There are times when you go to inject epi during a code and for some bizarre reason, you are clumsy and “accidentally” miss the IV tubing port and it goes on the floor.
Yes, sometimes accidents like that are the most ethical thing one could do.
02
Jul
“It was morphine, and I accidentally injected it into my thumb.”
Here’s hoping you are on when I cross the river….
Didn’t they decide that all those medications during codes don’t work that well anyway?
Oh not this again.
You don’t get to unilaterally make that decision. If the patient is a full code and you just choose on a whim not to code them, then you’re not only breaking several important laws, you’re also being unethical by lying to your patient and his family.
If you’re so sure he deserves to die, then have the guts to say so openly. Talk the family into making him DNR, or if he has no family, come out and overtly say that he is not a candidate for resuscitation. Can’t do either of those? Then you just aren’t sure enough.
This secretive “slow code” shit is the coward’s way out.
If I ever wind up coding in the ER, I don’t want my doctor to be a liar or a coward.
Good point Nurse K. Epi’s about the only thing that does. And even that sucks.
Totally agree with Tog on this, Im afraid. If the guy has put himself down as a full code (and, youre also gonna be charging his damn insurance for it), please just go ahead and do your job, and stop playing god. His life may suck, but he asked for it. You dont get to decide.
Why are you guys so angry? He said it was an accident.
A lot of the time it’s not the pt’s decision to let him continue his persistent vegetative state, but the family’s. Accident’s do happen all the time and this is less traumatic than having two attendings get together and decide it’s futile care and pull the plug later.
Relax, there is NO evidence for epi (or ANY other drug) and he did NO harm…
It’s time that we acknowledge that.
This guy dissects it nicely :
http://roguemedic.com/2012/07/too-much-medicine-and-evidence-based-guidelines-part-ii/
The ongoing research about epinephrine’s long-term outcomes does not make this right.
If you think the drug is effective, then you committed malpractice by withholding it. You refused to do so openly, which means you’re a coward. Plus you falsified your charting, which means you’re a liar.
If you believed the drug useless, then you shouldn’t have drawn it up the first place. Giving a drug that is of no benefit to the patient would still have been malpractice, and you’d still be a coward and a liar, only for slightly different reasons.
Tog, you seem upset. Do you need a hug?
Tog, you couldn’t have it more backwards.
Its the family’s of these patients who are the cowards, not the doctors. The doctors are the ones with the actual courage, doing what’s best for the patient, despite the irrational requests of the family members. Family members who haven’t seen the patient in three years, haven’t bothered to come see them in ICU, don’t pick up the phone when you try to call and tell them what’s going on, and how much their “loved” one is suffering and how futile the course is. Sometimes ending the suffering of your patients IS the best and only thing you have left to do for them that’s going to make any sort of difference.
I’m sympathetic to the doc, but the answer is not “accidentally” violating the protocols for a code. To do so is an act of civil disobedience, which is fine, but only justifiable if it’s open and the dissenter is willing to face the consequences (see MLK and Gandhi).
If you’re not willing to engage in civil disobedience, then your only really ethical choice is to work for reform of the law and/or widespread public education about what end-of-life really looks like. We need the kind of education we’ve had about smoking and seat belts. Family practitioners need to sit down with HEALTHY patients and explain death, dying and POLST forms.
TOG is not angry, and doesnt need a hug. Withholding what the doctor himself believes to be lifesaving care, and is intended as such, is murder. No matter how well intentioned, noone escapes the consequences of the law.
Neville, you make the point exactly, it’s not life saving care, it’s futile care, so therefore it’s withheld. Extending a heart beat for ten minutes until the patient codes again is not saving a life.
Erjedi: since you believe it’s futile care, why not withhold it openly? Why pretend to give it, and then lie about it?