Medical Ethics Question

[fishsticks2629]

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Working as a CNA for a few different hospitals I have had the, at times unpleasant, experience of taking care of complete vent patients (patients that need full assistance). With that being said, some of those patients are a responsibility of the state. Which for whatever reason, the patients have noone to make decisions on their behalf. A great majority of the patients spend their time with pressure ulcers (bedsores) deep enough to see the bone and lie in their feces most of the day. Needless to say the patients have a poor prognosis with almost none of them able to recover.

My question is, should the state allow the patients to live this psuedo existance or should they allow "nature" take its course? Its obvious the state is trying to be moral and not kill anyone, but are they in fact being immoral by allowing the patients to remain in the state they are in?
Thoughts?

 

[Cleavername]

Working as a CNA for a few different hospitals I have had the, at times unpleasant, experience of taking care of complete vent patients (patients that need full assistance). With that being said, some of those patients are a responsibility of the state. Which for whatever reason, the patients have noone to make decisions on their behalf. A great majority of the patients spend their time with pressure ulcers (bedsores) deep enough to see the bone and lie in their feces most of the day. Needless to say the patients have a poor prognosis with almost none of them able to recover.

My question is, should the state allow the patients to live this psuedo existance or should they allow "nature" take its course? Its obvious the state is trying to be moral and not kill anyone, but are they in fact being immoral by allowing the patients to remain in the state they are in?
Thoughts?

oh boy....

 

[Perrotfish]

Working as a CNA for a few different hospitals I have had the, at times unpleasant, experience of taking care of complete vent patients (patients that need full assistance). With that being said, some of those patients are a responsibility of the state. Which for whatever reason, the patients have noone to make decisions on their behalf. A great majority of the patients spend their time with pressure ulcers (bedsores) deep enough to see the bone and lie in their feces most of the day. Needless to say the patients have a poor prognosis with almost none of them able to recover.

My question is, should the state allow the patients to live this psuedo existance or should they allow "nature" take its course? Its obvious the state is trying to be moral and not kill anyone, but are they in fact being immoral by allowing the patients to remain in the state they are in?
Thoughts?

My personal opinion: No it's not moral to let people with no hope of recovery rot in demented agony, and neither is it moral to spend millions of public dollars maintaining their marginal life functions while many citizens who are much more clearly alive go without the basic necesities. I sympathize with what their caregivers are trying to do but at some point you need to evaluate how you can best use the resources you have.

 

[LizzyM]

Let me put it to you this way, you are being paid to care for these individuals so that they do not sit in their own excrement. Are you doing your job?

 

[GH253]

The state should not support them.

 

[FrkyBgStok]

Let me put it to you this way, you are being paid to care for these individuals so that they do not sit in their own excrement. Are you doing your job?

+1. i hope to get a cna position when schedule allows and as much as i may not want to, i am fully aware that this is part of the job.

 

[phathead]

Let me put it to you this way, you are being paid to care for these individuals so that they do not sit in their own excrement. Are you doing your job?

Bingo. Don't ask if the state should kill off these people, perhaps you should talk to an admin or something and have people actually do their jobs.

 

[The right Path]

The diligence of hygiene (while of utmost importance) isn't the answer to the problem of providing inappropriately aggressive care.

Witholding aggressive measures is not commensurate with killing off people by the way.

Everybody dies. Sure we can put them through the mill for quite some time before the major organs are decimated beyond resuscitation. Is that what society is obligated to do to those that have no one to speak for them?

 

[LizzyM]

There is a big chasm between putting them through aggressive medical treatment and letting them die. Many survive for years, decades even, with decent nursing care and nourishment. Karen Ann Quinlan, for example, was thought to be respirator dependent, her parents won the right to have her removed from the respirator in 1976; she died in 1985. My own aunt had the physical capacities of a six month old after a tragic stroke but she lived in a nursing home for 4 years without ever visiting a hospital or emergency department. She died peacefully without any high tech interventions. I am grateful that taxpayers supported the difference between her retirement income and the cost of her nursing home care after she exhausted her own savings.

Should we close all the Medicaid nursing home beds and throw the wretched sick elderly into the streets? Perhaps Mother Teresa's sisters will come and open a home for the dying here in the US for the disabled persons who we think are unworthy of life.

 

[The right Path]

There is a big chasm between putting them through aggressive medical treatment and letting them die. Many survive for years, decades even, with decent nursing care and nourishment. Karen Ann Quinlan, for example, was thought to be respirator dependent, her parents won the right to have her removed from the respirator in 1976; she died in 1985. My own aunt had the physical capacities of a six month old after a tragic stroke but she lived in a nursing home for 4 years without ever visiting a hospital or emergency department. She died peacefully without any high tech interventions. I am grateful that taxpayers supported the difference between her retirement income and the cost of her nursing home care after she exhausted her own savings.

