AN IMPATIENT PATIENT?

This blog author has been up to his usual tricks. The ones where he gets paid. And held accountable. No, not for giving ethereal physical pleasures to beautiful women with hour glass figures. The aforementioned never bills for such activity, as it is done with great reciprocal pleasure. Not to speak of the peculiarly perverse view of the world to it. In other words, I am referring to the tender, loving care of surgical patients. Result: no blogging time. No blog surfing time, etcetera.

Allow me some more blogulent digression:
Man is unique in some fundamental ways, compared to the rest of the animal kingdom. The one I am focussing on in this post is the fact that man is one animal whose tail is not much bigger than his head. Except some privileged women.

Well, this post is aimed to correct this human frailty. I will (for reasons of time) posit this very serious issue here, and I expect you, my dearers readers, to wax eloquent in your comments. I will chip in with my views somewhere in between. The beef of the post should reside in the comments!

A colleague in the Western world has a problem:
“Female 99 yrs old, self inflicted stab LUQ, CT scan confirms splenic laceration with extravasation of contrast. Mildly hypotensive – Patient says she ‘DOES NOT’ want an operation, did not want to come to hospital, ‘let me go, I want to die…..’, knows what she has done and where she is, understands that she will die without an operation.” She also takes aspirin, which makes blood thinner, and may increase bleeding. In other words, she has stabbed herself, and is going to bleed to death, unless the doctors operate on her.

Ambulance workers, her GP, and all concerned say she is compos mentis (of sound and reasonable state of mind). Her husband is not available.

What should the doctor do? Plus, what opinions do you have on aging and death?

Let’s hear your tail!

19 responses to “AN IMPATIENT PATIENT?

  1. Paging Dr.Kevorkian ? When we as a society approve of capital punishments, many of which in cases where the evidence is not beyond reasonable doubt, and the premise is just the republican south(in USA), there ought to be a way in which a person, in his/her senses, should be able to make a decision about one’s life. But then again, if that were so simple, we would not be arguing about a few cells in a petridish (that would anyways be tossed to a trash bin) and it’s ethicality vis-a-vis painful chronic illnesses that need a cure..

    My sympathies to the old lady for whatever ails her. It is sad to see her knocking the doors of death. That notwithstanding, these non fatal attempts are non fatal for a reason, and they are not so by accident in most cases. They are more a call to be heard rather than an attempt to end life.

    She does not want to really die, she wants the pain to go away…

  2. Suicide is NOT euthanasia. Any fellow human being (doctor or not) will be held responsible for manslaughter if the woman is not treated. She may recover or not. But allowing her to bleed to death because she wills so is NOT ethical.

  3. At the age of 99 she should be allowed to do what she wants to do! She is not supposed to take care of any dependents. Her husband is not available so no problems there also. She has lived enough and she is not greedy for more so why should anybody have a problem with that. It must be difficult to live when you don’t feel wanted. I would like to respect her wishes and let her do what she wants to do with her life.

  4. R-Doc: At any age, when one is deemed Gillick competent (and compos mentis), one should be allowed to deal with one’s own body the way one wants.

    By the way, has anyone checked if this woman is not just doing a Marlene Dietrich (or whoever it was who said this…) impersonation: “Leave me alone; I vant to die”

  5. If I were the lady in question I would mean that I am tired of living and should be left to die and I would expect doctors to respect my wishes.
    But what the doctor should do depends on the laws of his land and the ethics of his profession.

  6. R-Doc: And it is not only when they speak out loud; it is also the dreaded DNR.

    http://whitecoatrants.wordpress.com/2008/01/23/shes-a-dnr/

    My sister in law, a doc in the US, said to me that one should never sign a DNR. The doctors do not even try, for fear of being sued, to revive you. Alas once you are dead there is no time to regret signing a DNR…

  7. If she is 99 and wants to die, well…I think she should have her way. Not that I endorse euthanasia or suicide. I just put myself in that old lady’s place and answered the question!

  8. i agree with nita
    what should u do – call dr death to do the deed or as amy wineheart to provide her with some crack coke … at least it will numb the pain and let her go up on a high

  9. ugh… my englishh is today more soupy than ever but here it goes:

    When you’re stabbing yourself there is no way that you’re completely mentally stable. She might not have felt a reason for living but killing her out of compassion (letting her bleed to death) seems a little odd. wasn’t there a first do no harm rule or something?

    99 or not she’s still a human and her life is just as valuable as others – giving her some prospective, a reason to enjoy life, help to cope with her sentiments, who knows what the outcome is. Maybe years from now she will be banging her head against the wall for thinking of suicide.

    There was a symposium on this matter here called ‘Taking car is silver doing nothing is gold’ whatever the doctor decides it’s not an easy decision and to be honest I don’t think it’s that fair to put a person in a position where he/she has to decide wheter you should life or not. Guilt kills.

    glad your back, doc!

