Tuesday, May 25, 2010

After reading Chapters 16 & 17

This one's a bit tough - Dr. Nolen describes treating terminally ill patients and that "a surgeon is reluctant to 'pull the plug'? As recently as 2005 with the "Terry Schiavo" case, how to address the dying is something most of us are reluctant to deal with. If you were the attending surgeon would you be comfortable "playing God"? If you were a family member of a terminally ill patient, what would you do?

Respond by Friday, May 29th.


  1. Brett said...

    Ms. Doering was right when she said that this question is "a bit tough." Having control over whether someone lives or dies is a frightening thought, even if you have the best intentions. This question is especially difficult for me, as I am Catholic, and therefore I believe in miracles, in the power of prayer and hope, and in the sanctity of life. For me, there is always a possibility that someone who is terminally ill will survive. There are many doctors in my family, and I have heard many stories about patients who were "condemned to death," so to speak, and who not only did not die within a few days, but who went on to fully recover and are still living today. Now, many would say that these cases are few and far between, and those people would be right; however, the point is that miracles DO happen, Dr. Nolen says it himself. Yet, I have never had my faith truly tested. If it came to the point where I had to witness the suffering and pain of a loved one who was supposed to die, it would be extraordinarily difficult. When we love someone, we want them to be in as little pain as possible, and seeing someone suffer is simply unbearable. I do not know if anyone watches CSI Miami, but in one episode one of the detectives saved a man from death. However, his face, hands, chest, and arms were severely burned, and not only was he horribly disfigured for life, but his recovery was slow, painful, and incomplete. The detective who saved him later asks her friend if she did the right thing in saving him. This is the same sort of question. Can we bear to see someone we love, or even another human being we really do not know (as in CSI Miami) suffer? It depends. I believe that deep down all of us have hope, and I believe for me this hope would make it impossible to "play God." I know that many people call this selfish. Many people believe that you only keep a terminally ill loved one alive so that you can see them that much longer, even though they are in pain.
    Perhaps this is true, but perhaps not. If a loved one really is going to die within, let's say a week, and you decided to pull the plug early, you may save him or her a week of suffering. However, what if your loved one is the 1 in 100 or 1 in 1000 that will spontaneously recuperate? Did you really just take away his or her life? Although it is much more likely that you will have saved your loved one some suffering, there is a chance that, put frankly, you robbed the one you love so much of the rest of his or her life.
    So, to answer the question, no, I would not be comfortable playing God. When I think of "playing God," I think of the various "Angels of Death" who have existed over time who (for those of you who are unfamiliar) would kill tens of patients simply to "put them out of their misery." Now, to be fair, some of these were psychopathic serial killers (actually they all were), but many of them thought they were saving their patients from suffering, even those who were not terminally ill. I cannot bear to think of myself life that. No matter how small, I do think there is always hope. When my 39 year-old uncle had a massive stroke almost three years ago, the doctors said he had a 99% chance of dying. He survived. They then told him and my family that he would be paralyzed forever. He can now walk by himself and move almost every part of his body. Miracles do happen, maybe we just have to believe...

  2. This question IS tough, to think about having someone's life in your hands is a lot to take in. Unfortunately, it comes with being a surgeon. There is no way to save lives like surgeons do and not have to deal with the ending of lives. Every time I have ever pondered becoming a surgeon, everything sounds great, until we get to the "life or death" part. I couldn't imagine being in a surgeon's shoes when it comes down to a final decision. I personally would be extremely uncomfortable with making decisions about plug pulling because I would feel as if it were not my place. I know the patient would not be able to make the decision for themselves, but still i would constantly be thinking, "Who am I to make this decision? What if my assumption that they have no chance of living is wrong, and they could be just fine?". I don't know how I would handle if it if I found out after the fact that the patient I pulled the plug on could have made it. I feel as though this part of a surgeon's job is the most difficult to handle, but it would be even worse if they died because of a mistake you made, rather than because they were terminally ill. It is so hard to give a straight answer to this question, there are so many factors that could come in to play.

