Ethics

[witchdoctor]

Oh yeah, one more thing. I live across the street from a nursing home. Rest assured I will raid that place if needed on my way out of town. They are hardly secured, no resistance will be put up, tons of prescription meds on hand and food. Take what you need and leave!!! Most people will not think about that as they are trying to rob Walmart, the Drug Store, or go to the hospital.

[Dr. X]

I live across the street from a nursing home. Rest assured I will raid that place if needed on my way out of town...

I can only hope it's one of the many run by my girlfriend's bitchy momma...:D

as ever,
Dr. X

[DrBaboon]

I've taken the perogative as the moderator of this section to move the above post to begin a new thread.

I believe this is worthy of discussion on its own.

Which type of situation do members believe that it's more likely to encounter?

A) Something so cataclysmic that all societal organization is gone forever (and will not be replaced with any manner of organization anytime soon).

B) Societal organization is gone, but is replaced by the actions of people organizing.

C) Societal organization is weakened, and distant for a time, but is re-established.

D) Other.


Do each of us/any of us have values that transcend whatever circumstances we might encounter? Does that vary with the type of disaster/austere circumstances we face, or is it as much of a constant as can be managed with those circumstances?


Further, how do one person's answers to these questions end up influencing their planning - particularly for matters of health care.


Does the aftermath of Hurricane Katrina offer any lessons about ethics, force of law, re-establishment of order?


Does a disaster result in losing our character, or does it reveal our character?

[Jonas Parker]

I've taken the perogative as the moderator of this section to move the above post to begin a new thread.

I believe this is worthy of discussion on its own.

Which type of situation do members believe that it's more likely to encounter?

A) Something so cataclysmic that all societal organization is gone forever (and will not be replaced with any manner of organization anytime soon).

B) Societal organization is gone, but is replaced by the actions of people organizing.

C) Societal organization is weakened, and distant for a time, but is re-established.

D) Other.


B.Societal organization is gone, but is replaced by the actions of people organizing. Organizing in our small town will probably be by street, block, or Church.

Do each of us/any of us have values that transcend whatever circumstances we might encounter? Does that vary with the type of disaster/austere circumstances we face, or is it as much of a constant as can be managed with those circumstances?

While I could never raid a nursing home for drugs or supplies, I do have to provide both for myself and my wife. We are both medically trained and could possibly save lives as long as we could keep going. We probably would not share our preparedness gear and supplies with strangers, no matter how "heart-wrenching" their "tale of woe" might be. Both of us have had patients die in our care and in our arms. Does it bother us? Yes! Will it keep us from doing our job? Nope!

Further, how do one person's answers to these questions end up influencing their planning - particularly for matters of health care.

We have provided for the care and treatment of ourselves and a small group of friends with whom we would band together in a disaster situation. We cannot provide for the entire town, or indeed the entire neighborhood.

Does the aftermath of Hurricane Katrina offer any lessons about ethics, force of law, re-establishment of order?

Actually, Katrina didn't hit here, but Hurricane Rita slammed us pretty good. It was still a Catagory 2 hurricane when our small town got hit with Rita's NE quadrant. Water, electricity, and phones were knocked out. Streets were blocked, homes were damaged (ours slightly, the next-door neighbor's severly). Yet there was no disorder, no looting (an armed population is a great crime deterrent), and our small community sheltered many refugees from the south of us. Ethically, the only real screwup was the Mayor who insisted that his street's electricity be reconnected first, and this will probably end his political career at the next election. The sheriff's department and police department carried on without members going "AWOL" and order didn't have to be reestablished since it was never lost in the first place.

Does a disaster result in losing our character, or does it reveal our character?

Hard times always reveal character. (Unfortunately for some, it tends to reveal their bad or weak character).

Originally Posted by witchdoctor

I live across the street from a nursing home. Rest assured I will raid that place if needed on my way out of town...

witchdoctor, if you tried that here, you'd never have to worry about "heading out of town"...

[witchdoctor]

Let me go in to more detail on my original post.

First, I have see way too many people that will not take care of themselves get more and more medical care provided by the taxpayors.

Second, I believe that when TEOTWAWKI happens it will not matter much about ethics, survival of the fitest will be the law. So honestly I would rather write off a bunch of old people that are non-productive in a nursing home and have the ability to help other people in the future. Also, as shown in Katrina the healthcare workers at the homes will abandon the residents for themselves.

As for what we are likely to encounter, I believe we will see A and/or B depending on the events. I would not plan to loot or rob or whatever you want to call it unless TEOTWAWKI was occuring. I am not a heart-less bastard and I have done more than my fair share of good in the world. But if society collapses then the elderly that are not prepared are doomed, we can all agree on that. Nursing homes and hospitals will be left abandoned... I cannot imagine people still showing up for work if there is no pay or administration.