Should we close all the Medicaid nursing home beds and throw the wretched sick elderly into the streets? Perhaps Mother Teresa's sisters will come and open a home for the dying here in the US for the disabled persons who we think are unworthy of life.

I've never suggested anything close to denying care to those who are completely dependent. Suggesting that someone is unworthy of life is also quite offensive to my sensibilities. Someone once said that a society can be judged by how it cares for its most vulnerable. The unfortunate reality that I was referring to is that people with no next of kin or other real appointed healthcare surrogate are subjected to procedures and resuscitation which cause considerable suffering for no true benefit simply because no one is there to intervene. I believe that this was the scenario in which the OP was refering to, and it is a valid ethical dilemma. Naturally, there isn't a simple easy answer, however, with all due respect, the answer isn't, "do a better job of keeping the nether regions free of soilage."

 

[whoknows2012]

I've never suggested anything close to denying care to those who are completely dependent. Suggesting that someone is unworthy of life is also quite offensive to my sensibilities. Someone once said that a society can be judged by how it cares for its most vulnerable. The unfortunate reality that I was referring to is that people with no next of kin or other real appointed healthcare surrogate are subjected to procedures and resuscitation which cause considerable suffering for no true benefit simply because no one is there to intervene. I believe that this was the scenario in which the OP was refering to, and it is a valid ethical dilemma. Naturally, there isn't a simple easy answer, however, with all due respect, the answer isn't, "do a better job of keeping the nether regions free of soilage."

I agree...this clearly has nothing to do with the ethical dilemma at hand

 

[mvenus929]

Here's another one for you.

At my hospital, we've had a handful of patients who were, for all intents and purposes, wards of the state. They had no next of kin that we could identify. They got so sick that there was no hope of recovery. One individual went into cardiac/respiratory arrest several times, and had a complete resuscitation team there, loading the patient up with drugs and going full out to keep this patient, who was clearly going to die in the very near future, alive.

Is it right to give these patients such aggressive treatment, simply because they don't have anyone there making the decision to say 'enough is enough, let him/her die peacefully'? The doctors won't stop such aggressive treatment for that reason, so until they can't be brought back from arrest, they'll continue to get such treatment.

 

[hithere3387]

Here's another one for you.

At my hospital, we've had a handful of patients who were, for all intents and purposes, wards of the state. They had no next of kin that we could identify. They got so sick that there was no hope of recovery. One individual went into cardiac/respiratory arrest several times, and had a complete resuscitation team there, loading the patient up with drugs and going full out to keep this patient, who was clearly going to die in the very near future, alive.

Is it right to give these patients such aggressive treatment, simply because they don't have anyone there making the decision to say 'enough is enough, let him/her die peacefully'? The doctors won't stop such aggressive treatment for that reason, so until they can't be brought back from arrest, they'll continue to get such treatment.

As they should, regardless of position of the state. These are certainly questions that physicians and other medical professionals should take part in both asking and answering; but, within the clinical setting, these same medical professionals have a responsibility to treat every condition both aggressively and diligently, regardless of prospects. Perhaps we should be talking about a government appointed committee or social workers who would be assigned specific patients who are not capable of making decisions in place of next of kin. I agree that this is a complex ethical question that should be addressed, but the role of the medical professional should not change because of a patient's background.

 

[LizzyM]

The OP was talking about people with bedsores who sit in their own waste. The OP is being paid as a CNA to see that they are clean and dry.

Should these people be disconnected from their vents and wheeled into the street to die?

An incompetent adult who has no one to make decisions (and these folks are few, almost everyone has a next of kin whether it is a sibling, a nephew, or a cousin) is a ward of the state and the state is very conservative in making decisions that could result in the death of a ward. (Passive decisions to underfund the care of the disabled is another story, of course.)

 

[GH253]

deleted

 

[Dial71]

The OP was talking about people with bedsores who sit in their own waste. The OP is being paid as a CNA to see that they are clean and dry.

Should these people be disconnected from their vents and wheeled into the street to die?

An incompetent adult who has no one to make decisions (and these folks are few, almost everyone has a next of kin whether it is a sibling, a nephew, or a cousin) is a ward of the state and the state is very conservative in making decisions that could result in the death of a ward. (Passive decisions to underfund the care of the disabled is another story, of course.)

Gee, I don't think that blaming this kid for poor job performance isn't very fair to him or even relevant to the argument. Why are you blaming the victim?

The parties ulitmately responsible for this poor care are the absentee owners who set staffing at dangerously low levels in order to maximize profit. Nursing home caregivers deserve respect for their work. They take care of some profoundly ill and disabled people.

Before any of you pass judgment, please ask yourself if you could perform their jobs forty or more hours a week.

Are you blaming the OP for poor job performance because end-of-life issues disturb or frighten you?

 

[fishsticks2629]

Let me put it to you this way, you are being paid to care for these individuals so that they do not sit in their own excrement. Are you doing your job?

