Ethics

In health care we are faced with many ethical issues.  Some major issues like cryonics for the purpose of banking organs, or freezing embryos,abortion, right to die, no code status and the list goes on.

As a health care professional I have to deal with people who make choices and do things that I don't morally agree with, but as a health care provider I must put my personal beliefs aside and care for these patients.

I remember when I was a nursing student and one of my instructor who use to be an ER nurse would share with us openly how she was sick and tired for caring for patients who tried to commit suicide.  She also made it abundantly clear that she had no time for alcoholics.  At the time I thought she was terribly harsh and thought it was most probably a good thing she wasn't doing direct patient care any longer.

Here I am 21 years later, and I find myself in a somewhat similar boat.  In the hospital that I work we care for psychiatric patients on an in patient and out patient basis.  As a recovery room nurse the psychiatric patients I see are recovering from an ECT(electroconvulsive therapy) . From a personal position I have never agreed with ECT.  I have not seen effective results, although I know their are patients who do benefit from the procedure.  The literature states that the duration for ECT is generally done in a six week series of treatments, so why then am I seeing patients who have been receiving ECTs for longer periods than this?  We had a an outpatient the other day who was so aggressive post procedure we had to call a code white(aggressive patient).  This patient has been receiving ECT on and off  for over three years.  I remember when she started she was thin, appeared well kept  and could actually have a civil conversation with you.  This has progressively not been the case.  This women now is more withdrawn. doesn't care for herself the same as she did and has become increasingly more aggressive after each treatment.

So I ask myself, what purpose is this serving?  Is she leading a more productive life? Is she enjoying life more?  What I have observed would tell me not.  She is not the only patient I have seen who has and continues to have months and years of ECT with little effect.  So who decides?

According to the literature the patient has the ultimate say but I can't help but wonder if there aren't other factors that make them chose to continue with the procedure.  We treat patients with dementia with ECT, are these patients really making informed consent? Who is making this decision?

What are your thoughts.