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2018-09-21

intensive care medicine: Between sense and senselessness

Periodically I read in the articles in the media about our social system. In Germany we have a System that makes all of the Insured medical care at a very high level. We live in a country in which every man is entitled to everything. This provides us, especially in the field of intensive care medicine, but also in front of ethical and moral conflicts.

I have in this Blog repeatedly over the emotional burdens spoken of by my work area – for example, in the contributions BETWEEN MAN AND MACHINE, WORKING IN THE ICU BETWEEN LIFE AND DEATH and HOW, TOGETHER, WE HEALTH BURNING – AND HOW from IT LIGHT AND HEAT .

The question of the reasonableness of medical activity also plays a role. We should do everything just because we can do it? The answer to this question is difficult. And again, there are differences of opinion.

Conflict is as old as medicine

This ethical and moral conflict is almost as old as medicine itself, and to this day nobody has found a solution that raises new questions and problems. As a society, the answer is apparently very simple. The unnecessary Action causes costs for the community of solidarity, which should be avoided. It is not affected by the consequences of these decisions, this way a logical point of view. Let me figuratively Express: imagine you have two cars. One drives and is good in the shot. The other one is old, the engine has a damage and also the clutch no longer works. It is rusting in all the corners, and half the time it won’t start it. The Tanks in both cars are empty and you get 50€ for Refueling. Which car gets a full tank of fuel? Simple answer, is it?

Now the cars are replaced by people and the filling of the tank, through the provision of healthcare. What is your decision now? It is your own mother, your own father or a close friend, the Situation is often different, of course. At once, many will say that both people should get the maximum therapy.

We have the privilege that the financial burden will be borne by solidarity community. The decision, which car is refueled, is removed thus. Nevertheless, the cost remains out of the question.

What is the Best for a patient?

In practice, in the hospital, our System always provides us with great challenges. These are usually less of a financial nature, but more ethical. I would like to give an example: A Patient, we have him here, even 94 years of age, is associated with an acute illness in an intensive care unit. This acute disease would be left untreated, lead to death – but it can be treated. There is a slight Chance that the man could recover after a long stressful treatment (!).

Our fictional Patient had been suffering for many years with chronic pain and has several other pre-existing conditions. He was already bedridden and in need of continuous care of his family and of care services. He is demented and no longer know where or who he is. He has not seen his home for a year, since then in the hospital. This is not an atypical Situation, but a reality. Now what?

Should be treated this Patient for several weeks in an intensive care unit? With what success could be expected? This Patient a good quality of life? To treat him “a little bit”? Maybe not at all?

Who decides when the Patient can?

Who should make this decision? The Patient? The can’t currently. The Family? A Judge? Should meet with a physician maybe this decision or the nursing team that cared for him and perceives?

Although in Germany we have very clear structures, who gets to decide for a human, no longer should he be in the same situation, this also Involved immense challenges.

I am grateful that I do not need to meet as a nurse, these decisions and take responsibility for it. Nevertheless, I’m here to be a part of an interdisciplinary team. I develop a sense for the patients, and take up his reactions. I speak with the family and can make me at least a fragmentary picture from the presumed will of the patient.

Often I also have the feeling that we will do the people no favours if we give him all the opportunities of a modern intensive care. But this is my personal assessment – not the patient. Who am I, that I could presume to be able to this decision on the life or death meeting?

Living wills are not just for seniors

In the past few years, a document, the recovered patients, in importance and I would like to use my contribution here has been to sensitize you for this! Take care of your wishes! What do you hope to find for a supply?

One thing I have learned in the past few years: It may be faster to be relevant, than you might think. A sports or traffic accident. A stroke or heart attack – perhaps due to a genetic predisposition. It is not a question of age. Whether it’s 20 or 90, it doesn’t matter!

My family and my friends know what I want, or more importantly, what I don’t want to. It writes, describes exactly and precisely what you want for you or don’t want to. Posted in any General descriptions, a patient must be detailed. Let yourself be advised! On the Internet you can find a lot of information on patient dispositions. Yes, it is time-consuming and a bit complicated. It is an unpleasant topic. But your life, your wishes are a few days of work worth it!

Us staff in the hospital, but also to Your families you will help this immensely. Because we can then meet in Your best interest decisions.

We can be proud of our health care system. Ultimately, the responsibility comes to each of us to decide. You decide what is useful or useless. Whether your suffering is now 94 years old, and the chronically or 20 years old and fit as a fiddle.

Photo: Fotolia / Alex Tihonov

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