3 ms·

not trying to play doctor here, but a quick skim through the wikipedia article shows a high risk for developing neurological issues, infection, and blood relate

by ausbah 4y ago

not trying to play doctor here, but a quick skim through the wikipedia article shows a high risk for developing neurological issues, infection, and blood related ailments I imagine, and I hope someone with more knowledge can add on or correct me, that medicinal professionals are generally reluctant to use ECMO for extended periods due to the aforementioned issues. I personally know if my odds of waking up brain dead from a procedure were 50-50%, I wouldn't take that risk. so I wonder if doctors in this case saw a corresponding decrease in such risks? https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation?wprov=sfti1 https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...

leereeves 4y ago
I'm not a doctor either, but doesn't chemo have similarly high risks of serious side effects? When the odds of death are close to 100% otherwise, a treatment that improves those odds to 50% doesn't sound so bad.
- kingkawn 4y ago
  This is a serious decision, not just between 100% death and 50%, but a significantly worse death for the other half of people than the original certain one. Take the final period of a person’s life from them and their family for a devastating treatment that doesn’t help and then see how simple of a choice it feels.
- JohnBooty 4y ago
  My understanding is that hesitation to employ ECMO isn't about the risk of failure. It's not like chemo or dialysis where you can live some kind of meaningful life while the treatment has an X% chance of buying you Y years. It's extremely labor intensive. Another commenter mentioned 1:1 fulltime nurse care. If true, that means multiple fulltime employees, working in shifts, per ECMO patient. Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. In that sense it is similar to other "extreme measures" like ventilators and so on. We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. (edit - when I say "we" I mean society. not "we" as in "we medical professionals." I am not a medical professional!)
  - jessriedel 4y ago
    > We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. There are people on ECMO who have permanent heat and/or lung failure but are conscious, comfortable, and do not wish to have care withdrawn. In this case, it can absolutely make sense to continue to support them even if they have no hope of getting off the machine. The non-trivial ethical question is what to do if the cost is extremely high. > Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. Outside the short-term, we can always hire more nurses and docs, and build more machines and hospital rooms. We should not pretend that the amount of these are fixed in order to justify withdrawing expensive but beneficial care (other than in emergency situations). If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly.
    - JohnBooty 4y ago
      I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly. I feel like the discussion is super explicit about this? For nearly all situations, I would agree that nobody should be suffering or dying because of a lack of willingness or ability to provide or pay for medical services. But there are practical limits. There is a reason why we don't all get weekly mammograms, prostate exams, and dental checkups even though this would inarguably be the most effective way to catch things early.
      - jessriedel 4y ago
        > I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. I clearly state in my comment that I was not talking about the short term. In the long term we just train more and pay more, it’s not rocket science. But if you are curious about how we could have a for-all-practical-purposes infinite pipeline in the short term, that is also easy: just recognize international medical degrees and give foreign doctors work visas. > I feel like the discussion is super explicit about this? I don’t think it is, although I agree that different people will interpret conversational norms differently. IMO, there is constant equivocation between medical rationing and medical triage. The mealy-mouth-ness is so ubiquitous that we take it for granted. Like, why are we even talking about nurse shortages in this thread? If we were discussing whether it’s worth it to pay for an extra floor on our expensive houses, people wouldn't keep bringing up how we have to consider last year’s lumber shortage and how the US has too few skilled craftsmen because it doesn’t properly support trade schools (which is ofc true). We would just say “having another floor is nice, but it’s not worth an extra $100k”.
- pnutjam 4y ago
  death and serious brain damage are not the same risk
jessriedel 4y ago
> I personally know if my odds of waking up brain dead from a procedure were 50-50%, I wouldn't take that risk. You would accept guaranteed death to avoid a 50% chance of brain death? That’s not necessarily an inconsistent preference, but it’s a highly unusual one.
- coderaptor 4y ago
  Did you consider the impact on those responsible for your long term care?
  - krisoft 4y ago
    Brain dead is dead. [1] There is no long term care. They turn off the machines pumping air in your chest and that's it. I think you are confusing brain death with vegetative state caused by severe brain damage. 1: https://www.nhs.uk/conditions/brain-death/ https://www.nhs.uk/conditions/brain-death/
- ceejayoz 4y ago
  The poster's point would've made more sense, I think, if they'd used "significant cognitive impairment" instead of brain death. Being left in a permanent state where I'd be conscious enough to want to die, but not be able to legally access that option, is a scary thought. I'd rather not live in a nursing home bed for fifty years.
  - vkou 4y ago
    Fortunately for your case, once people are bedridden, they very rarely survive fifty years. Our bodies don't work very well when they can't keep moving.

