As a physician working in the Intensive Care Unit for the last eight years, I often have to take care of patients that are literally struggling between life and death. As a doctor, my foremost duty is to save the lives of my patients.
But, today, I will tell you about a situation when the duty to save life conflicts with the Hippocratic oath of “doing no harm.” Yes, there are times when you may harm someone by saving his/her life.
It mainly depends upon what “life” means to a particular patient. Every individual has complete control over what they would want when they are suffering from a life threatening illness.
For some, being alive at any cost is the definition of life. For others, the quality of life is more important than being alive.
Quality of life also means different things to different patients. Being able to breathe on their own without being hooked up to a machine may be the most important consideration for some patients; being able to think and communicate may be the most important one for others.
When a patient with serious illness deteriorates rapidly in the hospital, it triggers our duty to save life by doing certain things. I am talking about those situations when doing nothing will almost certainly result in a natural death.
For example, when the heart of a patient suddenly stops completely or when someone stops taking breath. Treating someone at this point is, therefore, called resuscitation or revival. It triggers a series of events that we do in an attempt to bring the patient back to life. It includes chest compressions, artificial breathing and sometimes using electric shocks in an attempt to literally “jump-start” the heart. Some patients come back to life with these maneuvers; others do not.
This process of revival from imminent death is also called “running the code” in the medical community. It is our duty to run the code on these situations unless the patient had given us specific instructions not to do so in advance.
Just like every individual has the right to define the quality of life, he/she also has right to define death. Some people do not want to “brought back to life.” For them, death is when their heart stops or when they stop breathing. These patient have the choice to tell the doctors about this particular situation in advance. These are called “Do Not Resuscitate(DNR)” orders. Running the code on someone with DNR order is against medical ethics and is considered causing harm to the patient.
For someone who is struggling with a terminal illness, death is inevitable. It is just a matter of time. Having the chest compressed multiple times with force and getting electric shocks to jumpstart the heart are examples of very traumatic experiences. When death is inevitable, getting back to life with so much trauma is almost equivalent to dying many times instead of just once.
But this is a decision only the patients can make for themselves. As doctors, we can not decide what they would want in those situations. We can only do our duty by either honoring the DNR order or by running the code if no DNR order exists.
If you or your loved ones have a terminal illness and would like to make an informed decision about what you would want in those situations, we can definitely explain all your choices and answer all your questions.
But we can not make that decision for you. It is your life, and it has to be your decision.
Nabin Sapkota, MD, is a physician with the hospitalist program at Columbus Community Hospital. His book, “The Secrets of Modern Medicine Revealed” can be purchased online at medicinerevealed.com .