This mortal coil

Article Abstract:

An 89-year-old woman recently died a peaceful death. After nursing attendants had positioned her upright in a chair, she slumped forward on her tray and died. Maude had been a very active woman; ten years earlier she had traveled to Central America to help with the orphans of the war, and had lived with her son in the past year. This was all to change when she fell and subsequently went to a nursing home. Her decline included moderate confusion and a large skin ulcer that required surgery. The patient stopped eating and repeatedly told her friends and family that she was dying; the only people who did not listen were the hospital personnel. Medical treatment included additional surgery and tubes that were inserted into her arms and stomach. Her son stated that he did not want her to receive aggressive medical treatment, and she was placed in a room far from the nursing station where she had little contact with the nurses. After staying there several weeks, Maude was discharged to a nursing home and subsequently died. Medicine tends to treat the illness, but not the entire person; defines dying only when a treatment is no longer effective; and avoids the subject of death and dying. A medical resident recently stated that physicians tend to ignore the obvious and press ahead with vigorous medical treatment; a patient is considered to be dying only when there is nothing left that they can do. A team of researchers concluded that in our culture dying is considered a result of physician failure; a patient dies when treatment fails. In this case, the family refused further treatment, Maude was isolated far from the nursing station, and was perceived as a treatment failure. The President's Commission on bioethics concluded that respectful, competent care be given to patients who refuse potentially life-saving therapies. If this was already in practice, Maude's last days might not have been regarded as a treatment failure, but rather as an inescapable fact of life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mortality, Death

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Weal and woe: on the loss of lament

Article Abstract:

Survivors of airplane crashes frequently suffer anxiety and nightmares concerning their ordeal. One man surviving the crash landing of United flight 232 suffers flashbacks as a result of the crash, and is now suing United Airlines with a 'fear of death' suit. In March 1985, the Food and Drug Administration issued licenses for a blood test that screened the blood supply for the human immunodeficiency virus that causes acquired immune deficiency syndrome (AIDS). These bloodbanks have been sued by AIDS patients who were infected as a result of blood transfusions that occurred between 1983 to 1985. A pregnant woman who repeatedly drank herself into unconsciousness is now suing the liquor company for causing her child's birth defects. These legal examples address the issue of personal suffering and show that someone has to be blamed for a perceived injustice. Health professionals in our society do not address the issue of personal suffering and have lost the ability to lament. Our society does not engage in lament, but rather feels more comfortable thinking happy thoughts 'don't worry, be happy'. Lament allows a person to vocalize the unhappiness that is part of the human condition. It acknowledges that we as humans suffer undeserved, meaningless pain, but that we do not have to accept them. The loss of lament has severed the connections of the common bond that unites us as humans, and has led to the externalization of suffering. If recaptured, it may bring about a more harmonious situation in which all may share in the suffering that is an inextricable part of life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Evaluation, Grief

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Slow code, partial code, limited code

Article Abstract:

Cardiopulmonary resuscitation (CPR) is a method used to restore a heartbeat after cardiac arrest. Some CPR procedures are invasive and violent. Many factors influence the decision to resuscitate including probability of success and if resuscitation will place an additional burden on the family. Situations where there is no 'do not resuscitate' (DNR) order and when CPR is not appropriate, and in situations where only limited resuscitation efforts are requested, may result in confusion for healthcare practitioners. Walking slowly to 'codes' (an organized effort to begin resuscitation) gives the appearance that something is being done when it is not; this procedure is not recommended. An obstacle to initiating codes is the false notion that 'all' resuscitative activities must be instituted when a code is called. Other factors that may enter into the decision are personal feelings about death and the idea that a patient's death represents a failure. It is suggested that partial codes be considered when the decision of whether or not to resuscitate is being made. Limited codes may include chemical code only, basic CPR only, or only providing ventilation for the patient. A limited code is justified when a patient would otherwise have a unacceptable quality of life if a full code is initiated, or when a patient desires some interventions, but not others. Partial codes are preferable over the ethically questionable and essentially dishonest 'slow code' method. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Usage, Artificial respiration, Mechanical ventilation, CPR (First aid), Cardiac arrest, Cardiopulmonary resuscitation, Resuscitation

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