Answer questions 1-3 and Reply to POST 1 AND POST 2.

1. Do you agree or disagree with the physician who was interviewed in this segment? Explain your position, either pro or con.

2.Do you believe that medical services should be rationed to the elderly? Explain your position, either pro or con.

3.What do you think should be done to deal with this issue in the future? What is the nurse’s role in all of this?

POST 1

Do you agree or disagree with the physician who was interviewed in this segment? Explain your position, either pro or con.

I do agree with the physician who was interviewed in this segment. I can understand where the family is coming from. It is hard to let go of your loved one, but it also comes down to their suffering. We can continue all treatments and hope for a miracle or we can let go and allow the patient to die peacefully without having them go through so much unnecessary trauma. A physician will do everything possible for a patient, but if they can scientifically say that the interventions will make no change on patients outcome, then the patient or family should inquire about other options for their loved one.

Do you believe that medical services should be rationed to the elderly? Explain your position, either pro or con.

I believe that medical services should be rationed, but not only to the elderly. It should be rationed to everyone. That would cut down on so many unnecessary procedures. For example, a patient must meet guidelines for an organ transplant. They can only qualify to be on the list if the transplant will enhance their quality of life and will not be rejected according to their comorbidities. This same thought process should be made for other procedures. During a patients end of life, if they do not have a living will, their family tends to keep them alive for much longer because of the guilt to let them go And will agree to all interventions regardless of necessity.

What do you think should be done to deal with this issue in the future? What is the nurse’s role in all of this?

What I believe should be done is educating patients and families about living wills, DNR, power of attorney, etc. As a nurse, we can help in the education of patients and their families. If the patient has their decisions made and documented, the decisions for their care is off of anyone’s hands and no one has to feel guilty for giving up hope. The dying patients family will feel comforted that they are following their wishes. Having that talk with family tends to be uncomfortable and is put off for another day; but our time can come at any moment, young or old. It is best to be open.

POST 2

This was a great segment. Certainly an important one, however, the physician didn’t do himself any favors coming across as a representative of death. As a nurse, I struggle with a DNR orders. Not the activity but the concept. Ever since I was a paramedic a thousand years ago and the idea of DNR was being talked about, it went against everything I stood for. My job was saving lives. I was very good at it and being called to a home and to be told by family that I can’t do that was contrary to me.

Practically speaking, I get it! But what this doctor is suggesting leans real hard toward death panels. “Well, Mr. Jone, your wife is critically ill. Unfortunately, Mr. Smiths wife has a slightly better chance of surviving so we are going to let your wife die so we can focus our resources on her. I assure you it will be with dignity. We have hospice!” I believe a society has an obligation to care for the elderly. What would people think if we extended the concept of the physician. “Ms. White, your child has suffered anoxic brain syndrome which mean he will most likely be in a coma. We have very limited resources to care for your child, so we have decided your child must be left to die”. This kind of decision the doctor is suggesting would have catastrophic results in a civilized society. I hope as a country we never get to the point of having to choose like.

Nurses are in a difficult position. We must have the compassion to care, and the desire to help. Although, I hate the idea of letting someone die, I understand that at this time, we have no other alternatives to the DNR. My mom and I had a conversation one day and she said, “I don’t want to be put on a machine. If something happens let me” I was relieved at that point. then one day, she called to tell me she had been diagnosed with stage 3b lung cancer and her chemo and radiation were starting the following week. I asked her why. “You always said you didn’t want anything”. “Let me tell you something, until you are faced with your own mortality, you won’t really understand. This way, I get to chose how far and how much.” That struck me, and I’ve never forgotten it. 11 months later, she was struggling in every way and she and I were on the phone and I said, “it’s ok Mom, don’t wait for me, go if you want”. She died 4 hours later in the hospital as a DNR patient.

These decisions are very personal and I do not believe anyone other then the patient should make that call.