tho.

For all I know you could be right, my mum is 68 and got her science education from Geordie off Star Trek.

Anyone elses mum a Trekie?

I dunno, this sounds weird. Was this a corrective thing they did after the first heart attack or something? It sounds like she's describing a bypass.

Sorry tarv.

No way in Bob's green earth I'm going to comment on a specific case where there are a bajillion factors that govern the diagnosis, prognosis, and subsequent decision to treat or not.

Just for starters, a 'heart attack' can mean many different things; beyond that, other purely clinical factors include Body Mass Index, Cholesterol levels, respiratory function, tolerance to transfusion, tolerance to anaesthesia, blood group, clotting ability, glucose tolerance, mental health/strength. . .

Therefore, please note the following are generalisms, not references to any individual.

Decision to treat is primarily based on the benefit (to the patient) of treating, versus the adverse impact of the treatment. Occassionaly, cost is a factor, but extremely rarely. (One headline a week about unaffordable care among the millions of patients treated each day makes the public disproportionately alarmed, but it does sell tabloids).

Low benefit vs high adversity means that providing treatment is often considered inhumane (and yes, I do mean 'often').

Intensive Care is an appalling experience for a patient and their loved ones, introduces new risks of Hospital Acquired Infections, and is usually (apart from trauma cases) reserved for people who are on their way out anyway.

If a condition is advanced, irreparable and terminal, treatment has to be palliative (I.e making the final stages bearable, usually through Pain Management), restorative (I.e. improving the quality of life), or remedial (I.e delaying the impact of the condition itself).

A hypothetical scenario based on real recent decisions:

An 89 year old with advcanced dementia (no clue what's going on) and a terminal cancer with low life expectancy (a few weeks) develops a renal failure. Would you put threm though a gruelling regime of surgery, medication and blood therapies for their last weeks on earth, or manage the end stage of their life to allow them to die with dignity and free from pain, in the care of their loved ones?

The only comments I will make on the tragic situation you describe are that I find it extremely unlikely that cost has even been discussed or considered as a factor. Any combination of just a few of the clinical factors I mentioned at the beginning (and numerous ones besides) could mean that treatment is not a kind or sensible option.

Finally, I'm really sorry to hear about this family friend, and that she's been unfortunate to contract such a serious condition. I'm confident that the decisions taken by her consultant will be based on her interests.

You should see me when I put on my professional thong

You forget. I've seen you naked, for all that I know.


Men and their nude torso societal permission.

/unhijack

Paul - I'd assumed a CABG

Oh! there's another nude male torso in the OOT today.

Galkaman obliged me by supplying a photograph of the incision scar all the way up his spine.

I know modern surgery is very good, but it still surprised me how very neat his scar is. They did a lot of work in there. I'm all kinds of impressed.