I knew this would be brought up. Let me ask you this, have you ever worked as a CNA? Or better yet, have you ever heard of incontinent c-diff patients with constant diarrhea? Within minutes of "clean-up" the patients begin to soil themselves once again. Now then what should I do, spread my care to the other ten patients I have, or should I spend all my time with that single patient? During my eight hour shift I can assure you I clean up the patients 2-3 times, but more than that would take away from other patients.
It is quite normal to assume from your ivory tower that I or other workers would be the one to blame for their perpetual soilage. Need I also remind you that I only make ten dollars an hour to clean up human feces. Thus you should be thankfull for CNAs and not so quick to judge.
BTW this is totally off topic from what I was originally asking.

 

[LizzyM]

Working as a CNA for a few different hospitals I have had the, at times unpleasant, experience of taking care of complete vent patients (patients that need full assistance). With that being said, some of those patients are a responsibility of the state. Which for whatever reason, the patients have noone to make decisions on their behalf. A great majority of the patients spend their time with pressure ulcers (bedsores) deep enough to see the bone and lie in their feces most of the day. Needless to say the patients have a poor prognosis with almost none of them able to recover.

My question is, should the state allow the patients to live this psuedo existance or should they allow "nature" take its course? Its obvious the state is trying to be moral and not kill anyone, but are they in fact being immoral by allowing the patients to remain in the state they are in?
Thoughts?

You asked my thoughts and have only criticism of me as a response?

Could you be more specific regarding what you would consider the ideal for these patients?

Perhaps the operators of these facilities are to blame, perhaps the State has a share in the blame in permitting these facilities to provide what is obviously substandard care (staffing insufficient to provide for the needs of the patients). How do we as a society want to provide for the most vulnerable in society, those who have no one to speak for them?

 

[The right Path]

As they should, regardless of position of the state. These are certainly questions that physicians and other medical professionals should take part in both asking and answering; but, within the clinical setting, these same medical professionals have a responsibility to treat every condition both aggressively and diligently, regardless of prospects. Perhaps we should be talking about a government appointed committee or social workers who would be assigned specific patients who are not capable of making decisions in place of next of kin. I agree that this is a complex ethical question that should be addressed, but the role of the medical professional should not change because of a patient's background.

That is not correct.

The OP was talking about people with bedsores who sit in their own waste. The OP is being paid as a CNA to see that they are clean and dry.

Should these people be disconnected from their vents and wheeled into the street to die?

An incompetent adult who has no one to make decisions (and these folks are few, almost everyone has a next of kin whether it is a sibling, a nephew, or a cousin) is a ward of the state and the state is very conservative in making decisions that could result in the death of a ward. (Passive decisions to underfund the care of the disabled is another story, of course.)

The fact that the OP works as a CNA with the duty to assist people maintain hygeine who otherwise cannot do for themselves is not the main issue. The OP's job is the circumstance which has brought to the attention of the OP, a legitimate ethical issue. Clinical work (paid or volunteer) is about more than just puttin' in the hours. It is often times the first glimpse into what real healthcare issues are- as opposed to House, Grey's Anatomy, etc.

Bringing up the issue that people (it doesn't matter how common) are subjected to inappropriately aggressive procedures is a far cry from suggesting that this vulnerable population is unworthy to receive care and therefore should be kicked to the curb sans ventilator.

The concern for the dignity and respect for these people is the reason for examining whether what we do is done for them or to them. It is unfortunate when any sort of healthcare provider approaches his/her job as just a job to be done with out consideration for the implications it has for the recipient of "care".

 

[GeneCoDoctor86]

Let me put it to you this way, you are being paid to care for these individuals so that they do not sit in their own excrement. Are you doing your job?

I think she is doing the best she can in her job. Obviously, she is concerned about the condition that some of the patients are in. A lot of nursing homes especially are severely understaffed and lack enough resources to take decent care of the patients. She has probably seen this while going for her first round of her shift and wonders why no one took care of this patient sooner. She maybe wondering herself if some of the other CNA's and nurses are doing their job. Or she ended up working in another section of the hospital that she normally does not work in and finds that some of the patients have these horrible bed sores. There is only so much that one person can do in one day and taking care of individuals who are this sick is very time consuming. Its a shame that these patients have to live like this. I know that there are some nurses out there (not all nurses, most are very good at what they do) who don't do their job as well as they should. I volunteer in a hospital and the nurses will sometimes just ignore the patient's call for help or delay it if they happen to be in a chitty chatty conversation with the other nurses about what they did last night, even if I go up to the nurse and tell them that patient in room, say 3 needs help. Sometimes they don't get to the patient until after 20 minutes, and as a volunteer, I can only do so much. I often can't help the patients with what they need and I feel so bad about that. Its like teamwork, a lot of time goes into this care and when everybody isnt working hard, some patients may unfortunately be neglected. Its not right.