List Archives

Fri Jul 20 10:38:26 BST 2007

1.  Severe pain is an emergency.

2.  Spinal / epidural analgesia in labour is well established and non 
controversial.

3.  Interventions in emergencies can be made ïn good faith" with the 
principle of implied consent.

4.  Our primary duty as humanitarians is to relieve suffering.  Just do it.

As an aside - if this girl needed an urgent C-Section would you withhold it 
for lack of "consent""?  No.  It's just that there are degrees of 
emergencies and the treating physician must make a decision as to when 
allowing the emergency to continue contravenes his primary duty of care as a 
physician.  In my view allowing a patient to remain in severe pain is 
unconscionable and inhumane and I'd argue that position in front of any 
tribunal later.  We wouldn't let animals suffer so surely we have even more 
of an obligation to relieve suffering in humans and hang the legal niceties.

John

Dr John L Holmes
Director Emergency Medicine Training
AMC & OLVG
Amsterdam
The Netherlands

>From: KMATTOX at aol.com
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: trauma-list at trauma.org
>Subject: Table Top Test - CALL to you "an on call medical supervisor"
>Date: Thu, 19 Jul 2007 23:06:46 EDT
>
>
>This is a real time Table Top TEST for ALL persons willing to take  
>physician
>or administrative Call.   We live with this  DAILY.     I have had at least 
>6
>frustrating policy, system,  ethical, moral, and ethical issues just this
>afternoon.    Not  any were patient safety issues (YET), but were close to 
>system
>issues which  cause frustrations.    This is real time, and NOT any HIPPA
>violations.   Take this table top and keep your own  score.     I will 
>leave a
>space between decisions.
>
>You get from a senior faculty to assist with a problem, relating to legal
>and ethical policies as well as a rapidly unfolding clinical  need.
>
>A 19 year old woman is in full labor, with her first pregancy.  It is  a
>tough progress and she is in a great deal of pain.   She has reached  a 
>stage
>where most women are clinically ready for a spinal block to aid in the  
>progress
>of the delivery.    She is underage and  unmarried.   She has not revealed 
>the
>name of the baby's  father.   No parents are present.     Can she give
>PERMISSION for the spinal anesthesia?
>
>
>
>Good try, but we have a problem.     She is severely  hampered by a mental
>health problem and the psychiatriast has written note in  the chart that 
>the
>patient cannot give permission for herself.     The chief of obstetrics 
>strongly
>desires that a spinal anesthesia be  administered.    NO PERMISSION 
>available
>from the  patient.    No parents, available.   No father  available.
>Anesthesia service states that they cannot give spinal  anesthesia without 
>permission
>either from a fully aware patient, a surrogate  permission giver, or an ad
>lidum.
>What to do?
>
>
>
>While calling for help, it is discovered that there is a phone number in  
>the
>purse of the patient of a grandmother in a distant city.   Can  this
>grandmother give permission?
>
>
>
>
>
>GOOD ANSWER and you had a good thought there.   Permission is  granted from
>administration to use HCHD funds to call this very long distanced  
>telephone
>number and the grandmother answers the phone.      GREAT STROKE OF LUCK.
>
>
>Problem.   This grandmother has already disowned her own children  and only
>vaguely knows of even the existence of this now your  patient.     She 
>states
>that she cannot and will not give  permission and states some words I 
>cannot
>print here.      She hangs UP.     What to do?
>
>
>
>
>
>One of the faculty has a good friend that is a family court judge (actually
>a neighbor).     She calls that judge for  "advice"    It is 5:20 PM and 
>the
>judge and court are CLOSED for  the week end.   "Call back Monday" message 
>is
>heard.      What to do?
>
>
>You guessed it.   The chief of OB calls YOU and asks for the  options?
>I now ask you to answer this  inquiry?    If you wait long enough to find a
>court person, the  baby will be delivered with great pain and suffering and 
>a
>huge amount of  horrible screams heard two floors down .     The nurses are
>crying that something be done.   The patient is getting more and more  
>mentally
>disturbed.   The medicines to be used to sedate her or to  treat her
>psychiatric diagnosis can harm her  baby.         HELP
>
>
>
>
>Woops.    It is late.   I will have to give you  the next installment
>tomorrow.
>
>K Mattox
>
>
>
>
>************************************** Get a sneak peek of the all-new AOL 
>at
>http://discover.aol.com/memed/aolcom30tour
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Table Top Test - CALL to you "an on call medical supervisor"