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>Futile care and when to "let go."

>The idea that “we should do it because we can do it,” is poor reasoning in destructive embryonic research. It is also poor reasoning in the face of death by natural causes. Good medicine and science allows non-maleficence to inform beneficence:

Heal when possible, but first, do no harm.

Here are two items that deal with the issue of “futile care” that are outside the realm of the usual.

I’ve posted links to the “Cheerful Oncologist,” before. That blog, written by an always thoughtful, sometimes cheerful oncologist has moved to Scienceblogs.com. He discusses the dilemma of when to stop aggressive chemotherapy, etc. and change the focus to comfort and paliation in patients with cancer in, “Letting Go.”

Another dilemma at the end of life is whether “first responders” other than paramedics (policemen, sheriff’s departments and Emergency Medical Technicians, etc.) should initiate attempts to revive patients with intubation, electrical shocks, and CPR in the field and transport all those found without a heart rate to the ER. A study out of Canada is published in the New England Journal of Medicine (full content by subscription, only).

From an article on Reuters reviewing the report (emphasis is mine):

The assessment of 1,240 cardiac arrest rescue runs over two years in Ontario, Canada, found that only 1 in 500 people survived to be discharged from the hospital if EMTs could not restart the circulation, automatic defibrillators did not shock the heart, and rescue workers were not present when the heart stopped beating effectively.

The University of Toronto team led by Laurie Morrison said new guidelines letting EMTs know when to give up “would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent,” a reduction she characterized as “pretty phenomenal.”

“These findings suggest that it is possible to identify a subgroup of patients … in whom resuscitative efforts can be discontinued and the patient pronounced dead in the field,” Gordon Ewy of the University of Arizona Health Sciences Center added in an editorial.

* * * *

Nor do they apply to paramedics, who can use various medicines and intubation to try to restart the heart and keep patients alive. Paramedics already have similar standards.

About bnuckols

Conservative Christian Family Doctor, promoting conservative news and views. (Hot Air under the right wing!)

Discussion

One thought on “>Futile care and when to "let go."

  1. >These are good points, but I find your post confusing. Partly the problem may be that I'm not familiar with the breadth or detail of your opinions on various issues, but, still, it seems to me the implicit opinions you seem to hold are contradictory.Though you do not say it explicitly, I take it the thrust of your post is that there are times – even when a slim chance of saving or prolinging a person's life is barely possible – when it is better to seek the most likely good end rather than blindly work to extend any mere biological process: when it is better to provide possibly-life-shortening supportive care to patients near death than to flog them with aggressive treatment that could work but almost certainly won't; that it is better to allow an unambiguous, relatively dignified (and much cheaper) immediate end for stopped-heart patients than to impose lengthy, invasive, and expensive treatment on 499 corpses for the sake of one deperately impaired, suffering survivor. I agree, and I applaud the sentiment behind these claims, which I regard as realistic and humane.But you preface this by explicitly analogizing not treating severely impaired patients who might still recover and go on with their lives with protecting non-person embryos who have no conscious life to go on with in the first place. If it is reasonable to stop life-prolonging treatment for fully alert, self-aware (but dying) adults, why would it possibly not be reasonable to perform research on a ball of a hundred or so cells with virtually no physical organizaion or life processes beyond mere cellular metabolism, let alone consciousness, self-awareness, and personhood, as well as values, goals, interests, and desires? Or to look at it the other way, if we're so obsessed with mere biological life at any cost that we're willing to protect blastulas under any and all circumstances, how can you justify ending life support, or denying resuscitation, to actual people?As I said, I think you positions on life support and resuscitation are correct. But it also seems obvious to me that if we can forego the chance to extend the consciously-lived lives of real persons in support of other values – as indeed we can – then it should be a no-brainer that we can make use of the non-conscious cell balls lying around in laboratories to support still other values that are also of importance.

    Posted by Kevin T. Keith | August 4, 2006, 1:41 am

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