  10. taking care – not going for a ride. bloody typo’s.

  11. The medical view: she presents with an urgent , self inflicted injury…now the medico-legal complex is involved. What are doctors, nurses, social workers, etc to do? Respect her suicide wish and discharge her home to bleed to death? I would think psychiatry would intervene and talk to her – after all, depression is very common in the old-old. This poor woman cannot expect “helping professionals” to let her die. What, give her a room in the hospital in order to bleed out?

  12. Ladies,
    Thanks for pitching in with your views.
    Usha:
    we are talking of the ethical issues here, NOT the legal ones.
    Prerna:
    “At the age of 99 she should be allowed to do what she wants to do! ”
    At what age should one NOT? 😉
    Shefaly: I think this is about the first time we have come somewhere close to agreeing on something?! 😉
    Purnima:
    I challenge your contention. I will address this now.
    Jackie:
    No time for psych. She is bleeding to death. She is NOT depressed. She is making a conscious, reasonable decision that she does not want to live any more (for all the obvious reasons likely).
    The surgeon has to decide to operate NOW. Not deciding would also be a decision, because it would allow the hemorrhage to reach a point of no (venous) return.
    This is what I had to say on this issue:
    “Ethically, the patient has absolute ownership of her body till she decides to give you a power of attorney over it for some time.
    If she means what she says, she just has to refuse consent for operation.
    No surgery. A doctor (or anyone else) cannot do good or bad by force. An operation would be an act of force, and cannot ever be supported ethically.”

  13. A very learned and senior surgeon has this to say on this:

    “My response would be the same in any mentally competent person above the age of consent. Habeas corpus: their life is their own. Would you restrain and sedate a 19 year old Jehovah’s witness to transfuse them?

    Suicide does not automatically equate to insanity. In the case of Heath Ledger there was depression, and perhaps other illness, and intervention, had it been possible, would have been appropriate. In the hypothetical case quoted, however, the patient was rational. The desire to end life at 99 might in certain cases [such as here] be supremely rational and intelligent. We have previously discussed the death of a most famous American surgeon, and to that I add the name of the psychiatrist / philosopher HJ Eisink. The desire to end life when it becomes intolerable has profound reason.

    I think it would be breathtakingly presumptuous to countersay a rational person’s decision to end their own life were it intolerable. The Catholic Church holds that it is not for the individual, but God to take life. To this I would respond that He really overdoes things sometimes.”

  14. I would say that people have a right to live, or die, as they choose as long as they don’t harm anyone else in the doing.
    Scott Ahrens

  15. (no surgery is gold. breathtakingly presumptuous – should I add that to my resume 😉 )

    If I would decide, rationally, at one point that I do not want to live anymore I would choose, rationally, a way to kill myself.

    Taking blood thinners, stabbing yourself – it doesn’t sound like a real thought out suicide attempt – there are quicker, less messy and more effective ways. Why would she choose a way of killing her self that got her in to the hospital, into a situation where other people have to decide wheter she lives or not. Could she subconsious not have wanted to be ‘saved’.

    How does the mental road towards rational suicide look like? Self-injury is quite oft by the patient themselves not perceived as irrational behaviour.We are not capable of being fully aware of our behaviour and thought processes. Could we therefore not misjudge our own supposedly rational sentiment of wanting to commit suicide?

    Final, A very very dear teacher of mine had to undergo surgery. There was something in his belly that hurted him. At one point the pain became intolerable. Right before surgery he jumped, from the the hospital balcony. In class he always used to joke about his ugliness. One time during lunchbreak he told me he was not happy.

  16. We allow murderers to go scott free, peadophiles on bail and allow mass destruction of civilians, innocents in the name of wars, but get our knickers into a twist when a 99 year woman, turning insane at the thought of prolonged longevity, gets into a rage and wants to end her existence.
    At times, the agony of living far precedes the peacefulness of death. Doctors and right minded people can demand for the right to live, but it’s difficult to ensure quality of life at certain situations. Ask those who’s lives hurt beyond our imagination and they’d agree.

  17. Oh I forget to answer your question:’What should the doctor do?’
    Docs are cursed for caring anyway. From my window, into the operating theatre, whether a good doc is saving or killing, I can only see that he has blood on his hands!

  18. Rambodoc, if a woman tried to do this at the age of 30 or 40 there would be issues like what happens to her kids if any or how would the parents cope with this loss. At 99 the parents are not expected to be alive,the children if any would be above 60 so there is no justification for anybody to interfere. Husband is unavailable otherwise I would have thought about the poor old man left alone in this world. It is easier to say it is her life but when you have responsibilities it is not only your life anymore.

  19. R-Doc: I am evidence driven. Based on prior evidence, I would say this is not the first time. 🙂

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