Pete Gossett said:On second thought, here’s another idea: give a script for OxyContin & send him on his way. Maybe he’ll sell/trade them for meth, or maybe he’ll just eat a handful and make his problems all go away?
The guy has cancer. Add fentanyl to the oxy and send him on his way.
Edit: the guy doesn’t “want” to commit suicide. He just wants to get high. His lifestyle IS going to kill him, if disease doesn’t first. I can’t figure out why he hasn’t gone septic already.
OP.. you are having this dilemma because you are still a good human who wrestles with morality(as we all do).. I just want to commend you for that.. In the medical profession(and many others, teaching included).. We can sometimes turn ourselves off after a certain point and just go about life robotically..
Fueled by Caffeine said:OP.. you are having this dilemma because you are still a good human who wrestles with morality(as we all do).. I just want to commend you for that.. In the medical profession(and many others, teaching included).. We can sometimes turn ourselves off after a certain point and just go about life robotically..
Big plus one to this.
racerdave600 said:Many of them are lonely and just want someone to talk to, so they call an ambulance and head to the hospital for a problem that doesn't exist. They will change their symptoms constantly but you have to take them seriously and do your best.
A similar burden will start happening with baby boomers who are without family. I hear of it already - elderly patients who resist leaving the hospital because they don't have anyone to go home to. They don't have the money for a senior living situation or a nursing home, but they aren't bad enough for hospice.
Locally we had an older gentlemen, himself a senior, would would drive around to visit senior citizens. More or less just checking on them. When he eventually stopped doing this due to his own health problems, his clients were up in arms. They believed the program he was employed had been defunded. It wasn't until he released a public statement to his 60 or so clients explaining that no, he was a volunteer, and he had encountered health problems of his own. They were more or less reliant on him for social interaction throughout the week. 60 people who relied on an old guy to call or visit to make sure they weren't dead, in a small town of 60k.
There must be hundreds of thousands of seniors out there in similar situations.
I don’t know how medical professionals deal with patients like this every day. As cruel as it may sound I’m edging closer to the hand out needles and heroin and let them do all they want. I tend to see them just before or after their hospital visit and they’re incredibly frustrating. I was a very empathetic person but it’s worn away quite a bit.
I get my regulars like “Ed” who get on a bus and start disassembling themselves and leaking fluids so that the driver has to call EMS and have them removed, “Kevin” who I’ve dealt with for years, recognized me in an ER when I was interviewing an injured customer from an unrelated incident and pulled a freshly crafted turd from his pants and threw towards me, and most aggravating of all “Fred” who liked to shoot up at my dispatcher post behind the methadone clinic. One morning he OD’d and collapsed right in front of me. I called 911, mostly because if I didn’t I’d be on the cover of the paper as the heartless monster that let him die, and the firemen came and shot him up with narcan instantly jumpstarting him before the booing crowd of old people in the courtyard behind us. The entire time they were chanting “Let him die” and they were right. A couple weeks later he stabbed one of them in a mugging. If I had minded my business that would probably not have happened.
My mom was an ER nurse for 35 years in one of the busiest hospitals in our province, I listened to her talk about this sort of thing pretty much every night at the dinner table.
I have no idea what the solution might be but there -has- to be a mental health issue at work here, surely someone from the puzzle factory can get him admitted becuse he's a danger to himself and others.
In reply to ShawnG :
In many states it’s hard to commit someone against their will. My cousin is a paranoid schizophrenic and his parents tried for years to get him placed into an institution but as long as he said no they couldn’t do it no matter how dangerous his doctors and people around him thought he was. Eventually he got into a fight with my uncle and stabbed him to death. At that point the state put him away but they review his case regularly to see if he can e released. If he could be trusted to take his meds regularly and not get violent the state would be pushing to set him loose.
No. No one should ever be left to die. I'd say this poor guy needs to be admitted for some kind of psychiatric condition. Surely refusing, and sabotaging ,care for life threatening injuries shows major mental health issues. Can't he be admitted on some kind of psych watch, restrained and treated at least until the major issues are under control and dealt with. Then he should be released into some kind of re-hab facility.
