Thursday, February 12, 2009

Journal entry 2- ME, Winter 2009 

My reaction to Assisted Suicide:

I have always wondered about PAS, and what I would do if that situation faced me as a PA. I have  thought it the right thing to do- the kind thing to do if the end was indeed inevitable. What I had not considered were the feelings that would go along with actually carrying forth the intention.

I still believe it’s necessary, and  truly a valuable part of being a member of the medical community. In addition to thinking about what I might do in such a situation, the thought of what a patient might want, if I was in a different thought process, and how I would handle this request, had not been one I had fully considered.

I found that the articles, and the ensuing conversations opened up my eyes. Since it seemed so clear to me with my work with patients in the ICU who often linger on for so much longer then necessary. I feel they feel pain-(and indeed sometimes actually believe that I feel their pain in a physical way) so to watch them getting something so simple as getting bathed can be difficult as a caretaker.  

I am beginning to see why this is such a difficult decision for so many, and therefore, why it's such a tough thing to settle for the masses. We don’t live with anothers thoughts and experiences, and so for this (and I am beginning to glean for all of philosophy), we must somehow step outside of our own pre-conceived notions and memories and move into a different realm.

In our class, there is a girl that obviously has strong memories, and therefore her feelings on this issues are based on one certain situation rather then looking at the whole. In ME, we need to look at the whole, rather then focus on our smallish world. I do not set a judgement in how she sees things- she creates a very good argument against PAS. Her belief in God is so very strong, and therefore she feels very strongly that  he is the one that should make such decisions regarding life and death. This makes sense given her frame of reference. I believe more compelling for her is when her friend got pulled from life support before she felt that all hope was indeed gone. She felt this was the wrong decision, made for the wrong reasons, and cheapened life. For her, (as for myself, but for different reasons) life is a gift and one that must be preserved at all costs. I respect that- but am not sure that it is the right one when looking at the issue of PAS and what it means for the medical community.

In the end, I do believe it’s about resources- more human then types of medical intervention. It is true that in other countries, after the age of 65, there are certain things that would not occur that are considered normal medical practices here. No person over 65 would get placed on dialysis- it just would not happen. Yet, in the US, this is something that is “usual and customary” and the outcry if we denied this for a patient would be (rightfully) riotous.

But the reality is that human resources are limited. There is only so much that one person can do. Given our current economic state, it is unrealistic to think that we can have unlimited attention from one MD- or others.  The cost would be far too high to pay- yes, if the need is a crisis, any MD I know would do all that they could to help that person make it to another sunrise. However, if it's a situation where there is no hope of a meaningful life (and yes, that is a whole other discussion...) one might feel the need to move onto their next patient...if that patient would benefit from their attention.

I suppose we need to consider what a meaningful life is- and this is probably where the issue truly lies.  Even if this is the underlying issue, is this something that the MD is responsible for defining? I am not sure, and nor do I think it a fair question to ask of someone who's attention needs to be in preserving life...meaningful or not, as this is not a decision one should be thinking when treating a patient.

We do have advanced directives in this country- and I for one would tattoo DNR-DNI on my chest if it would ensure that I would not end up in a state where someone else had to take care of me. That is my criteria for life- I want to be able to take care of my own needs at all times. I would never want to linger in a hospital bed, nor would I be okay as a quad. It's just not something that I have the internal reserves for. It's a brave person that can live that way, and I am very sure I am not that brave. 

I understand that this may  not be what my children or husband would want- they may want me "there" no matter what state I would be in- but I know who I am is very much not what being tied to a machine would be. Yes, I value life, I love life, I treasure life, but life for me is the ability to breath, eat and move as I was put on this earth to do.

I do know, and I do appreciate that many do not feel this way, and that's okay. I do however, think that coming up with some sort of code as a community is imperative. It's obvious from the class discussions, however, that this is not going to be easy. 

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