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Old 13.09.2012, 09:32
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First the right to die, now the right to live

Just seen this on the BBC wesbite:

http://bbc.co.uk/news/health-19570364

This is absolutely disgraceful. They don't want to know with someone like Tony Nicklinson, yet make these sort of decisions without any reference or input from the patient and his family. According to the man from MENCAP placing this type of order without familial consultation is against the law, so will the hospital/doctors be prosecuted for murder if he dies while under their care? If I were his family I would certainly sue the hospital/doctors if he did so.
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Old 13.09.2012, 12:43
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Re: First the right to die, now the right to live

Sorry - can't agree with your standpoint.

According to the information given, the patient in question is obviously in the last stages of his life anyway and is on a downward spiral. It's a given fact that Downs Syndrome people very rarely live longer than 50 years and this man is 51.

On top of that he has dementia, is bed bound and, if I understand correctly, is being fed through a tube. Why on earth resusitate someone in this condition. For what? Much better to let him die a natural death than to prolong a life that has reached it's natural end.
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Old 13.09.2012, 12:48
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Re: First the right to die, now the right to live

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Sorry - can't agree with your standpoint.

According to the information given, the patient in question is obviously in the last stages of his life anyway and is on a downward spiral. It's a given fact that Downs Syndrome people very rarely live longer than 50 years and this man is 51.

On top of that he has dementia, is bed bound and, if I understand correctly, is being fed through a tube. Why on earth resusitate someone in this condition. For what? Much better to let him die a natural death than to prolong a life that has reached it's natural end.
Do you really believe what you're writing? The patient and his family should have no say in whether a DNR notice is issued? Frankly I find it hard to accept that anyone would think like that.

And groaning someone for just pointing this out - having a bad day, are we?
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Old 13.09.2012, 12:49
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Re: First the right to die, now the right to live

I think the point was that the decision has been made by someone else than family...
(ie here X has the right to make an official decision leading to death, while in the law there's no possibility to request that decision for extreme cases)...

Ie it seems: administrative bullsh1t process and overpower VS political crap and powerless to make sensitive decision...
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Old 13.09.2012, 13:01
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Re: First the right to die, now the right to live

if this is true, it's really scary. not just bureaucratic bullsh1t.

"The reasons ((for not resuscitating in case of cardiac arrest)) given were "Down's syndrome, unable to swallow (Peg [percutaneous endoscopic gastrostomy] fed), bed bound, learning difficulties".

still, hospital day-to-day reality, sadly.
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Old 13.09.2012, 13:22
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Re: First the right to die, now the right to live

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Do you really believe what you're writing? The patient and his family should have no say in whether a DNR notice is issued? Frankly I find it hard to accept that anyone would think like that.

And groaning someone for just pointing this out - having a bad day, are we?
I agree. It's not that he might be in the last stages of life it's the fact that the hospital just issued the order without any sort of consultation. That's simply appalling, not to mention high handed and arrogant on the part of the doctors and hospital. Would the same order have been issued if the reasons were just listed as "unable to swallow and bed bound"? I doubt it very much.
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Old 13.09.2012, 13:29
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Re: First the right to die, now the right to live

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Sorry - can't agree with your standpoint.

According to the information given, the patient in question is obviously in the last stages of his life anyway and is on a downward spiral. It's a given fact that Downs Syndrome people very rarely live longer than 50 years and this man is 51.

On top of that he has dementia, is bed bound and, if I understand correctly, is being fed through a tube. Why on earth resusitate someone in this condition. For what? Much better to let him die a natural death than to prolong a life that has reached it's natural end.
What you are saying is spot on however, it is the family that should decided not the doctors.
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Old 13.09.2012, 13:37
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Re: First the right to die, now the right to live

Looks as if it's not unusual.
Quote:
Care homes warned to discuss 'do not resuscitate' forms with families
NHS says homes must follow law on decisions to attempt resuscitation, after issuing apology to woman who stumbled on 'DNR' order in father's notes
Quote:
Elderly patients condemned to death by secret use of DNR orders
The orders – which record an advance decision that a patient's life should not be saved if their heart stops – are routinely being applied without the knowledge of the patient or their relatives. On one ward, one-third of DNR orders were issued without consultation with the patient or their family, according to the NHS's own records.
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Old 13.09.2012, 17:57
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Re: First the right to die, now the right to live

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Do you really believe what you're writing? The patient and his family should have no say in whether a DNR notice is issued? Frankly I find it hard to accept that anyone would think like that.

