What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Wednesday, February 08, 2006

COPD, Euthanasia by Omission

One of the common causes of death in Canada today is C.O.P.D. (emphysema), and although the life expectancy for people with heart disease has been on a dramatic rise, the same cannot be said for people with C.O.P.D. One of the reasons has been that although medical advances have been shown to be a great benefit to cardiac patients, the same cannot be said for medical advances for patients with C.O.P.D. Medications for this group of patients show good symptom relief but really no prolonging of life. Surgical interventions, in select patients, have been helpful, but the numbers helped are a small percentage of the total group. Good nutrition and exercise can have a positive effect, IF the patient quits smoking! In fact, the only thing that consistently and significantly extends the C.O.P.D. patient’s life is the cessation of smoking. This follows, of course, because by far the most common cause of COPD is smoking.
As a society, we will be seeing the impact of this group of people in the years to come, not just from a cost and care perspective, but from a “life expectancy” perspective. Already we are seeing the prominence of smoking in the 40’s/50’s/60’s/70’s and 80’s translated into C.O.P.D. and consequently, pulmonary failure and death. The impact of this group on our health care system of the future may well be much greater than anticipated.
Death occurs because of organ or multiple organ failure. We can prevent death (extend life) by:
1) Preventing deterioration of organs, e.g. reducing cholesterol to prevent heart disease.
2) Assisting organs in their function, e.g. angioplasties on coronary arteries to assist the heart to function.
3) Taking over the function of the organ by some means e.g. organ transplants, dialysis for renal failure, etc.
People die from pulmonary failure when their lungs deteriorate to such a degree that they do not have the capability or the strength to exchange air quickly enough to provide their body with oxygen and to get rid of the accumulating CO2. Lung transplants are done but in an environment of scarcity of donor organs, age basically disqualifies the COPD group. Is there some way that modern technologies can assist the lungs and the patient in gas exchanges? Well, as a matter of fact there is; but it is rarely talked about in a positive way. It is Mechanically Assisted breathing. I had the opportunity to look after someone who was on mechanically assisted breathing and it extended his life by three years. Was it ideal, no, but was the patient quite functional, definitely.
Most people see this situation as being continuously hooked up to a machine, lying in bed all the time. In fact, I think the situation is often “put down” by care givers when they ask the patient “ do you want to be hooked up to a machine all the time and have the machine breath for you?” Actually since the problem is patient fatigue, the machine only has to help you breath and you can have short periods to talk, do your bathroom functions, etc, but it is quite tiring. The machines are quite compact and can be used in your home, the range of movement determined by the length of the electrical cord.
Minimizing effort in other areas is a good idea(walking, moving, etc creates greater oxygen demand) so as time goes on this does become more of a problem. Good nutrition is important to keep up your strength. You can enjoy your children and grand children’s visits and you can correspond through E-Mail and have active internet dialog. You could continue to run your business if you were so inclined. We live in a technical age where entertainment is brought into the home and our homes can be run through your computer. So why are people not choosing this option instead of dying. They certainly would be better off than many people who have strokes and still choose to carry on with their lives. Perhaps in the one to three years that their life is extended a new drug will be discovered that facilitates the transport of gasses though their lungs! The vast majority of these patients simply say they wish to not be “put on a machine,” possibly with little knowledge other than preconceived ideas from television. possibly augmented by frowns and resistance by caregivers. Many of them die in the emergency departments, our hospitals, our long term care facilities, our palliative care units, or in their homes. I’ve often wandered what the information presentation was like to these people and their loved ones. Is cost once again coming into the equation? Are we as health care information providers practicing euthanasia by omission?

5 Comments:

Blogger batistuta said...

The anteroposterior diameter of their chest may increase; this symptom is sometimes referred as "barrel chest." kamagraThe patient may lean forward with arms extended or resting on something to help them breathe. Be careful with this situation, I think that this can be so dangerous!22dd!!

28/4/11 9:29 AM  
Anonymous broken hearted said...