by ausbah 4y ago

leereeves 4y ago

I'm not a doctor either, but doesn't chemo have similarly high risks of serious side effects? When the odds of death are close to 100% otherwise, a treatment that improves those odds to 50% doesn't sound so bad.

kingkawn 4y ago
This is a serious decision, not just between 100% death and 50%, but a significantly worse death for the other half of people than the original certain one. Take the final period of a person’s life from them and their family for a devastating treatment that doesn’t help and then see how simple of a choice it feels.
JohnBooty 4y ago
My understanding is that hesitation to employ ECMO isn't about the risk of failure. It's not like chemo or dialysis where you can live some kind of meaningful life while the treatment has an X% chance of buying you Y years. It's extremely labor intensive. Another commenter mentioned 1:1 fulltime nurse care. If true, that means multiple fulltime employees, working in shifts, per ECMO patient. Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. In that sense it is similar to other "extreme measures" like ventilators and so on. We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. (edit - when I say "we" I mean society. not "we" as in "we medical professionals." I am not a medical professional!)
- jessriedel 4y ago
  > We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. There are people on ECMO who have permanent heat and/or lung failure but are conscious, comfortable, and do not wish to have care withdrawn. In this case, it can absolutely make sense to continue to support them even if they have no hope of getting off the machine. The non-trivial ethical question is what to do if the cost is extremely high. > Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. Outside the short-term, we can always hire more nurses and docs, and build more machines and hospital rooms. We should not pretend that the amount of these are fixed in order to justify withdrawing expensive but beneficial care (other than in emergency situations). If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly.
  - JohnBooty 4y ago
    I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. If we are going to withdraw care because we just don't want to pay for it given the size of the benefits, we should acknowledge this explicitly. I feel like the discussion is super explicit about this? For nearly all situations, I would agree that nobody should be suffering or dying because of a lack of willingness or ability to provide or pay for medical services. But there are practical limits. There is a reason why we don't all get weekly mammograms, prostate exams, and dental checkups even though this would inarguably be the most effective way to catch things early.
    - jessriedel 4y ago
      > I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here. I clearly state in my comment that I was not talking about the short term. In the long term we just train more and pay more, it’s not rocket science. But if you are curious about how we could have a for-all-practical-purposes infinite pipeline in the short term, that is also easy: just recognize international medical degrees and give foreign doctors work visas. > I feel like the discussion is super explicit about this? I don’t think it is, although I agree that different people will interpret conversational norms differently. IMO, there is constant equivocation between medical rationing and medical triage. The mealy-mouth-ness is so ubiquitous that we take it for granted. Like, why are we even talking about nurse shortages in this thread? If we were discussing whether it’s worth it to pay for an extra floor on our expensive houses, people wouldn't keep bringing up how we have to consider last year’s lumber shortage and how the US has too few skilled craftsmen because it doesn’t properly support trade schools (which is ofc true). We would just say “having another floor is nice, but it’s not worth an extra $100k”.
pnutjam 4y ago
death and serious brain damage are not the same risk

jessriedel 4y ago

> I personally know if my odds of waking up brain dead from a procedure were 50-50%, I wouldn't take that risk. You would accept guaranteed death to avoid a 50% chance of brain death? That’s not necessarily an inconsistent preference, but it’s a highly unusual one.

coderaptor 4y ago
Did you consider the impact on those responsible for your long term care?
- krisoft 4y ago
  Brain dead is dead. [1] There is no long term care. They turn off the machines pumping air in your chest and that's it. I think you are confusing brain death with vegetative state caused by severe brain damage. 1: https://www.nhs.uk/conditions/brain-death/ https://www.nhs.uk/conditions/brain-death/
ceejayoz 4y ago
The poster's point would've made more sense, I think, if they'd used "significant cognitive impairment" instead of brain death. Being left in a permanent state where I'd be conscious enough to want to die, but not be able to legally access that option, is a scary thought. I'd rather not live in a nursing home bed for fifty years.
- vkou 4y ago
  Fortunately for your case, once people are bedridden, they very rarely survive fifty years. Our bodies don't work very well when they can't keep moving.