Sunday, May 1, 2011

Difficult Decisions

Healthcare is full of difficult decisions to be made. Do you take the Utilitarian perspective and make the choice that brings good to the greater number of people? Do you take the Deontological perspective and base your choice on adherence to a set of rules or duties? There are a multitude of other ethical theories that you can use to assist you in making difficult decisions.

Many times in healthcare, the decision to make is not between good and bad. Many times you have to make a choice between two difficult decisions. Do you pull the plug on the machines that are keeping an individual barely alive? Do you let grandma go in for a surgery knowing that she may never come out of it alive, but also knowing that if she doesn't get the surgery, she will most likely die soon?

At work the other day, I worked with a man who was living a normal life a couple weeks ago. He suffered an accident that caused him to stop breathing, and he was clinically dead for about 15 minutes. Paramedics arrived on the scene and shocked his heart back to life. This man now lays in a hospital bed with a tracheostomy being his only way to breathe. He can't talk, and he has clearly suffered very severe brain damage due to a lack of oxygen to his brain for 15 minutes. He isn't able to clearly communicate what he wants done and is almost constantly choking on his own mucus secretions in his tracheostomy. Would it have been better for the paramedics to not revive this man? If you were in his shoes, would you rather go to the next phase of life not having to suffer for who knows how many years in that awful situation. I can tell you that if I were that man, I would not have wanted paramedics to revive me. The hospital I work at used to be ran by nuns in the Catholic church. Many of them had DNR tattooed to their abdomen, so they would never have to be placed in the awful situation that this man is in.

A professor of mine recently told a story of how she came across a car accident. When she got to side of the individual driving the car, it was clear that they had been dead for some time. The person my professor was with told her she needed to revive the individual. My professor made the decision to let the person stay dead, and not subject him to a vegetative lifestyle if they were able to revive him. She felt she made the right decision afterward, but couldn't sleep for many nights.

The older widow in the nursing home whose husband died several years ago keeps asking you when her husband will be there to see her. Do you tell her that her husband died several years ago and will not be coming and make her relive all the suffering and agony that she went through once when her husband did die? Or do you reassure her that you will let her know when her husband is there to see her. Of course you would do the latter in this case.

Many decisions in healthcare are very difficult to make, and that's why I'm glad I have the gospel and the Lord's spirit to let me know His will and help guide me when those decisions come my way. Stay tuned...

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