#LifeOrDeathDecision #ToughChoices #MedicalDilemma
Hey there, folks! So, picture this: we have a patient with intussusception, a serious condition that requires surgery to save their life. However, this patient is not the best candidate for surgery due to some pretty scary comorbidities. The catch? If they don’t get the surgery, they’ll kick the bucket in a matter of days.
Now, imagine being in the shoes of the doctors faced with this dilemma. On one hand, you have a patient who will almost certainly die without the surgery. On the other hand, the patient’s chances of surviving the surgery are pretty slim. It’s like choosing between a rock and a hard place!
So, why would the doctors choose not to do the surgery? Why opt for almost certain death over guaranteed death? What angle are we missing here?
I’m curious to hear your thoughts on this puzzling scenario. Drop a comment, cast your vote in the poll below, or share any insights you might have. Let’s dive into this medical conundrum together! 💬🤔 #MedicalEthics #SaveLives #JoinTheDiscussion
How certain are you that the intussusception without surgery carries higher than a 50% chance of death within 30 days?
It’s hard to have an idea without knowing what are the patient’s comorbidities and their prognoses outside of the intussusception.
Surgeons (or any physician) are not under an obligation to offer a treatment because a patient or family want it if they feel it’s not appropriate, the risks are prohibitive, etc.
If you want to know the specific reasons why these particular surgeons are refusing to operate on this patient, the best option would be to speak to them and ask any questions you may have. Otherwise, there is not nearly enough information for anyone here to expand any further.
From a nursing standpoint, life prolonging procedures don’t always equal a prolonged and good quality of life. Surgery may extend life, but recovering from surgery can be really hard on the body, especially with advanced age and other comorbidities.
Another factor to consider is resources. Inpatient operating rooms need to prioritize emergency and urgent procedures. I am not well educated on where a procedure like this would fall and may even be considered elective if it’s not medically indicated. So that can be hard to even get an OR team available for that.
Palliative care can provide a few more good, lucid, reasonably comfortable days before the inevitable demise.
Aggressive management with a risk profile like the one quoted often results in a few weeks of increased pain and fairly total disability, prior to the above palliative management, but occasionally has other outcomes.
Those other outcomes are, in fairly reasonable order of commonality (being less common than the first scenario above):
– Survival, but at a very increased level of disability, such that they may be unable to mobilise, toilet or feed themselves as they could prior.
– Major complication such as stroke or heart attack that results in a swift decline postoperatively, but with some period of lucidity prior.
– Full resolution and return to a similar quality of life to prior (this is very rare.)
– Death on the operating table or in ICU in <24hrs post-op, with no period of wakefulness (this is extremely rare).
Usually the decision to operate on these patients will result in increased suffering with minimal benefit – but it will often still be offered as every surgeon who has been operating a while will have seen some of these very low hope cases pull through and get home again. Most doctors, nurses etc would usually _not_ pick the operative route for their loved ones though.
This is also to say nothing of the financial implications of various forms of management, which can be very significant depending on where you are.
I don’t know if you’re being intentionally vague here but it’s impossible to give specific insight without more details about the clinical picture.
All I can tell you is that in general if I refuse to operate on someone, it’s for the patient’s own benefit. As a surgeon there is no problem I can’t make worse.
It’s possible that operating on this patient may result in terrible morbidity like requiring an artificial airway/feeding access, open abdomen, long icu course, likely extended rehab stay all to result in the same outcome as not operating in the first place.
It’s torture and miserable for patients in 99% of cases whereas some family members simply want the patient to continue breathing to make themselves feel better and no other reason. They would rather see their family member live and suffer rather than do the compassionate thing and let their loved one go peacefully. I see it all too often and I wish it the culture around death and dying could become more compassionate and less selfish.