Professional Soldiers ® - View Single Post - Ethical question: to tube or not to tube?

swatsurgeon · 02-07-2011, 10:03

No intubation for sure, as far as the nurse stating that she's young, etc, have her review the two cases of wrongful life: successful lawsuits against medical personnel that wrongfully resuscitated patients out of a paternalistic need to intervene when there were written advanced directives and orders to do no resuscitative maneuvers. Both were in the 10's of millions against the medical personnel/hospitals, etc., and in my opinion were appropriate lawsuits.

When faced with these issues, as long as no documentation is in evidence, do all appropriate medically indicated treatments, they can always be withdrawn when a durable DNR order is uncovered or an advanced directive is produced. The withholding or withdrawal of artificail medical support are one and the same as per the courts so not starting something or removing an intervention or therapy is viewed as the same and appropriate when orders exist to remove/stop/not initiate said therapy.

If she regains consciousness and says stop all Tx's, then make sure her family is at bedside so they see it and then document it and stop all Tx's....we do it all of the time.....and feel good about being able to follow the wishes of the patient, NOT the wishes of the family. It is always a matter between patient and physician, the family is hopefully representing the wishes of the patient, not their own.

ss

02-07-2011, 10:03	#4
swatsurgeon Guerrilla Chief Join Date: Jul 2004 Location: Phoenix, AZ Posts: 880	No intubation for sure, as far as the nurse stating that she's young, etc, have her review the two cases of wrongful life: successful lawsuits against medical personnel that wrongfully resuscitated patients out of a paternalistic need to intervene when there were written advanced directives and orders to do no resuscitative maneuvers. Both were in the 10's of millions against the medical personnel/hospitals, etc., and in my opinion were appropriate lawsuits. When faced with these issues, as long as no documentation is in evidence, do all appropriate medically indicated treatments, they can always be withdrawn when a durable DNR order is uncovered or an advanced directive is produced. The withholding or withdrawal of artificail medical support are one and the same as per the courts so not starting something or removing an intervention or therapy is viewed as the same and appropriate when orders exist to remove/stop/not initiate said therapy. If she regains consciousness and says stop all Tx's, then make sure her family is at bedside so they see it and then document it and stop all Tx's....we do it all of the time.....and feel good about being able to follow the wishes of the patient, NOT the wishes of the family. It is always a matter between patient and physician, the family is hopefully representing the wishes of the patient, not their own. ss __________________ 'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that. (adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 ) Education is the anti-ignorance we all need to better treat our patients. ss, 2008. The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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