Read the case study (link via the assignment title above) provided and answer the following questions:
What should the emergency department staff do? Why?
Suggested completion date: October 10, 2008
Friday, September 12, 2008
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22 comments:
Planned Parenthood should absolutely NOT be forced to turn over private records.It is a major violation of Patient Privacy. This could cause distress to the women who had pregnancies and were examined at Planned Parenthood. There could be women who may not have wanted family members to know that at one time she may have been pregnant and this could be awkward. What if the woman, upon investigation who was previously pregnant miscarried? What kind of emotional distress would that cause her? Secondly, what do you think would happen to the reputation of the Planned Parenthood facility? It would undermine their integrity. Every patient, man or woman has a right to keep their health information private. I believe that criminal investigators should not be allowed to act on assumptions, and in this case, believing that the mother was a Planned Parenthood pregnancy case. They should have to have more factual information before they could call out and ask the medical providers to hand over confidential information.
If the issue it that the patient might not be aware enough to make an educated decision then I think that John was definitely in his right mind. He made the decision to end his life based on prior experience with his mother and having done research on Huntington’s I realize that it is a progressive disease and can be totally debilitating. I think that since he was able to keep the diagnosis from his wife means that the disease had not progressed to the point that we was unable to make an educated decision. The emergency room, since it was written by the patient and he was in sound mind should honor his wishes to not resuscitate or perform any life saving procedures.
ML
I think the doctors should do everything they can to save him for a few reasons. First,who is to say that he wrote the note? There is a slight chance that someone was attempting to kill him and left the suicide note for him. I know it’s a one in a million shot but so is the lottery and people win that every week. Also don’t you think his wife should know about this and have a say in the matter. When he got married he made a commitment to her, “in sickness and in health”, so if he truly loves her he would tell her about it. I think his actions are selfish and cowardly. Another possibility could be that after taking the medications he changed his mind but before he could do anything about it he was unconscious. No matter what way you look at it I believe the doctors should save him and if he lives through it he can always attempt it again but just do a better job of it. It’s not the doctors’ job to make moral decisions. They should just focus on saving lives.
Joe King
I think the Emergency Room staff should treat John for the acute condition of a drug overdose for several reasons. The first is that John attempted suicide and pinned a note to his chest. He is an attorney and knows that a living will would ensure those type of instructions would be carried out. The note pinned to his chest indicates extreme emotional distress when he wrote it and attempted to commit suicide. Legally that could fall under mental incompetence. Now that John is unconscious, he is no longer capable of making any decisions. His wife is his surrogate and has the final decision on his treatment.
That is the legal aspect, but there is a more emotional one. My mother always said if she got really ill she didn’t want major medical intervention. However, when she was diagnosed with metasticised lung cancer she made the decision to fight. The doctors said it was hopeless and my mother was a health care professional who knew what was involved. All her life she said one thing, and made a different decision when actually confronted with death. I think that John is in a similar situation. If he stopped and thought about what his actions would do to his family, he might not make that decision. If he really does want to die, he knows how to do it right and inform his wife so she won’t interfere.
Greg Dawson
A written note is considered legal documentation. If that patient survived and decided to sue everyone involved in his rescue he would win. Nothing good could come from saving his life. He would either commit suicide again or probably live a few more years and then die anyway from the disease.
There are so many things you can say after an event like this has happened but when you are in the moment there are only a few spare seconds to save someone’s life. It’s sad that medical decisions are based on legal actions that will follow but that’s what today’s society has caused.
Either way everyone involved will probably be sued. If they save John they will be sued by John. If they let him die they will be sued by the family for wrongful death. Being in the medical profession myself I would not save his life.
Amanda Rhoades
BIOTHICS SCENARIO-FOUR
EDDIE. PRATT
10/13/08
Doctors take an oath for life
80% of men use a hand-gun for suicide
20% of women use some kind of pills
John is a lawyer who wrote a letter of intent is not meant to be binding
and does not hinder the parties from bargaining with a second party -wife.
So, I feel he was only depressant, he didn’t want to commit suicide. With
a little help from psychologist he will adjust to his few remaining years.
Joe King-
You bring up a great point, the ER staff could definitely ask the wife or family members for permission to resuscitate.
Amanda Rhoades
I think that the ER staff should do everything in their power to save John. The fact the John had been visiting a psychiatrist and openly admitted he wanted to kill himself, should show that he was not in the right state of mind. Just because the Huntington’s had not progressed does not mean that he was not “sick” in other forms. He obviously was haunted by the mere fact that he could contract the disease, but aren’t we all a little scared of contracting a genetic disease? My dad had a quadruple bi-pass at the age of 45, and 4 of his siblings died in their 40’s of heart attacks, does that mean that if or when I am diagnosed with some kind of heart problem that I will ask to not be revived because of the long road you will have ahead? At any rate, it should be the wives decision on what path to choose, whether to save him or to respect his wishes. He was obviously not well enough to make the decision that he had made.