I strongly believe as a society that health care, including mental, is a human right and should be denied to no one, no matter their circumstances and everyone from this poor, addicted, very very sick homeless guy up to and including POTUS or Bill Gates / Jeff Bezos should get the same attention and services. Money, ability, status etc. should never enter into this conversation. The only time this should come up is for transplants where life expectancy and recovery unfortunatly need to be weighed up.
Adrian_Thompson said:No. No one should ever be left to die. I'd say this poor guy needs to be admitted for some kind of psychiatric condition. Surely refusing, and sabotaging ,care for life threatening injuries shows major mental health issues. Can't he be admitted on some kind of psych watch, restrained and treated at least until the major issues are under control and dealt with. Then he should be released into some kind of re-hab facility.
I strongly believe as a society that health care, including mental, is a human right and should be denied to no one, no matter their circumstances and everyone from this poor, addicted, very very sick homeless guy up to and including POTUS or Bill Gates / Jeff Bezos should get the same attention and services. Money, ability, status etc. should never enter into this conversation. The only time this should come up is for transplants where life expectancy and recovery unfortunatly need to be weighed up.
Adrian, your point is a different (but still necessary) discussion, and it isn't even about socialized medicine. Unfortunately he probably cannot be admitted if he is refusing treatment. See Wally's post above. Now, maybe there is enough there to say "Hey, this guy is currently criminally insane", but it is extremely difficult. Add in that if you got him stable, would he continue to take his meds (even if they were at no cost) after he was released?
In reply to Adrian_Thompson :
Could not possibly disagree more.
Nick Comstock said:In reply to Adrian_Thompson :
Could not possibly disagree more.
Ditto. Adrian, I think you're projecting your values and standards onto others. It's unfortunate, but there are people out there who don't want to "get better" so it isn't up to us to force them to. As I said before, much of modern medicine is done because we "can'. Not because we "should".
I would even throw in the big picture issue of population. With 7.5 Billion humans around, the value of each individual is reduced. And in the case of some (like the fictitious fellow in the original post) their carbon footprint VASTLY outweighs any potential good or use they provide to society.
Medical care is very resource intensive, as we all stew away in our own cesspool we might want to stop filling it up.
In reply to Adrian_Thompson :
The state of New York’s opinion is that you can’t be held against your will unless you’ve committed a crime. It’s one of the issues driving our homeless problem here. As long as he doesn’t wish to be put somewhere they can’t force it on him even if it’s for his own good. We have a family friend we’re trying to make arrangements for because his mother is getting older and it’s very likely that he will live with my brother and his family because my brother is the only one besides his mother he respects/fears enough to behave for.
Maybe I'm a cold heartless bastard (very likely to be the case), but this guy sounds like a lost cause. Time, effort and resources that he is consuming could be better spent on somebody who wants treatment and actually is going to listen to medical orders.
Adrian_Thompson said:No. No one should ever be left to die.
Another thought that echoes my second post (on the first page): Is there any other option for this guy? Seriously, he's HIV+, HEP-C, he has colorectal cancer, a bone infection... I think the appropriate decision in this situation for just about anyone is hospice/palliative care.
About the only other option is to have him arrested and put in psych. But Toebra already tried that and was shot down. But again, even there... I gotta figure that the best case scenario even removing the drug issues is a life that is not long and not pleasant.
I have to say, I'm with Adrian on this one. At what point do we say, "You're life isn't worth saving." Because many of you are saying are getting at, "Well he uses drugs, so he deserves to die in a ditch." That's pretty cold. Let's take the next step in that line of thinking.
Should we stop giving treatment to people who are obese? Morbidly obese? I mean, they chose to keep eating and not exercising right? Let's quit providing insulin, lap band surgery, etc.
It's very easy to fall into that line of thinking, I think as a society, we should try not to.
Who knows how this guy ended up in his situation.
A lot of us might think we make all the right choices, we're tough and we've got it all figured out but the bottom line is, you don't know just what it would take to push you over the edge and end up in a similar situation.
I'd like to think that if I ever ended up where this guy is that someone would still want to help me and treat me like a human being.
My hat is off to you Toebra, I don't know how you people manage to keep doing your job. I know I couldn't cut it.
ShawnG said:Who knows how this guy ended up in his situation.