    In the case of being the relative of a terminally ill patient, I feel as though the decision would be much much harder. In that case it would come down to your caring about the relative enough to let them go. If they were so ill that if they lived they would live in pain and suffering, while the decision would be heart wrenching, it would be the most unselfish to let them go. I feel as though in this case you would have to attempt to put your own feelings aside, much easier said than done. I want to say that i would do what was best for my family member, even if it meant pulling the plug, but I know that it would be hard to decide if I were in the actual situation.

    In response to what Brett said, I am a firm believer in Miracles as well. I believe that Miracles do happen, but not as often as I'd hope. If a patient were to be miserable on earth, then maybe pulling the plug would be the most humane decision, no matter how difficult.

    In conclusion, I think practicing surgeons are quite strong, and I hope they really enjoy what they do. Because they see enough good in the majority of their work, they are willing to deal with the hardest part of the job as well. I think this is one of the deepest forms of dedication.

  3. Karli said...

    I'll be honest- this is an extremely difficult question for me. If it were me that was dying, I'd probably ask for the plug to be pulled. I'd rather enjoy a "pleasant" death while I could still think rationally, with my friends and family around me. However, if it were me pulling the plug, that's completely different. In theory, I'd want to pull the plug. In practice though, I don't think I could "ok" something like that. It would be unbelievably hard, especially if I really knew/loved that person. If I knew that they would want that, I most definitely honor their wishes. But if it were solely up to me, I'd probably tell the person what the situation is, make them understand that their are always miracles, but there also aren't miracles. Anything could happen. I'd leave it up to them to decide, in the end.

  4. For me it's not a matter of "playing god" by pulling the plug, but "playing god" by keeping the person alive. The deviation from the natural course of the patient life is caused not by pulling the plug, but by putting the patient on so many machines to begin with. From my perspective, I would rather a natural death then to be kept alive on machines. Luckily, there is law that dictates this. A patient can decide on their own what should be done in this situation beforehand, or if they have not a loved one can decide. The choice is not the doctor's. It is not a moral dilemma, because the doctor must follow the instructions of the patient or the relative acting in his or her place.

  5. Well, I hardly think this whole thing is about "Playing God" as the prompt to the question says. It is a tricky legal issue, that comes into conflict with laws about homicide and suicide as well as intense moral issues about deciding the fates of others, and issues about quality of life. Who has the right to end another's life? Is it doctors, with their medical knowledge? Or the family of the person, who knew that person's values and sentiments? And these sorts of situations also bring up questions of the quality of life. Is being brain dead really living at all? These are not questions that I can very easily take a overwhelming position on, as I can see the problems with all sides of the argument.

    With regards to the "am I comfortable 'Playing God'" question, I don't think so. With my current set of values, I probably would have issues with ending another persons life. However, if I saw that the person in question was suffering, and there was no hope for recovery, I would argue in favor of "pulling the plug." This answer applies to both the scenario where I am a surgeon or a family member. I know that if I was in a vegetative state, and had been so for enough time that recovery seemed very unlikely, I would rather be "let go" than to continue my passive and pointless existence.

  6. This question, as many have said, is a difficult one. Of course, the easiest answer is simply to go with whatever the patient would have wished for (I myself, in idle conversation, have managed to inform most of my extended family that, if I am every to go into a vegetative, that I would want the plug pulled.) This answer only works, though if you actually know what the patient would have wanted.

    Without any knowledge of the patient's wishes, as a surgeon I would have to advise pulling the plug once the probability of being cured dropped below, say five percent. Which may seem an arbitrary number, one which I might change with better knowledge of whatever terminal disease the patient had contracted (i.e. the more painful, the earlier I would pull the plug).

    And as a family member, I would try to do the same.

    Now for my explanation of why. I am a romantic at heart, a believer in stories with a beginning and an end. But for me, this romanticism doesn't translate into clinging to faint hope of a happy ending. I think that it is a much sadder thing to see a great person terminally ill. It's a horrible thing to see someone you know and love reduced to something less than they were by some bug. Keeping them alive to nearly no purpose is like a song that goes on too long, a tune that keeps on going long after it should have ended with a bang, a tune that nobody wants to hear any longer. Ending someone's life when they are still reasonably strong allows them to pass away on their own terms, allows them to be remembered better as who they are and not who the sickness is making them become.