And groaning someone for just pointing this out - having a bad day, are we?
Well yes, I do believe what I'm writing. I trained as a nurse (albeit in the early 1970s) and, at that time, it was usual for the doctors to recommend DNR without asking for permission from the families. Am very out of touch but perhaps it IS usual nowadays to consult the family.

The groan was for thinking it OK to sue/take legal action. Oh yes, and thanks for asking but actually I've had quite a nice relaxing day!!!
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Old 13.09.2012, 18:01
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Re: First the right to die, now the right to live

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Looks as if it's not unusual.
To be fair decisions are made based on the fact that the patient in question probably will not live very long anyway or has a terminal illness.
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Old 13.09.2012, 18:08
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Re: First the right to die, now the right to live

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To be fair decisions are made based on the fact that the patient in question probably will not live very long anyway or has a terminal illness.
Wasn`t that one of Hitlers reasons also?

You go left, you go right.........
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Old 13.09.2012, 18:09
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Re: First the right to die, now the right to live

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The groan was for thinking it OK to sue/take legal action. Oh yes, and thanks for asking but actually I've had quite a nice relaxing day!!!
Well it's a debate between:
Overpower full doctors VS Doctors that can be sued for their medical/professional decision...

On one hand you don't want the doctors to decide everything without even the possibility to have a word to say, without possibility of contesting. On the other hand, you don't want to be able to sue them for every professional/medical decision they make or have to make...

That's quite a debate... Unfortunately the justice system seems totally incompetent in that, and they still have to deal with such situations.
Why did I write "seems"??? it's clear that the justice system is incompetent!
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Old 13.09.2012, 18:13
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Re: First the right to die, now the right to live

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Wasn`t that one of Hitlers reasons also?

You go left, you go right.........
Well hitler was supported by many many many people, on various positions of the society...

Here it's somewhat similar:
The doctors much have pressure from "boss" not to spend so much in "lost cases", probably bosses get their pressure from political to "watch their budgets" and so on...
Not only that even the doctor's professional decision must be made on difficult conditions (they probably see many people dying often, so they must be "tinted" by that). They probably think that's the only choice to make.

Not defending them though, or not trying to say that the family had nothing to say. Or not trying to say that the justice system and political system are completely inefficient and that they cost more that they serve....
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Old 13.09.2012, 18:20
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Re: First the right to die, now the right to live

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Wasn`t that one of Hitlers reasons also?

You go left, you go right.........
No comparison. Sometimes the really, only compassionate thing to do is to let someone die. Have even spoken to people who have been resuscitated and wish they hadn't been.
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Old 13.09.2012, 18:22
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Re: First the right to die, now the right to live

We should also consider that we do not have access to the patient's medical records, but consider:

The patient is already suffering from dementia
The patient is having to be fed through a tube

So far, not enough reason to deny resus, but a very high percentage of DS sufferers have severe heart issues, the patient has suffered pneumonia recently.

Without medical notes it is impossible to say (and the family would sadly not be qualified to make a decision), but there is a high chance that trying to restart the patient's heart would cause additional problems in the unlikely event it would succeed and the patient would be left even more debilitated than at present. The major rule of the Hippocratic Oath is that the doctor shall do the patient no harm, and perhaps the medical records indicate a high probability of that if resus is attempted.

I do agree it is very poor not to inform the relatives of this, someone should sit them down and tactfully explain why this decision was reached.
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Old 13.09.2012, 18:25
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Re: First the right to die, now the right to live

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Well hitler was supported by many many many people, on various positions of the society...

