8 year old and fentanyl?

[Mman]

Why is organ harvesting being planed if the person is not dead?

because they have a terminal condition and are felt to not survive upon extubation and the family wishes to donate organs. Harvesting DCD increases the number of available organs, but it's after death is declared. Unfortunately when you die your organs start to die as well and so you need to harvest as fast as possible if they are going to be suitable for transplanting into someone else.

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[Robotic Wis-Hipple]

This DCD thing is basically used when all of the Doctors see the patient as dead, but the law doesn't, so they have to allow but never hasten cardiac death. Honestly, it was only a matter of time for one of these cases to happen.

 

[dhb]

because they have a terminal condition and are felt to not survive upon extubation and the family wishes to donate organs. Harvesting DCD increases the number of available organs, but it's after death is declared. Unfortunately when you die your organs start to die as well and so you need to harvest as fast as possible if they are going to be suitable for transplanting into someone else.

So in this case a dying patient which couldn't breathe on his own is extubated to hasten his death but people are quibbling over a dose of fentanyl?
Makes perfect sense

 

[pgg]

You're advocating for procuring organs from living patients? Under which circumstances?

Under the circumstances when the family has elected to withdraw care and donate the organs.

Do you see a moral or ethical difference between the two options being discussed?
- option A: "killing" a moribund patient by extubating them and withdrawing support
- option B: "killing" the same patient by harvesting organs for transplant

 

[pgg]

So in this case a dying patient which couldn't breathe on his own is extubated to hasten his death but people are quibbling over a dose of fentanyl?
Makes perfect sense

It makes perfect sense to people more fearful of the appearance of the barest shadowy hint of impropriety than they are in actually doing the right thing.

 

[dpmd]

So in this case a dying patient which couldn't breathe on his own is extubated to hasten his death but people are quibbling over a dose of fentanyl?
Makes perfect sense

Active killing versus passive allowing of death. One is not legally allowed the other is. Hence the quibbling.

 

[pgg]

Active killing versus passive allowing of death. One is not legally allowed the other is. Hence the quibbling.

Only a lawyer or a physician desperate to avoid confronting reality would call extubating a ventilator-dependent patient anything other than active killing.

It's ethical, moral, compassionate, legal, and right ... but it's still going to be the proximate and immediate cause of death.

I'm all for keeping the lawyers away. To be clear, what I'm arguing for here isn't for anyone to break the law (flawed though it is under end-of-life circumstances) but rather that we just admit what's really happening, that it's really OK, and that the law should be changed so that the kind of misconduct allegations and criminal proceedings in the OP-linked article would be laughed away because they're absurd and everyone knows it.

 

[deleted171991]

This is just another example that "first do no harm" has become "first cover your butt".

 

[dpmd]

Only a lawyer or a physician desperate to avoid confronting reality would call extubating a ventilator-dependent patient anything other than active killing.

It's ethical, moral, compassionate, legal, and right ... but it's still going to be the proximate and immediate cause of death.

I'm all for keeping the lawyers away. To be clear, what I'm arguing for here isn't for anyone to break the law (flawed though it is under end-of-life circumstances) but rather that we just admit what's really happening, that it's really OK, and that the law should be changed so that the kind of misconduct allegations and criminal proceedings in the OP-linked article would be laughed away because they're absurd and everyone knows it.

You might find that you don't get the outcome you desire if you go around saying the two things are equivalent. There are plenty of people out there who would fight hard to prevent us from being able to withdraw support if it were advertised as something beyond the passive allowing of nature to take its course.

 

[deleted171991]

You might find that you don't get the outcome you desire if you go around saying the two things are equivalent. There are plenty of people out there who would fight hard to prevent us from being able to withdraw support if it were advertised as something beyond the passive allowing of nature to take its course.

"Thou shalt not kill."

