Sunday, April 3, 2011

Alzheimer's Blog:

Today I want to talk about Ethics.

I looked it up and here is the definition I found.

eth·ics   /ˈɛθɪks/ Show Spelled [eth-iks] Show IPA –plural noun 1. ( used with a singular or plural verb ) a system of moral principles: the ethics of a culture. 2. the rules of conduct recognized in respect to a particular class of human actions or a particular group, culture, etc.: medical ethics; Christian ethics. 3. moral principles, as of an individual: His ethics forbade betrayal of a confidence. 4. ( usually used with a singular verb ) that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.

Than I looked up Quality of Life:

Within the field of health care, quality of life is often regarded in terms of how it is negatively affected, on an individual level, a debilitating illness that is not life-threatening, life-threatening illness that is not terminal, terminal illness, the predictable, natural decline in the health of an elder, an unforeseen mental/physical decline of a loved one, chronic, end-stage disease processes. Researchers at the University of Toronto's Quality of Life Research Unit define quality of life as “The degree to which a person enjoys the important possibilities of his or her life” (UofT). Their Quality of Life Model is based on the categories “being”, “belonging”, and “becoming”, respectively who one is, how one is connected to one's environment, and whether one achieves one's personal goals, hopes, and aspirations.

I know you are wondering where this is coming from. I wrote on March 23 about one of my patients that I ran who had Alzheimer's, can not communicate and was having respiratory distress. I ran on her again early this morning. The nurse at the nursing home begged me not to bring her to the same hospital because she said that this patient came back three hours later and not stable. So she insisted that I go to a hospital fifteen minutes away. She said she had a DNR but there was no doctors signature on it so it was not valid. If you could understand my position you would realize how risky this was. I had an unstable patient, in respiratory distress, by my self. If this patient stops breathing and her heart stops, it will be very hard for me to work a code by myself.

My EMT and I were busy after we loaded her on my gurney and in my ambulance. We took vitals, placed ecg leads on her moist and cool body. Gave her a SVN albuteral treatment and solu-medro to help her with her breathing. It was hard but we even got in an IV.

We reached the hospital with the doctors angry with me for passing up other hospitals due to her respiratory distress. They finally got a hold of the family who said it was fine to intubate her but no compressions is she codes. I am so confused. Do these people know what they are doing to there mom. This patient is confused, scared, and has no idea what is going on. Yet her family is trying to keep her alive so they can visit her once in a while at the nursing home. What kind of quality of life is that for her?

Sorry I just had to vent. Think about this as you make your living wills for your loved ones with Alzheimer's.

Sincerely, Marie Fostino

Alzheimer's A Caretaker's Journal - Seaboard Press An Imprint James A Rock Pub., Co.

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