Consent in EMS? andrew, ante

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This was all going so well; but I couldn't disagree more.

I think there's a bit of a language barrier at work here.  The notion of
"ending someone's life" (as opposed to allowing someone to die) steers us
off the moral course a bit.  But in either event, the "professional" is the
servant of the patient, and by proxy, the next of kin.  Envisioning the
doctor as someone who can (much less should) unburden the family of
end-of-life decisions is arrogant, patronizing, and false.

It is the job of all health professionals to guide and support families in
these cases, not to marginalize them "for their own good."  The latter is
too easy, and for some, entirely too tempting.

Pret


----- Original Message -----
From: "Jago Miloguz" <japrak at gmail.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, May 30, 2006 11:10 PM
Subject: Re: Consent in EMS? andrew, ante


> yeah, l think we update eachothers statement, l agree that decision
> regarding ending someones life,should be left up t professional, who is
not
> in any other way bounded with the pt.
> ante
>
>
> 2006/5/30, Hall, John R <John_R_Hall at wellmont.org>:
> >
> > Prett,
> > It had to happen.  I agree with you.  That is my point exactly.  The
> > patient/child is the boss.  Inclusion and proxy control are the basis.
Too
> > often our colleagues forget the proxy part and place the burden on the
> > family.
> >
> > ps.  As seen below, no email address for you :)  (but I don't see mine
> > either)
> >
> > John
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of Bjorn, Pret
> > Sent: Tue 5/30/2006 12:57 PM
> > To: Trauma &amp; Critical Care mailing list
> > Subject: RE: Consent in EMS? andrew, ante
> >
> >
> >
> > My favorite pediatric intensivist introduces herself to distraught
> > families with "Your child is my boss."  It's a reassuringly simple
> > statement and a stunningly powerful sentiment.  I wish I'd thought of
> > it.
> >
> >
> >
> > The best among us will always find a means of ceding each patient due
> > control.  The patient's participation may be grudging, teased from exam
> > findings, lab values, advanced directives, or the intuition of loved
> > ones; but however complex the calculus, we should strive as precisely as
> > possible to do what our patients would wish - just as we would have done
> > for ourselves.
> >
> >
> >
> > Where the family is concerned, inclusion and proxy control need not
> > engender guilt.  On the contrary, helping the doctor find a proper path
> > can be a very rewarding experience.
> >
> >
> >
> > Pret Bjorn, RN
> >
> > Bangor, ME USA
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Hall, John R
> > Sent: Tuesday, May 30, 2006 11:39 AM
> > To: Trauma &amp; Critical Care mailing list
> > Subject: RE: Consent in EMS? andrew, ante
> >
> >
> >
> > Andrew.
> >
> > Agree with your care fully.  Family stated "Not what she wanted"
> >
> >
> >
> > Ante, We are probably on the same page.  Family needs to be consulted -
> > but cannot be "decision maker".  They need to advocate for the patient's
> > wishes as in Andrew's case.  Doc needs to tell them up front that "It is
> > not their decision, it is the doc's -- what the doc needs from them is
> > what they believe the patient's wishes would be".  Besides being the
> > true meaning of "advocate", it takes a lot of guilt away from the
> > family.  Too many times, I have heard residents and other doc's ask the
> > family "What do you want me to do" or "What is your decision"
> >
> > j
> >
> >
> >
> > ________________________________
> >
> > From: trauma-list-bounces at trauma.org on behalf of Andrew J Bowman
> > Sent: Mon 5/29/2006 1:40 PM
> > To: Trauma &amp; Critical Care mailing list
> > Subject: Re: Consent in EMS?
> >
> > I recently had this case in my ER
> >
> > 69 female
> > multiple medical problems (heart, lung, hypertension, diabetes, etc),
> > living
> > with husband in an assisted living facility
> >
> > Acute onset dyspnea, medics found in arrest. Pink frothy sputum noted on
> > intubation
> > Husband distraught and of little help on history.  Facility staff state
> > "Full Code" to medics.
> >
> > Pt to ER and is resuscitated.
> > Areflexic, no spontaneous resps.
> >
> > Large number of family members arrive and are at bedside.
> >
> > Uniform response "She did not want this" (vent dependent)
> > "She was supposed to be a no code"
> >
> > Called living facility, they fax over a signed but undated Do Not
> > Resuscitate paper that somebody has scrawled "FULL CODE" in black marker
> > over front.
> >
> > Long discussion with family, all agree that this is not what pt wanted.
> >
> > Extubated in ED and all family at bedside. I did the extubation, would
> > never
> > dream of asking family to turn off any machines.
> >
> > Gone in less than 5 minutes.
> >
> > Andrew "3 Minute" Bowman, RN, BSN, CEN, NREMTP,  etc, etc ad (almost)
> > infinitum
> >
> >
> >
> >
> > Jago,
> >
> > Having been on both sides of the discussion - having a doc ask me if I
> > Wanted to disconnect my father is, I believe putting too much on the
> > family
> > member.
> >
> > If you look at ethical and legal discussions - and we have tossed this
> > about
> > in my hospital - the family member is the ADVOCATE of the patient.  That
> > means that he/she is supposed to advocate for what the patient would
> > want in
> > that case.  I am sure that you and most members of this group have had
> > family members who state:  "Dad would not want to be attached to a
> > ventilator like this, but I cannot take him off".  Similar situation
> > with a
> > living will and family unable to do so.
> >
> >
> > --
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> >
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> >
> >
> >
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> >
> >
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>

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