 

[pgg]

You might find that you don't get the outcome you desire if you go around saying the two things are equivalent. There are plenty of people out there who would fight hard to prevent us from being able to withdraw support if it were advertised as something beyond the passive allowing of nature to take its course.

Well, of course there's a tactful and compassionate approach to take with family members who are facing the death of a loved one. Of course nobody would say to them them, yeah, this is going nowhere, we're going to pull the tube and kill your son, mmmkay?

The point I'm getting at is that when we talk to families and discuss withdrawal of care, we should be able to present organ procurement for donation as an ethical alternative to removing tubes and shutting off equipment and waiting and then hastily snatching ever-more-degraded organs for transplant. Objectively, both actions result in hastening global cellular death and shortening the time to signing a death certificate, but one is clearly superior in terms of organ viability for donation.

Don't you think that many (most?) families that have made the hard choice to withdraw care and donate organs would want to maximize the odds of those organs being transplanted successfully? You'd still have some who'd want the tube pulled and the pumps turned off so they could sit with their loved one and wait for the agonal respirations to fade and halt, and that's OK. But I think a lot more would rather say their goodbyes and take additional comfort in knowing that subsequent transplants were going to be done in a way that would maximize the odds of success.

Or maybe I'm just crazy.

 

[dpmd]

Well, of course there's a tactful and compassionate approach to take with family members who are facing the death of a loved one. Of course nobody would say to them them, yeah, this is going nowhere, we're going to pull the tube and kill your son, mmmkay?

The point I'm getting at is that when we talk to families and discuss withdrawal of care, we should be able to present organ procurement for donation as an ethical alternative to removing tubes and shutting off equipment and waiting and then hastily snatching ever-more-degraded organs for transplant. Objectively, both actions result in hastening global cellular death and shortening the time to signing a death certificate, but one is clearly superior in terms of organ viability for donation.

Don't you think that many (most?) families that have made the hard choice to withdraw care and donate organs would want to maximize the odds of those organs being transplanted successfully? You'd still have some who'd want the tube pulled and the pumps turned off so they could sit with their loved one and wait for the agonal respirations to fade and halt, and that's OK. But I think a lot more would rather say their goodbyes and take additional comfort in knowing that subsequent transplants were going to be done in a way that would maximize the odds of success.

Or maybe I'm just crazy.

I agree many would. However, I also understand that organ procurement organizations are quite eager to distance themselves from the perception of organ donation as a means by which doctors will give up prematurely and not provide best care in order to obtain more donors. Allowing donation before cardiac death for the non brain dead patient might backfire with the general public (not those families who are there and understand what went on, and were in complete agreement with how things went down) and as a result bring down the overall number of donors. I get where you coming from, I just think there is value in making the distinction for the general public.

 

[nimbus]

Well, of course there's a tactful and compassionate approach to take with family members who are facing the death of a loved one. Of course nobody would say to them them, yeah, this is going nowhere, we're going to pull the tube and kill your son, mmmkay?

The point I'm getting at is that when we talk to families and discuss withdrawal of care, we should be able to present organ procurement for donation as an ethical alternative to removing tubes and shutting off equipment and waiting and then hastily snatching ever-more-degraded organs for transplant. Objectively, both actions result in hastening global cellular death and shortening the time to signing a death certificate, but one is clearly superior in terms of organ viability for donation.

Don't you think that many (most?) families that have made the hard choice to withdraw care and donate organs would want to maximize the odds of those organs being transplanted successfully? You'd still have some who'd want the tube pulled and the pumps turned off so they could sit with their loved one and wait for the agonal respirations to fade and halt, and that's OK. But I think a lot more would rather say their goodbyes and take additional comfort in knowing that subsequent transplants were going to be done in a way that would maximize the odds of success.

Or maybe I'm just crazy.

You're not crazy. That is the most reasonable course of action. Too bad we may never see that.

DCD as it is now is playing games for dubious reasons. The case presented by the OP demonstrates how unclear the rules are.

 

[nimbus]

"Thou shalt not kill."