  7. I have to agree with Eli when I say that you're playing God more when you choose to keep the patient alive on a respirator or artificial circulation machine. If there's no way that the patient would recover on his/her own, then you're defying nature as a doctor to keep that patient alive.

    That said, sometimes playing God could save somebody's life. The difficult decision comes in weighing the odds that the person would survive. If there are any factors that would indicate that death would be the better option, it may be wisest to pull the plug. For example, if the patient has expressed openly that they would not like to be artificially kept alive, or if the patient's family has made peace and realizes death is possible, it may be better to take the patient off life support. Furthermore, if the patient and his/her family are religious and believe in life after death or reincarnation, it would make letting the patient go much easier.

    However, if it were down to the situation where the patient was in a deep coma with only a 10% chance of waking up, the decision would not be so clear-cut. I feel like as a family member of the patient, in that case I would not choose to keep them on life support forever, because it would be a waste of the patient's life. If the patient had led a good and fulfilling life before his/her condition, it would be better to end it then rather than prolong everyone's suffering. However, the younger the patient, the harder it would be to accept the prospect of pulling the plug. If the patient were under 18, I would wait it out for maybe a month, but after that resign myself to the fact that life may no longer be possible.

  8. First off, let me just mention that I find it really funny how in every single person's blog entry, the phrase "pull the plug" has been used at least once, and often multiple times.

    Moving on, as Ms. Doering and everyone else said, this really would be a sticky situation to be in. Whether or not I would feel comfortable pulling the pl- I mean, making the decision to take a person off life-support depends on where exactly I fit into the situation. If I was the surgeon that was assigned to a person in a vegetative state and was only alive because they were hooked up to machines, I do not think that I would be able to make the decision that could determine whether or not that person lived. Having no direct connection to the patient makes me think that I am not the one who should be deciding whether they live or die. However, if I was a relative or close friend of someone in the aforementioned state, then that is completely different. Because I know the person well, I would most likely have a good understanding about how they felt about life-support and that sort of thing. I would also be more OK with making the decision to take them off life-support or to let them continue living in a permanent coma, so long as I actually knew their opinions on the subject. If it was still someone that I knew very well but I did not know their position on being in a comatose state, then that would definitely complicate things. I would only feel justified in ending someone's life if I knew, for certain, that it was what they wanted and that I was following their orders. If I had not spoken to them about what they would want me to do in that situation, then I do not believe that I could just end their life without knowing their wishes.

  9. It's odd to be thrown into a role where another individual's life is in your hands. Oddly enough, when I first read this prompt my thoughts landed on the topic of soldiers in the military. Every man in his platoon is responsible for the life of his platoonmates even if he hates them. In his recently published book, "War," Sebastian Junger argues that these men would rather die themselves than cause or not prevent the death of one of their fellow soldiers. And these men don't even receive the expensive educations of most doctors. They have to handle this extreme stress without the tools and knowledge available to those in the medicinal practice. And they would never, ever, pull the plug on a fellow soldier.

    However, if I was a surgeon I would know that handling the possibility of "pulling the plug" was something I would have to deal with at some time. Literature, philosophers, and doctors throughout the centuries have always said that there is something worse than death and as a doctor it would be my job to understand where that line lay. As to the family members, I can only hope that they would see reason and the fact that their family member probably didn't want to live in a state of intense agony just so they didn't have to feel guilty for "killing" him.

  10. This really is a tough question and I think that my answer now will probably change if I am actually ever faced with it in real life. I know that there is no way I would feel comfortable “playing God” and I think that no matter what decision I come to or how obvious it was to make, I will always wonder what if. I know that if someone were to make this decision for me, I would always in some way or another blame them for the death, and I would not feel comfortable having someone feel that way about me. I know that in many times it can be thought of as the “obvious decision” but actually contributing would be something that I currently would be unable to handle.
    I do believe that like Brett said there are miracles and chances that things will turn around, but much more often than not, they don’t. I think that deciding to let a terminally ill patient go will not only release the patient of his/her suffering, but his/her family will also be in a healthier place. I know that in movies and such, it is always the parents who are clinging on to the hopes of a miracle, and the patient has r is ready to accept that his/her time has come to an end. I think that it is much healthier to accept that in life some things are out of your control, and while you can keep someone “alive” they are not really alive and at some point you will have to let them go.