Yall can think what you want of me. The bottom line is survival and that is what it may take.

[Dr. X]

But if society collapses then the elderly that are not prepared are doomed...

Not just the elderly...that goes for ANYbody! Natural selection will once again take over and the weak and sick will die and I don't allow Mr. Parker or anyone else will be standing guard over them. No doubt they will be worrying about their OWN happy ass. History shows that societal collapse does not bring out the best in human beings, but I've been labeled a thug, so what do I know??? :rolleyes:

as ever,
Dr. X

[Jonas Parker]

Not just the elderly...that goes for ANYbody! Natural selection will once again take over and the weak and sick will die and I don't allow Mr. Parker or anyone else will be standing guard over them. No doubt they will be worrying about their OWN happy ass. History shows that societal collapse does not bring out the best in human beings, but I've been labeled a thug, so what do I know??? :rolleyes:

as ever,
Dr. X

No, I won't be "standing guard" over the elderly in the nursing homes, but you can bet your life (literally) that their families in this town will be "standing guard" over them, and it'll be worth your happy ass to try and raid the local nursing homes for supplies, food, and drugs!

[Dr. X]

No, I won't be "standing guard" over the elderly in the nursing homes, but you can bet your life (literally) that their families in this town will be "standing guard" over them, and it'll be worth your happy ass to try and raid the local nursing homes for supplies, food, and drugs!


Thin skin alert! :D Didn't mean to offend, Jonas, as I have my preps and won't be knockin' over the elderly in any case. If you'll check I wasn't the one who said I would to begin with. I also hold to my statement that most everybody will be worried about "their OWN happy ass" and not so worried about nursing home patients (Check out the Katrina nursing home abandonments and desertions in N.O. for recent cases, I'm sure History holds more). As far as raiding your local nursing home, No Worries! Transylvania is just a little removed from Tejas, wouldn't you think? :rolleyes:

as ever,
Dr. X

[DrBaboon]

(Check out the Katrina nursing home abandonments and desertions in N.O. for recent cases, I'm sure History holds more).

The hospital and nursing home situations REPORTED from Katrina/New Orleans are not the general situation, but are examples of some of why I split this into the new thread.

Sometimes, more than one "truth" is true at the same time. IOW - some really positive things can happen simultaneously with some really horrible things.

1) I know physicians who cared for patients in the NO area during and after Katrina, and have heard their firsthand accounts of the lengths they went to in rendering care. Their stories make me proud to be in medicine. In fact, there was about a 1/2 day of Katrina medicine at one of the medical meetings I attended a few months ago.

2) I don't know this next group of people personally, but will add links to their stories:

http://www.webmd.com/content/pages/23/109940.htm


These next 4 links are together - I found it easier to use them directly than go page to page:

http://auryn24.livejournal.com/298313.html

http://auryn24.livejournal.com/298736.html

http://auryn24.livejournal.com/298757.html

http://auryn24.livejournal.com/299034.html

3) Then there are the reports of abandoning patients, and the subsequent investigations.

4) And finally, this was one of the early news reports of euthanasia of patients in NO:

http://www.chron.com/disp/story.mpl/nation/3498960.html

I believe this is still working its way through the criminal justice process, so we don't know the outcome.


It's as good a time as any to post this link:

http://www.cafepress.com/austeremed

There are also a variety of sites where the book is hosted for download as a .pdf.

It's an excellent book, and really unique in many ways. There is some discussion that there might be an updated version one of these days.


From the AUSTERE MEDICINE text - on page 19:

"DOCUMENTATION:
Even in a survival situation documentation is important. You should keep a record of every patient you treat. What they complained of, the history and examination, what you diagnosed, and how you managed them, a very clear note of any drugs you administer, and a description of any surgical procedure you perform should all be recorded. Anyone with an ongoing problem should have a chronological record of their condition and treatment over time recorded. There are two reasons for this. First is that for the ongoing care of the patient often it is only possible to make a diagnosis by looking over a course of events within retrospect and it is also important to have a record of objective findings to compare to recognise any changes over time in the patient condition. Second is for legal reasons. If and when things return to normal it may be inportant to justify why certain decisions were made. Detailed notes from the time will make this easier."



The morals of the story seem to be:

Don't assume there won't be a reckoning in this lifetime. Whatever order is restored may very well pursue people for their actions in a survival situation.

Let's say that it's mob rule. I don't think that's of any consolation if someone is looking to do bad things to patients. I suspect the angry mob would not be as gentle as the courts after order is restored.

In a real sense, a PO'd relative or a mob that confronts one of us rendering care may really need to be convinced that we gave appropriate care.

I'm not sure that we are escaping the specter of malpractice by ending up in a survival situation. That may be relatively true, some of the time, but it's not a certainty.


So what do we do with the accusations of euthanasia in NO?