It is my experience with my mother that you are not told anything other than she will probably never get off the respirator if you choose that instead of bi-pap.The impression is that she will be sedated with a tube down her throat,unresponsive with very,very little or no chance to be weaned off of it.So what is the point.Some mention of pointless suffering is also mentioned.So you leave her that way or you "pull the plug".You try to see if she can get off of it,but eventually turn off the respirator or leave her sedated and on it indefinetly.Even if that were true that she can't be weaned off of it no mention of switching to a tracheostomy ventilator you could use at home.More importantly even a long shot at weaning might be better than staying on bi-pap with an
almost assured outcome of death.
I was told survivability with intubation was better but not that survivability on bi-pap was practically nil.They thought I was choosing comfort care or death.I thought I was holding off on intubation for now,waiting to see if she improved with a pick,a main line iv
of drugs.I thought bi-pap was still a reasonable course.As long as her o2 sats etc stayed up.Her heart gave out while on bi-pap,later that night.
I went to all her appointments,and
pulmonary rehab with her but was still in the dark,relying on whatever her hospital doctors told me which seems misleading now.
I think people are being led to be too phobic about intubation considering that not doing it in most cases where it is being suggested will result in death.
I also got mixed messages from different doctors about how painful
intubation would be for her.
I really wonder if everyone choosing
to forgo intubation understands what they are saying.Please read this:http://www.greatwhatsit.com/archives/1287it talks about this as well.
I am devastated by all this and hope this helps someone.
Every case is different but I wish I had tried a different course.Please try to ask alot of questions and do some of your own research if you can.

22/7/12 9:29 PM  
Anonymous broken hearted said...

Before you all go out and get do not intubate orders consider this:
In the CAOS study the majority(96%!) of those intubated said they would do it again!See the link.
http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/10990343/support-for-intubation-in-acute-copd
Also see this on how doctors discuss intubation with their patients.Perhaps a little disillusioning.
http://journal.publications.chestnet.org/article.aspx?articleid=1069386
Please remember some people would do it again.Intubation is not recommended unless they think you will die without it.Remember that.
Some people don't even remember anything about their intubations.Of course others do.Even of those that do feel alot of pain many would do it again.
You may also want to read this.http://www.greatwhatsit.com/archives/1287
Also note I was told survivability would be better if my mother was moved from bi-pap to ventilator but not that the chance of survival on bi-pap was practically zero.I had a main line iv put in and was hoping for reversal on bi-pap.They felt but didn't confirm that I was choosing "comfort care"(let her die)and she died while I was waiting to see improvement.So there is a real danger in being too hesitant to intubate and in rotten communications.
No one is suggesting intbation for recreational use.If it is being suggested they
believe they have exhausted all other measures and you will die without it.
Also I say die because I am tired of all the euphemisms.If it were put bluntly to me
that she would die if she stayed on bi-pap,sooner than later I would not have waited to see if she could make it on bi-pap.I also believe a restatement of what they think you want done as confirmation is in order.Some have even proposed decision making tools.http://journal.publications.chestnet.org/article.aspx?articleid=1078142There is some evidence that if your on bi-pap or other non invasive ventilation and you don't improve in two hours you should be intubated.

7/8/12 12:14 AM  
Anonymous maggie.danhakl@healthline.com said...

Hi,

Healthline just launched a campaign for called "You Are Not Your COPD" where COPD patients share their story or advice about living with the disease. You can see the homepage for the campaign here: http://www.healthline.com/health/copd/inspirational-stories

We have partnered with the COPD Foundation to promote the campaign and have pledged that for every submitted story, Healthline will donate $10 to the COPD Foundation.

I am writing to ask if you can help spread the word about this campaign by including it as a resource on your page: http://primaryhealthcare.blogspot.com/2006/02/copd-euthanasia-by-omission.html

The more stories we receive the more Healthline will donate to COPD research, support, and treatment programs. Would you please consider including this on your site or sharing with your followers?

I'm happy to answer any questions you may have.

Thank you,
Maggie Danhakl • Assistant Marketing Manager
p: 415-281-3124 f: 415-281-3199

Healthline • The Power of Intelligent Health
660 Third Street, San Francisco, CA 94107
www.healthline.com | @Healthline | @HealthlineCorp

About Us: corp.healthline.com

3/4/14 3:01 AM  
Anonymous Nicole.lascurain@healthline.com said...

Hi Al,

First off, I came across your site and wanted to say thanks for providing a great, much-needed lung health resource to the community.

Our readers have found this topic center to answer all of their COPD-related questions extremely useful, such as photos of what the disease can do to your lungs. I thought you might get a kick out of it as well: http://www.healthline.com/health/copd

Naturally, I’d be delighted if you share this resource on http://primaryhealthcare.blogspot.com/2006/02/copd-euthanasia-by-omission.html , and/or share it with your followers on social. Either way, keep up the great work Al!

All the best,

Nicole Lascurain | Assistant Marketing Manager
p: 415-281-3100 | e: nicole.lascurain@healthline.com

Healthline
660 Third Street, San Francisco, CA 94107
www.healthline.com | @Healthline

3/11/15 4:49 AM  

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