Can We Talk about Health Care?

In my years of nursing I have seen many things.  Some of these things make me laugh, some make me cry, some make me down right angry and some just leave me shaking my head.

Our governments are trying to feed us the line that our Canadian public health care system is no longer feasible,and that we must introduce private health care.  I say phooey on them.  The public system is sustainable what we need to do is look at how and where the monies are being spent and start to get some kahunas and make some real hard ethical decisions on how health care is delivered.

We are all going to die, that is inevitable.  Some of us are going to die sooner than others.  Heart breaking as that is, it's just the basic and simple truth.  So why do we as a society insist on prolonging something that is inevitable?

I know this topic is going to get some folks backs up, but really, we have to look at some of the things we do in health care to prolong life.

Let's look at one area in particular.  Dear beloved grandma or grandpa who is 80, 85 or maybe even 95 years old who have severe dementia have fallen and fractured their hip.  They are rushed to the hospital and now put in a very strange environment, they become increasingly more confused and in some cases combative.  The surgeon tells the family he can fix grandma's hip and of course the family go along with what ever the surgeon says.  So grandma under go's surgery, oh did I mention that grandma also has severe cardiac issues and COPD?  Yes well grandma goes and has her surgery and comes out on a ventilator, the doctors tell you oh that it will only be temporary, but grandma now has to go to the ICU.  Do you really think this is what grandma wanted?  Grandma makes it off the ventilator and out of the ICU, but she is by no means ready to go back home.  She goes to a surgical ward and then a medical ward, where because she is now demonstrating that there is no way she can go back home she sits in a hospital bed waiting for placement.

Not long ago the health care system would have just given grandma medication to keep her comfortable.  Yes she might have been bed ridden  but she would be made comfortable.  Think about this, grandma had to have surgery and so did the young 48 year old who fell off a ladder while working and got a head injury...he came into the hospital hours after grandma but grandma took the last ICU bed so now what?

WE as a society have to start making some tough decisions on where we will allow our health care practitioners to take us.  Ethics enters this arena. When you become a doctor you take an oath to sustain life at any cost.  Well I think it is this oath that has skewed how care is delivered.  Again, please don't get me wrong but I look back 25 years ago  when my sister went into premature labour at 5 and 6th months. Three times this happen to her.  She endured labour like any other woman but the outcome was not the delivery of a healthy child.  In those days it was unheard of for babies to live at 23 or 26 weeks.  Now days they are saving babies some as young as 20 weeks gestation.  Mom's and dad's are thrilled that the technology is there to save their precious bundle, but what about the long term effects?  Research is now showing us that even though these babies are being saved the long term health effects are huge and hence a cost on the health care system.

So let's ask ourselves, where do we draw the line, when do you say enough is enough, when do we allow nature to just take it's course?

I have never spoken as blatantly about this as I have today. I have eluded to this topic when I posted about Living Wills and Code status.  We as a society need to take a good hard look at where we draw the line. It's not an easy decision or topic to talk about but we have to.  Death is part of living, we know at some point we are all going to die.

I think we all need to start talking about this, don't you?

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.