The supposed reason why some people think euthanasia might have occured was that it became impossible to care for people, with medications running out, etc.

What doesn't make sense to me, is how much more narcotic it takes to reliably kill someone by overdose.

If there is so little medication available, why use it all up killing a few people?

That's an awful lot of doses of narcotic that could have been used to treat other people with for pain control.

It leaves me with the uncertainty if there were some bad apples who were determined to engage in euthanasis, and this was just a pretext, or if the story of euthanasia of 75-100 people will prove to be bogus when all is said and done.

If it is shown to be truly euthanasia, it still seems like poorly conceived triage and poor utilization of resources (narcotics).

IOW - some fairly large number of patients would not have received needed narcotics in order to euthanize a few people.

[Dr. X]

First, Dr., let me state that although I don't necessarily trust doctors, I am not down on the entire medical profession per se, or physicians in general. On this subject the old Hell's Angels quote comes to mind: "When we do good no one remembers, when we do bad no one forgets..." And I'm sure the bad get more airplay as the media is prone to feed on death and misery. You, Dr.Baboon, are obviously one of the good guys. (Notice that I said "MOST people" in my post, not everybody) Disasters of any kind tend to bring out the best and worst in people, somtimes simultaneously. I'd like to think that I'd do right by my fellow man in such a scenario, but I can't honestly say just what I'd do in the actual situation. I'm sure others wonder about this as well, if they would but admit it...

as ever,
Dr. X

[akfanatic]

Since this is now an ‘ethics’ thread and was started by my friend and ‘bug out/in’ partner I will chime in…

Both witchdoctor and I are EMT-Ps so we really don’t need any ‘ethics’ advice as we both had the class in college.:rolleyes:

(Moderator Edit)

In conclusion I would like to thank any MDs, RNs, EMTs etc... for their input on this forum. The end result of all of this is an exchange of information that can help save the lives of those that can be saved.
I remember a saying about the wisdom to know the difference between the things you can change and those you can’t…

[Jonas Parker]

Since this is now an ‘ethics’ thread and was started by my friend and ‘bug out/in’ partner I will chime in…

Both witchdoctor and I are EMT-Ps so we really don’t need any ‘ethics’ advice as we both had the class in college.:rolleyes: ...

So am I, and also an ortho-tech, and a surgical tech, with a history major, a double minor (English and military tactics) and nine hours towards an MBA, and I took my ethics classes at a Jesuit University.

[DrBaboon]

The end result of all of this is an exchange of information that can help save the lives of those that can be saved.
I remember a saying about the wisdom to know the difference between the things you can change and those you can’t…

Whether this surprises anyone or not, I don't agree with the theory that this is about knowing the difference about things you can change and things you can't.

It appears that you take the position that only care that saves a life (if the life can be saved) is appropriate.

There may be a *grain of truth* in what you are saying - that is - we need to avoid inappropriate or excess care, particularly if it takes away from our ability to care for one or more additional patients.

Sometimes the thing that is most needed is good, compassionate palliation. And that probably does not involve inappropriate consumption of resources or other problems.

IOW - this is not a binary equation. It is not a situation where people are either able to be saved and get resources, or unable to be saved and don't resources.

There's much more of a spectrum of possible situations.

[sparkky]

a "true" survival situation is just that; how you react determines whether you
and yours live or die.
it comes down to one question; would you prefer to live with a guilty conscious or die with a clean one?
to stay alive we will do things we aren't proud of now or afterwards. and we'll have maybe a SPLIT SECOND to make our decisions.
I figure cemetaries are full of folks with ethics and life is full of folks who spend the rest of their lives wondering if they should have had more.

[tedbo]

'S okay,I will be in front of The Almighty sometime and I like the idea of a clear conscience.After all,isn't that the True test?Maybe its just me.....
I know that there have been several times in my life where I have had to make a hard choice and when it came right down to it I had found an alternate route and was spared.Prayer,boy...,prayer.....

[witchdoctor]

This topic has brought out some interesting points. The bottom line for me is I am not planning to treat random people. If you are on my team or in my family I will treat you, but otherwise I am not going to bother. I will have limited supplied and I am not THE HEALTH DEPARTMENT, I am not the free clinic!!!

If I choose to raid a nursing home to get supplies so be it, none of you will have to answer for it. That is MY OPINION and my right to express it has been fought for by many heroes!!! When on duty I have give the best damn care I can, regardless of who/what/where/why/when!!! I am a firm believer that not all people can be saved and yes sometimes it is my job to determine who lives and who dies. I do the best with what I have... but in a survival / TEOTWAWKI situation the keyword will be TRIAGE and if you do not know what that is... see AOL Keyword "TRIAGE".

Thanks AKFanatic for your support, cause you know those ill-gotten supplies will be used to patch your ass up!!!!