Induced Coma
A barbiturate-induced coma, is a temporary coma which is brought through a controlled dose of a barbiturate drug.Barbiturate comas are used to protect one’s brain during major neurosurgery (such as the removal of arteriovenous malformations or aneurysms) and as a last resort in certain cases of status epilepticus.
Doctors induce coma by using sedatives to put the brain to sleep, the patient’s brain activity is closely monitored, and the level of drugs adjusted accordingly, to guarantee that the brain stays ” asleep .”When an infection or disease is considered ultimately fatal and incurable it is considered to be a terminal disease. Usually a patient is recoginized as terminally ill when his/her life expectancy is projected to be six months or less and that person seems likely to die (because of that disease) despite diagnosis and treatment. Some cancers are terminal, as are the advanced stages of illness like heart diseases, Pulmonary Fibrosis, a disease inflicting the lung, people suffering from this illness are usually in their forties and fifties, and Accquired Immunodeficiency Syndrome (AIDS).Medical professionals try their utmost to spot and treat diseases during their infancy level.
However, sometimes the illness is detected during the last stages or a patient cannot afford the financial brunt/cost of the treatment. When it is recognized that a disease cannot be cured, attention is diverted to comfort or soothe the dying patient, and at times treatment efforts are withdrawn. The decision to terminate the treatment is reached by the patient and his or her doctor. Terminal disease patients often prepare directives which indicates how they wish to be cared for at the end of their lives, and asks a family member or a close relative to ensure that their wish is fulfilled. At times these patients are positioned in palliative care, which mainly provides relief from pain and includes other measures to make the last stages as comfortable as possible. The palliative care staff try their level best to ensure that their patient have dignified, comfortable, fearless, and painless death.
At times an individual goes through an aggressive medical care, which receives the benefits of every medication, technology, tool and trick that medical practioners can devise for the treatment of the illness. Surgery, antibiotics, radiation therapy, chemotherapy, dialysis or any other interventions (with an aim of and prolonging life) would be termed as aggressive care. In some cases when a patient is comatose, brain dead, or had acquired unacceptable quality of life, doctors may feel that an aggressive medical care is futile. Such patients may then be recommended for palliative care. Medical expenses are on the rise and are consuming a larger then ever chunk of personal and national incomes.Almost 40 years ago American spending on medical care was estimated to be 5 percent of national income, currently it is calculated to be 16.
5 percent. Some observers are convinced that the present American nation is more meticulous about their health and, therefore, is spending a bigger share of their income on health care.The rising cost of health care is becoming a matter of growing concern for private citizens and government. U.S.
healthcare is presently estimated to cost about $2 trillion per year, out of this a hefty $600 billion is never seen by recipients. Today, more than 40 million U.S citizens are without health insurance, simply because of unemployment and very low income level.Therefore, it would be astute if a patient seeks Advanced Directive, incase, they are suffering from a terminal illness.Advanced Directives are instructions in written form, regarding ones medical care preferences.
If an individual is unable to make ones own health care decisions, the family members or doctors will consult the Advance Directives of the patient.Advanced Directives assists in eliminating confusion or a disagreement. Anyone aged 18 or above may prepare it. Living wills are one part of the Advanced Directives and spells out ones treatment preferences in end – of – life situations.In some states, living wills are also known as “health care declarations” or “health care directives.
“Medical power of attorney (POA) also comes under Advanced Directives, and is a legal document designating a person who is one’s health care agent or proxy. This selected individual makes medical decisions on behalf of the patient when the concerned is unable to do the task himself/herself. The proxy makes health care decisions as long as the patient is failing to do so, if the patient regains this ability the proxy will no longer make the decisions. In the case permanent incapacitation, the proxy will go on and make the health care decisions as long as the patient is alive, or until the proxy is capable of carrying our the responsibility. Advanced Directives also include a “Do not resuscitate (DNR) order, which is a request not to have cardiopulmonary resuscitation(CPR)if and when the patients heart quit functioning or if breathing is halted.
During the 18th and 19th centuries, medical ethics were launched as a self-conscious discourse, and authors such as Thomas Percival wrote about medical jurisprudence and designed the phrase “medical ethics.” Medical ethics is the duty and responsibility of physicians in antiquity, such as the Hyppocratic Oath.During the 1847, the American Medical Association adopted the first code of ethics, which was based upon Percival’s work. Since the 1970s the influence of ethics on contemporary medicine is increasing and can be used in the Institutional Review Boards, which evaluated experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinical ethicist and the integration of ethics into copious medical curriculum. Euthanasia is the process of painlessly assisting a person (with terminal illness) to terminate his or her life, it is also known as asissted suicide or mercy killing, it is generally performed by using lethal injections.
Hyppocrates, the father of modern medicine, stated in 400 B.C that he will not give deadly medicine to anyone nor will he ever suggest any such counsel. The doctors are still bound by this oath to this date.In some countries euthanasia is a standard/legal medical practice. In such states , the aim is to put a final end to the pain of patient’s suffering fromm terminal illnesses.
Therefore, the “Primum no Nocere” is based on the inability of the physician to offer help.Not responding on these cases is considered to be more disasterous than relieving the patient from the suffering. The adequacy to help depends upon the limitation of what the physician can do.Informed consent in ethics is the thought that the patient must be thouroughly informed about the percievwed benefits and threats of their choice of treatment, as an uninformed person can mistakenly make a choice whish may not reflect his or her values or wishes.Terminally ill elderly Americans are treated aggressively and face death, they spend more time in the hospital during their final days, as a last ditch treatments that usually succeeds in grabbing only a few days time, and sky rockets the medical bills which the relatives and the loved ones of the deceased end up paying.More than 80 percent Americans die out of a long and progressive illness and above 80 percent of such patients report that they intend to avoid hospitalization and intensive medical care while they are dying(cited in the Dartmouth Atlas Project,2005).According to Dr.Ira Bysock,director of Palliative care at Dartmouth Hitchcock Medical Cemtre(2005):As these terminally ill adults are in a very ripe age ( where one loses most of the stamina) , they get more sick as they die and the treatments become a burden for them than the illness.
