*applause* March 4, 2008
Posted by keepbreathing in Blogroll, Medical Blogs, asinine, medical ethics, medicine, nurses, opinion.trackback
Markie, over at Mark On The World, has been thinking. He asks a question that I have been asking myself for ages:
Seriously, if a patient continues to behave in an unhealthy manner despite all evidence and advice to the contrary, when is it okay to stop treating? People with psychological conditions are forcibly treated, making it lawful to step in because the patient cannot distinguish reality, or is unable to care for themselves. The current popularity of blaming everyone else for our own condition is valid in a court of law (”They made the hot coffee too hot and I was burned”, “I can’t stop eating McFood, they must put something in it”, “I never would be this fat if they didn’t make Twinkies”….). Isn’t this a similar type of
crazyliving in a fantasy world?Shouldn’t the healthcare providers be able to say “no” to the people unwilling to care for themselves in any meaningful way? Part of me thinks
hell yeah!this is a possibility, and the other thinks that first part is sick. As nurses we’re here’s to help. But where is the line? Isn’t enabling exactly what we’re doing at some point?
I think it’s an excellent question. If somebody is unwilling to take steps to change their own behavior to improve their health, can’t we assume that they’re uninterested in their own health? If they’re uninterested in changing their behavior, why should we waste resources and time treating people who do not have any desire to get better? I’ve seen hundreds of patients whose chief complaint, verbatim, is “I can’t breathe good enough to smoke no more.” And while I can sympathize with the terror and horror of being unable to breathe (I’m asthmatic) I don’t really have a lot of sympathy for someone who takes a cigarette break while they’re in between nebulizers. What we are doing at that point is pretty much rearranging the deck chairs on the titanic. We can shuffle them around all we want, but the iceberg has already breached the hull and the ship will sink no matter how neatly those chairs are arranged. There are thousands and thousands of similar cases out there, draining resources and causing the cost of healthcare to spiral ever upwards for those few people who are actually sick through no fault of their own. You know. The people who need modern medicine.
Oh well.
Thanks for the visit! Your recent posts have actually made me think more about the matter. I still have very conflicting feelings about the whole matter, as well as our (healthcare “royal we”) treatment of the patients when they’re not around.
Markie
Hey there, I have read all of you blog and as a student who just gave their first treatment today I thank you for giving me a view of the world of acute care. I have a challenge for you though. I would like you to write a blog entry reminding us why you like your job. That would be welcome. Thanks in advance
I think the key issue here is psychological conditions. Who can make the judgement that a person is mentally able to know how to get better?
Even taking the smoking example who is supposed to decide if a person is capable of quitting and is lazy or, for whatever reason, is so addicted that the person is mentally incapable of even thinking about quitting?