We know people are killed for lessor reasons all the time.

 

[deleted126335]

Well, of course there's a tactful and compassionate approach to take with family members who are facing the death of a loved one. Of course nobody would say to them them, yeah, this is going nowhere, we're going to pull the tube and kill your son, mmmkay?

The point I'm getting at is that when we talk to families and discuss withdrawal of care, we should be able to present organ procurement for donation as an ethical alternative to removing tubes and shutting off equipment and waiting and then hastily snatching ever-more-degraded organs for transplant. Objectively, both actions result in hastening global cellular death and shortening the time to signing a death certificate, but one is clearly superior in terms of organ viability for donation.

Don't you think that many (most?) families that have made the hard choice to withdraw care and donate organs would want to maximize the odds of those organs being transplanted successfully? You'd still have some who'd want the tube pulled and the pumps turned off so they could sit with their loved one and wait for the agonal respirations to fade and halt, and that's OK. But I think a lot more would rather say their goodbyes and take additional comfort in knowing that subsequent transplants were going to be done in a way that would maximize the odds of success.

Or maybe I'm just crazy.

Emotionally and probably legally there is a significant difference between extubating knowing that that will hasten death and giving a dose of medication which has the same intention. Ethically, morally, and medically I am in complete agreement with your position, but the calm heads are just not there.

 

[drmwvr]

Only a lawyer or a physician desperate to avoid confronting reality would call extubating a ventilator-dependent patient anything other than active killing.

Death following removal of extraordinary means of life support does not constitute active killing. Bolusing with potassium is active killing.

I'm all for honesty too. If organ viability is more important than maintaining the integrity of what ethicists call non-objectification of patients, folks should just be honest and admit that the best thing to do would be to take organ donors determined to be non viable to the operating room. The time of death should be at the time of cross clamp. You'd get more viable organs that way too.

 

[fakin' the funk]

This DCD thing is basically used when all of the Doctors see the patient as dead, but the law doesn't, so they have to allow but never hasten cardiac death. Honestly, it was only a matter of time for one of these cases to happen.

That's...not true.

 

[fakin' the funk]

Under the circumstances when the family has elected to withdraw care and donate the organs.

Do you see a moral or ethical difference between the two options being discussed?
- option A: "killing" a moribund patient by extubating them and withdrawing support
- option B: "killing" the same patient by harvesting organs for transplant

Yes. The difference hinges on intent.

 

[Robotic Wis-Hipple]

That's...not true.

Enlighten us.

 

[twoliter]

Enlighten us.

I imagine he's saying the "all of the Doctors see the patient as dead" part isn't true. I imagine most physicians have the same definition of "dead" as the law does: either cardiac or brain death (those are facts that can be and are tested). That is different than "no meaningful chance of recovery, no awareness of self or environment, etc. (opinions). Those opinions should probably be also held by the family / decision maker before any withdrawal of care. With death, it doesn't matter what the family "thinks." Dead is dead.

 

[epidural man]

There was a case I heard about more than ten years ago second hand. A famous surgeon was involved in a case where they pronounced a patient after coding them. There was still some EKG activity on monitor. Surgeon asked for KCL to quiet the monitor because he and/or someone else found it bothersome. He had some conversations with law enforcement afterwards. Maybe some other consequences.


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Unhook the monitor - sounds like a better answer to me.

 

[dpmd]

Unhook the monitor - sounds like a better answer to me.

I have done this.

 

[fakin' the funk]

I imagine he's saying the "all of the Doctors see the patient as dead" part isn't true. I imagine most physicians have the same definition of "dead" as the law does: either cardiac or brain death (those are facts that can be and are tested). That is different than "no meaningful chance of recovery, no awareness of self or environment, etc. (opinions). Those opinions should probably be also held by the family / decision maker before any withdrawal of care. With death, it doesn't matter what the family "thinks." Dead is dead.

Yep. Thanks.