In Extremis

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   I haven't seen this really discussed, and I understand it is a sensitive subject.  Anyone who isn't ready to handle this concept yet, you might want to go on to another thread.

The biggest moral, ethical, and potentially legal dilemma we are
likely to face during a pandemic is that of a flu victim, in
extremis (near death), whom you could spare a good deal of pain and
agony by administering a sedative or a narcotic. 
We�re not talking a `normally lethal� dose.
Just enough to take the edge off, perhaps reduce the coughing spasms,
and even allow the patient to sleep.

But implicit in doing so, is the understanding
that these meds may depress the Central Nervous System, depress
respirations, and will likely hasten their death by a few hours. 
While this is done routinely for end stage
cancer patients by many doctors, and may be seen as humane by some,
could you do it to (or for) your spouse or child?

On the other hand, could you allow a loved one
to continue to suffer, knowing you had at your disposal medicine that
would calm them down, reduce their pain, and allow them to rest easily?

ARDS is a terrible way to go. Respiratory
distress, spontaneous pnuemothorax, pulmonary edema, wracking coughs,
internal bleeding . . . 
What price should a dying patient pay for
another hour or two of life. What matters more, quality or quantity of
life. If we are talking only a few hours difference, which would you
choose?

I know my answer, as I have crossed this bridge before. And if you don�t want to reveal your answer, that�s fine. 

But you need to seriously think about it.  
If you contract the flu, you need to make your wishes known to others while you are still able to.  And if someone you know has the flu, it's a question you must ask of them.  It wouldn't hurt to have a living will, or simply write a note expressing your desires.
I expect there will be deep religious and personal convictions on this matter. But it is something we all may face if a pandemic occurs.  

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Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Guests Thanks(0) Quote Reply Topic: In Extremis Posted: February 17 2006 at 6:23am
	I haven't seen this really discussed, and I understand it is a sensitive subject. Anyone who isn't ready to handle this concept yet, you might want to go on to another thread. The biggest moral, ethical, and potentially legal dilemma we are likely to face during a pandemic is that of a flu victim, in extremis (near death), whom you could spare a good deal of pain and agony by administering a sedative or a narcotic. We�re not talking a `normally lethal� dose. Just enough to take the edge off, perhaps reduce the coughing spasms, and even allow the patient to sleep. But implicit in doing so, is the understanding that these meds may depress the Central Nervous System, depress respirations, and will likely hasten their death by a few hours. While this is done routinely for end stage cancer patients by many doctors, and may be seen as humane by some, could you do it to (or for) your spouse or child? On the other hand, could you allow a loved one to continue to suffer, knowing you had at your disposal medicine that would calm them down, reduce their pain, and allow them to rest easily? ARDS is a terrible way to go. Respiratory distress, spontaneous pnuemothorax, pulmonary edema, wracking coughs, internal bleeding . . . What price should a dying patient pay for another hour or two of life. What matters more, quality or quantity of life. If we are talking only a few hours difference, which would you choose? I know my answer, as I have crossed this bridge before. And if you don�t want to reveal your answer, that�s fine. But you need to seriously think about it. If you contract the flu, you need to make your wishes known to others while you are still able to. And if someone you know has the flu, it's a question you must ask of them. It wouldn't hurt to have a living will, or simply write a note expressing your desires. I expect there will be deep religious and personal convictions on this matter. But it is something we all may face if a pandemic occurs.

cisco Members Profile Send Private Message Find Members Posts Add to Buddy List Valued Member Joined: February 06 2006 Location: United States Status: Offline Points: 57	Post Options Post Reply Quote cisco Report Post Thanks(0) Quote Reply Posted: February 17 2006 at 4:23pm
	Hi Fla_Medic: You're entitled to your opinion and I happen to personally agree with you, but what is the answer? How would the average person be able to administer this type of relief? My concern is that someone would attempt to make another person comfortable and have no idea of what they are doing and therefore might make an already bad situation worse. Normally people at the end of their lives are made comfortable in hospital or hospice settings. These people will be at home - entirely different, agree? I don't think this thread should offend anyone any more than the thread on how to bury your dead.......unfortunately these are the realities we will be dealing with. This is just my personal opinion. Cisco
	let's hang tight, tough, and together!

Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Guests Thanks(0) Quote Reply Posted: February 17 2006 at 4:44pm
	Cisco, I tried very hard (maybe I failed?) to present both sides of this issue. And I asked it as a question, rather than pushing my personal opinion. I bring this up because it is 1) Likely to happen and 2) A difficult decision. Therefore, it's worth considering in advance, while one can think rationally about it rather than emotionally. My advice, to state your preference to your caregiver in advance works either way, btw. One could easily say no to narcotics at that point, and then the caregiver would know what you wanted. Speaking for myself, personally, if I were on death's door I would hope someone would provide me with enough codeine to reduce my pain and anxiety. I'd take my chances on it hastening my departure. But that's my decision. One size doesn't fit all. I would be very reluctant to push my `solution' on anyone who hadn't stated their preference. Each of us needs to decide, in advance, what we would want. And make that preference known. My 2 cents. Edited by Fla_Medic

cisco Members Profile Send Private Message Find Members Posts Add to Buddy List Valued Member Joined: February 06 2006 Location: United States Status: Offline Points: 57	Post Options Post Reply Quote cisco Report Post Thanks(0) Quote Reply Posted: February 17 2006 at 5:08pm
	your questions and statements are great ones and by no means did you fail. what i was trying to communicate is that we (most of us) will be caring for our loved ones at home without the option of administering medicine to make them more comfortable. what then? scary...hospitals will be overcrowded and overflowing! i think it's great that you brought this up, because, as you stated: "it's worth considering in advance, while one can think rationally about it rather than emotionally. " these are things we all need to think about - what would we do and what would we want done! thanks for your input.........it is valued! cisco
	let's hang tight, tough, and together!

zumble Members Profile Send Private Message Find Members Posts Add to Buddy List V.I.P. Member Joined: January 16 2006 Location: United States Status: Offline Points: 24	Post Options Post Reply Quote zumble Report Post Thanks(0) Quote Reply Posted: February 17 2006 at 6:17pm
	assuming that one could even get the narcotics, fla medic. are you talking about roxanol?

Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Guests Thanks(0) Quote Reply Posted: February 17 2006 at 9:53pm
	Roxanol (Morphine sulphate) would certainly be one of them. But Morphine is extremely difficult to get. I was actually thinking more along the lines of Tylenol #3 (codeine/acetemenphin), hydrocodone, or any of a number of common narcotic analgesics that many people have. You go to a dentist, and you get a script of vicodin, but don't use them all. Most people I know hoarde a few for a rainy day. When I tore my miniscus on a Saturday morning a year ago, I was damn glad I had a couple in the medicine cabinet! Codeine based meds can be useful in controling coughs. That's why it used to be an ingrediant in cough syrups (still is in europe). As mentioned, these drugs have the potential to depress respirations. Not suggesting euthanasia here or administering with the intent to hasten death. I'd use the lowest possible effective dose. And only if the patient requested it. Doctors balance the value of reducing pain vs. the possibility of hastening death every day. It's just not something they like to talk about. When they give an end stage cancer patient a morphine drip, with a button to push to inject as needed (with limits, of course), they understand that the drug, while palliative, may shorten the person's life. It's an ethical question, with lot's of grey areas. Probably no one `right' answer. But it's one that you may face at some point. Best to figure out how you will deal with it now. The usual disclaimers apply: Not meant to be medical advice. Submitted for educational purposes only. Prices slightly higher west of the rockies. Your mileage may vary. Objects may be closer than they appear. Close cover before striking. etc.

Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Guests Thanks(0) Quote Reply Posted: March 06 2006 at 4:07pm
	GREAT TOPIC!!No matter the personal decision, it NEEDS to be in writing. Can potentially prevent a lot of problems later. How is your wrist? Any improvement?

Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Guests Thanks(0) Quote Reply Posted: March 06 2006 at 5:26pm
	I think the question is about responding to end of life wishes of an individual. In hospitals, these wishes are routinely known as, DNR orders, Do Not Resuscitate Orders. These are pre-authorized written instructions to the hospital staff not to take any extraordinary measures to resuscitate the patient in the event of some medical crisis, during the hospital stay. These might be given if someone had a terminal disease or very elderly with poor quality of life expectations. That is an approximation of what I understand. If you are over 50-years and are admitted into a hospital in Ontario, expect to see them, if you have anything serious. There might be periods when the normal rules of law do not apply and death rarely comes at a good time. It might be good to know in advance the degree of effort needed to prolong life, since resources might be scarce. ----- "will be caring for our loved ones at home without the option of administering medicine to make them more comfortable. what then? scary...hospitals will be overcrowded and overflowing!" --- I've been in a similar situation a few times, its tough, but if you are prepared to deal with it and accept some help, you can get through it. Educating yourself is the first step. Your first lesson is, there is always something that "can make them more comfortable". Sooner or later you would have to deal with this. You are far better prepared than I ever was. In my neck of the woods, hospitals are always overcrowded and overflowing like it was a pandemic!

Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Guests Thanks(0) Quote Reply Posted: March 06 2006 at 6:04pm
	The nurse who just received 11 life sentences should have read this. Hippocratic Oath -- Classical Version I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.