I always read these end of life debates with great interest. It is amazing the spectrum of opinions, and information or misinformation we DISers have.
I will speak of my personal experiences.
In general, we are able to tell when someone is dying. All of the information we are able to accumulate form the high level testing we are able to do gives us this ability. Do we know exactly when? Well, obviously not. Are there people who will defy the odds? Of course. But in general, someone with terminal cancer is going to die, and you can usually pin it to within weeks, if not days.
Healthcare is a balancing act. Hospital care is a bigger balancing act. Let's look at it from a different perspective.
Your father is having a heart attack. You call 911, the ambulance comes and he's off to the hospital. He gets to the hospital, and they are not accepting any more amubulances because there is simply no more room for patients in the ER or to be distributed throughout the hospital. The place is full, and yes, hospitals do have a census limit. Some of the reason that your father may not get into the first hospital he gets to while having his heart attack is because there are "X" number of terminally ill patients on ventilators taking up ICU bed space.
Still think that person who we know is dying is more important?
OK. The ambulance takes Dad to the next hospital 10 miles away, where they have room. Dad is seen in the ER, treated as appropriate. Dad needs to be in ICU, but wait...there are no beds because there are 3 terminally ill patients in there on ventilators. So Dad gets to sleep in the ER for 48 hours, on a gurney, in a cubicle the size of a decent walk-in closet, while chaos reigns all around him, because after all, ERs are always chaotic. This, of course, doesn't help his cardiac issues...all that stress etc, but well...we have no choice there are no beds, because many of them are being taken up by terminally ill patients receiving futile medical treatment.
Still think that person who we know is dying is more important??
OK, so 48 hours after admission Dad gets a bed in ICU. Of course, there are 3 terminally ill patients who require quite a bit of care, so Dad doesn't quite as much attention as he wishes he would, since out of the 4 of them, he's the healthiest and has the least requirements.
Still think that person who we know is dying is more important?
And these are the challenges, issues...call them what you want, that face healthcare providers every single day. How do you triage? How do you decide who is more important vs. less important? How do you decide whose case is worth blowing a ton of resources on because they have a chance, and who case is worth letting someone die a comfortable, dignified death because they don't have a chance? And who else will be impacted by your decisions...think back to Dad.
End of life is a hot button topic in this country for one reason...because we don't discuss death openly as being a natural part of life. Because the advances in medicine are leading people to think that healthcare providers can do it all, can save them, can make miracles. Because people think we can make them live forever. I hear it all the time "If they can put a man on the moon, why can't we cure this?"
The poor iwoman in this instance was given as many chances as a terminally ill person could get. She was given 10 days on the vent to see if she would improve. The hospital tried to get her to a facility that offered a more appropriate level of care. The hospital offered to the family to get her mother over here, as was her request, but they pooh-poohed that idea as being too difficult to deal with the red tape in Africa.
I do not personally believe in abortion. I will suppport a woman's right to get one because it is legal in this country. I do not personally believe in murder. I also don't believe in keeping someone with absolutely no quality of life alive. I believe in letting people die with dignity. I believe in trying my best to insure that they do. I believe in trying to make families understand that the last loving thing you can do for someone is to let them go when it is their time to go. A ventilator is exactly that...life support. Without it, she would have died. If she lived in Africa in a village where there were no hospitals or ventilators, she would have died a long time ago. If you are unable to survive for an extended period of time without mechanical ventilation, then you are not "OK", you are not "living"...you are being supported by machines. That is fine for short periods of time...God knows, the mechanics we have in healthcare today have greatly increased our ability to help people. But when it stops being support for a finite period of time for a specific reason, and starts to be the only reason a person is alive, then comes the time to decide quality vs. quantity, life at all costs.
Perhaps my views will land me in Hell someday. Perhaps my participation in keeping dying people comfortable rather than continuing futile treatment will land me a spot closer to the fire. I have seen enough to know that allowing someone to die with dignity, in peace and comfort, is the best thing I can do for them, so I'll take my chances.
I doubt very much that this young lady was allowed to lie there and suffocate and gasp for air for 15 minutes. There is a procedure for taking terminally-ill patients off of a ventilator, which includes medication to relax them, so that they sort of "fade away". It's not a bad way to go.