A lot of us might think we make all the right choices, we're tough and we've got it all figured out but the bottom line is, you don't know just what it would take to push you over the edge and end up in a similar situation.
I'd like to think that if I ever ended up where this guy is that someone would still want to help me and treat me like a human being.
So many internet hard asses. Yes. I agree. But the interesting discussion is around how far do we go to save those who don’t want to be saved. This guy, probably would be cheaper to just put him up in a hospice and keep him comfortable and wait for nature to take its course. Seems compassionate enough.
z31maniac said:I have to say, I'm with Adrian on this one. At what point do we say, "You're life isn't worth saving." Because many of you are saying are getting at, "Well he uses drugs, so he deserves to die in a ditch." That's pretty cold. Let's take the next step in that line of thinking.
Should we stop giving treatment to people who are obese? Morbidly obese? I mean, they chose to keep eating and not exercising right? Let's quit providing insulin, lap band surgery, etc.It's very easy to fall into that line of thinking, I think as a society, we should try not to.
Indeed, There but for the grace of God go I
Or someone dear to me. Plus who knows what that person at the end of their life is capable of. Remember the British Spitfire which is credited with winning the Battle of Britain and stopping Hitler for the first time was designed by a man dying of cancer!
I disagree that everyone is saveable / worth saving.
Honestly, if I was the person rejecting treatment and sabotaging my own health at every available opportunity, I would expect to run out of last chances at some point. This guys appears to be hoping he will.
I would not expect to be able to cheat on my wife repeatedly without her leaving me.
I would not expect to be able to steal from my employer regularly without getting fired.
I would not expect to assault people repeatedly without getting arrested.
I would not expect everyone to continue treating me with human dignity, when I refused to treat anyone else - or myself - with human dignity.
At some point, we as a society have a right to say "Since you do not wish to be part of our society, you no longer will be." I'm not saying he should be euthanized, but he should get extremely limited treatment (at best) until such time as he decides to cooperate in his own care and become part of society again.
If that makes me an internet hardass to you, then so be it.
In reply to Duke :
We used to have mental health hospitals where these sorts of people with self destructive tendencies used to be given treatment.
I understand what you are saying and I respect that opinion.
Duke said:At some point, we as a society have a right to say "Since you do not wish to be part of our society, you no longer will be." I'm not saying he should be euthanized, but he should get extremely limited treatment (at best) until such time as he decides to cooperate and become part of society again.
If that makes me an internet hardass to you, then so be it.
You are making an assumption that people with mental illness have a choice in the matter.
(not) WilD (Matt) said:Duke said:At some point, we as a society have a right to say "Since you do not wish to be part of our society, you no longer will be." I'm not saying he should be euthanized, but he should get extremely limited treatment (at best) until such time as he decides to cooperate and become part of society again.
If that makes me an internet hardass to you, then so be it.
You are making an assumption that people with mental illness have a choice in the matter.
I am.
But I am also assuming that it is not right to force someone to live or be what society deems "OK" against their own will.
mtn said:Pete Gossett said:On second thought, here’s another idea: give a script for OxyContin & send him on his way. Maybe he’ll sell/trade them for meth, or maybe he’ll just eat a handful and make his problems all go away?
While this is probably an appropriate solution for THIS situation, if this is the case, I think Toebra would want this thread deleted.
Oh I agree I was being specific to this situation(though it could apply to other similar ones). Not having a medical background, and especially with the growing concern over prescription narcotics, I can definitely see concern in prescribing them here. Though I’d generally think anyone with a hole through their foot, a colostomy, and this patient’s other issues, would potentially have a level of pain to warrant their use. I’m not sure if known issues of drug abuse would prevent them from being prescribed though?
If this guy was a domesticated or wild animal, anyone with a heart would be in favor of euthanasia. He is dying, and he doesn’t want to be alive. His care team has been doing everything they can to help him, but he continues to fight against them.
Since euthanizing people is still illegal, and this patient is combative, would it be any better to strap him to his bed & try to keep him comfortable? He’s demonstrated multiple times he doesn’t want to comply with orders given to him. Yet on the other hand he’s a danger to society if allowed to go free, and I’m personally not ok with that option.
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