Kayla Parent
Greg-
What a good point that you make about a written note pinned to your chest being a sign of mental distress, I never thought of this and you are totally right! Also I completely agree that his wife should make the decision, seeing as how she is the legal power of attorney now, altough if he was in fact very serious about the suicide they may be getting a divorce shortly afterwards. :)
Greg-
What a good point that you make about a written note pinned to your chest being a sign of mental distress, I never thought of this and you are totally right! Also I completely agree that his wife should make the decision, seeing as how she is the legal power of attorney now, altough if he was in fact very serious about the suicide they may be getting a divorce shortly afterwards. :)
(I forgot my name :) Kayla Parent)
In regard to Eddie:
I believe that it is going to take a lot more than a psychologist to help John and his family. As he had previously gone through this battle with his mother he was well versed in the problems encountered during a battle with Huntingtons. The family suffers also. It is heartbreaking to watch someone with this disease, they lose everything about themselves, personality, cognition, muscle control everything and I can understand why he would want to expire, he'd already been there.
ML
Michelle Camping
11-15-2008
I think they should let him finish what he started even though that is hard to do. He was well aware of his condition when he started.
I think the wife knew that and thats why she left the note on him. I have seen people live lives with terrible illnesses and it is so hard for everyone involved. His life would just be the same with then getting sicker, and he would probably try it again. They need to honor his request and let him go.
Michelle Camping
11-15-2008
I see where Greg is coming from on the legal side, but again he'll try it again. Once it is in thought to that point it is a matter of time. If it were a helthy person I would go against his wishes but this wasn't the case.
I think the hospital staff should treat John for the drug overdose despite the note he wrote refusing care. Suicide and assisted suicide is illegal and if John was trying to jump off a bridge, rescue teams would definitely try to save him even if he told them not to. He was obviously having a weak moment when he overdosed on the pills and was not of sound mind, and even though at the time he wrote the note he may have meant it, he might change his mind after seeing his wife and talking with her.
I don’t think that a note pinned to a shirt counts as a legal document, especially when it was written in a time of distress. Therefore the hospital staff has to treat him under legal obligation. After he is treated and revived, at that time he can make a decision about whether or not he will seek treatment for the Huntington’s disease.
Erin Bell
I believe that the medical team should honor the patient's request. if he says DNR then they shouldn't regardless of what their secondary 'emergency contact' says. It may be selfish of him to do this to his wife and family if he has more but he is the one who has to live through it and he witnessed his own mother going through it. I have a family member who had this and passed away, seeing her go through it was terrible. She had no control over anything, it was devastating to watch. I think if he witnessed what he did, he was able to make an educated decision.
He may have drank heavily and may have been depressed but I think he was in a sound state of mind especially if he had concerns of this happening to him prior to it actually happening.
Commenting on ML
I agree that I think he was in a right state of mind. He had witnessed his mother go through this disease and decided he did not want to go through the same his mother had. I know that the main 'rule' health care facilities go by is to save lives but if the patient has requested as such and isn't doing it 'just to escape' or any other unsound reason, their wishes should be honored.
amanda
You are right that everyone is being sued for the worst things these days. But as a doctor I think I would rather be sued for saving a life and not letting one go.
Joe K
I think the ER should grant his wishes and this was the patients choice to do what he did. I understad the wife didn't know about the diagnosis and she doesn't want to lose her husband but if the patient has a request then the doctors need to respect that and so should the wife. This was his life not anyone elses.
Jennifer Faulkner
I think that the care team at the emergency room should not honor John's request because the note would not be considered a legal document. John was obviously in a state of emotional distress when he wrote it which would discredit the note as a legal document if it were to ever be called into the court of law. Doctor's take an oath to step in and save patient's lives when necessary, not to stand by because a note possibly written by the dying patient says Do Not Resuscitate. There are specified legal documents put into place for situations just like this and if John did not have an official DNR on file, then the hospital staff should follow procedure and resuscitate. I also don't think that his wife should necessarily be told that there was a note, especially if she didn't realize it was there in the first place. I'm not sure about the legality of the note once John is taken to the hospital where it's discovered versus his wife finding the note prior, but I do know that if John were to live, telling his wife about the note would only bring further turmoil to an already complicated situation. -Alana Zinkie
In Response to Amanda Rhoades:
I agree with Amanda. I too feel that nothing good could come from saving John's life but in contrast I feel that the emergency staff would and should resuscitate. It's very unfortunate that in today's society everyone is forced to consider the legality of each situation even if the consequence means a law suit that you're forced to fight. -Alana Zinkie
I believe that the care team should help the man and try and save his life. I don't think that they should assist in his suicide. Although I can see John's side in regards to the disease other precautions and steps might be able to be made before just ending someone's life. I think that John should consider his wife and family as well and being a successful lawyer conduct more research on his disease rather than simply ending his life.
Shundeen Cadman
The medical team should save him regardless of his note. His wife wasn’t aware of such an important matter of life and death decision from husband. The decision and the note was obviously drawn up emotionally and careless situation. This is why as a civilized society, laws and medical teams have to examine and consider carefully before making the gravely ill choice.
For nothing else and sake of clarity, a society gave the patient a second chance to make his wish clearly.
JWK
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