Here it's somewhat similar:
The doctors much have pressure from "boss" not to spend so much in "lost cases", probably bosses get their pressure from political to "watch their budgets" and so on...
Not only that even the doctor's professional decision must be made on difficult conditions (they probably see many people dying often, so they must be "tinted" by that). They probably think that's the only choice to make.

Not defending them though, or not trying to say that the family had nothing to say. Or not trying to say that the justice system and political system are completely inefficient and that they cost more that they serve....
"Lost causes" and "watch the budget" is what goes together. A Downe Syndrome person is not likely to be a home-owner so there is no incentive to run up costs to keep him alive, as possible attachment of his possessions to settle debts is the "lost cause". Watching the budget is very important when it comes to decision making.

If the person is a drooling idiot, half conscious, unable to feed, have no memory, and no incentives, is in pain, needing 24hr medical attendance - but has a healthy bank account and/or close relatives, you can bet your bottom dollar it will take a huge court-case to allow this person to simply die in peace.
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Old 13.09.2012, 18:27
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Re: First the right to die, now the right to live

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"Lost causes" and "watch the budget" is what goes together. A Downe Syndrome person is not likely to be a home-owner so there is no incentive to run up costs to keep him alive, as possible attachment of his possessions to settle debts is the "lost cause". Watching the budget is very important when it comes to decision making.

If the person is a drooling idiot, half conscious, unable to feed, have no memory, and no incentives, is in pain, needing 24hr medical attendance - but has a healthy bank account and/or close relatives, you can bet your bottom dollar it will take a huge court-case to allow this person to simply die in peace.
Well it sucks but that what happened /what is happening apparently...
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Old 13.09.2012, 18:34
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Re: First the right to die, now the right to live

I hereby declare officiallybeing ofsoundmindanddisposingmemory that in case of cardiac arrest, coma, or any other condition where I would not be able to communicate on my behalf, I want every medical treatment possible to keep me alive.

Thanks.
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Old 13.09.2012, 18:39
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Re: First the right to die, now the right to live

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Well hitler was supported by many many many people, on various positions of the society...

Here it's somewhat similar:
The doctors much have pressure from "boss" not to spend so much in "lost cases", probably bosses get their pressure from political to "watch their budgets" and so on...
Not only that even the doctor's professional decision must be made on difficult conditions (they probably see many people dying often, so they must be "tinted" by that). They probably think that's the only choice to make.

Not defending them though, or not trying to say that the family had nothing to say. Or not trying to say that the justice system and political system are completely inefficient and that they cost more that they serve....
Usually doctors know from experience who will survive and who not, whereas the family's decision is often an emotional one, i.e.X must survive at all costs, which is why they are often not consulted.

In the aforementioned case, what would you then decide if you were a close relative?
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Old 13.09.2012, 19:02
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Re: First the right to die, now the right to live

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"Lost causes" and "watch the budget" is what goes together. A Downe Syndrome person is not likely to be a home-owner so there is no incentive to run up costs to keep him alive, as possible attachment of his possessions to settle debts is the "lost cause". Watching the budget is very important when it comes to decision making.

If the person is a drooling idiot, half conscious, unable to feed, have no memory, and no incentives, is in pain, needing 24hr medical attendance - but has a healthy bank account and/or close relatives, you can bet your bottom dollar it will take a huge court-case to allow this person to simply die in peace.
Yes, but the Downe Syndrome person in the aforementioned case is 51 and hardly likely to live longer than a year or two at the very most. Why
prolong this? Even if the relatives had been informed and had wished for resuscitation, the likelihood that he would have "pulled through" are still minimal because it sounds as if he is in a bad state of deterioration anyway. Just as a matter of interest, what would you decide if the man had been your brother?

The "drooling idiot" scenario: In the home in which I work, we have 2...
Neither of these have relatives and certainly not healthy bank accounts.
Both have been kept alive at public expense for 35/37 years respectively.
Mad? Maybe....

Sorry you are so cynical.
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