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A discussion of ethics

Published October 18, 2013 1:16 PM by Lorenzo Ortega

Being part of health care in the United States brings about a huge question of ethics, a concept I have faced on a great number of occasions in my young career. In this country we spend more money on health-related expenses than any other country in the world and I cringe every time I am reminded that I am a part of that number. Working in the ICU, I have seen the reality of those staggering expenses up-close almost every day. I have asked myself many days, "Why are we spending so much to try to keep ourselves alive?" Although I am not sure I have a clear-cut answer, I know for certain that our country and our culture is terrified of death. In my 23 year-old life I have growth up in a society that has glorified beauty and youth far above aging naturally. Pop culture has made us believe that products, surgeries, and pills will prolong our lives to the fullest, taking ten, twenty, even fifty years off our lives! Living longer, with dozens of alterations is apparently the way to live a "natural" life in these times.

Although I feel I have helped many people, there are a significant amount of patients who I felt that prolonging their lives was an unethical thing to do. I believe in many cases a peaceful death is a beautiful thing. Today in health care we can play the part of every major organ in the body. We can control respiratory drive with ventilation, maintain blood pressure with vasoactives, dialyze patients, the possibilities are almost endless. However, the reality is that one way or another our bodies will go back to the earth. Whether fast or slow, death is inevitable. One factor contributing to our fear of death in today's world is the distance society has from spirituality. This fear of death gives rise from the uncertainty may people have with what happens after death. In a world of emaciation, pain, and secretions from every orifice, I think its living in the hospital that we should really be afraid of, not death.

I had a very interesting discussion with some of the nurses on my unit several nights ago. As a young person you learn so many things about how to live your life. You learn how to socialize at a very early age and then are pushed through the ranks of formal education. Minds are molded and growth from a child to an adolescent and eventually an adult takes place. What our society needs is formal education on life and death, incorporating healthy living and dying, and in contrast, unhealthy living and dying. People are not faced with these tough realities until so much later in their lives and then they only see one option: life at all costs. It does not have to be that way. I am recently removed from formal education having graduated almost a year ago. As my age states, I am not very far removed from high school and elementary school, but not once do I remember learning about death and dying. It's as though we get taught all these wonderful things and at the end of our lives, SURPRISE! Guess what? You're going to die! No one told you?!

Something really needs to be done. The affordable care act does a good job focusing on health maintenance and early intervention, but we need to go much further. There needs to be some sort of mandate on youth education of health, life and death. Until these ideas are changed in the minds' of society, I am not sure what the future will hold. 


posted by Lorenzo Ortega


Hello Lorenzo:

What refreshing insight! This gives me encouragement about the new nurses coming into the profession. As a person who has "done it all" (not really) with 38 years in nursing, I could really relate to your thoughts. What was once standard thinking for those enlightened during church in the early part of my life, I am not so sure where those coming after me will get a viewpoint. I worked in a plastic surgery center for four years in my early fifties and found it very disturbing. I have seen some friends do Botox and fillers; I tried it myself once and thought it to be a very pricey way to look fresher for three months! I have been through losing friends to alcoholism and of course, the loss of my parents and my husband's parents more recently. As an investigator, I do get to see complaints about "not doing enough for my loved one" and hastening their death. I have been at the bedside of patients who have died. As nurses, we are given a large dose of this subject and the opportunity to reflect on what the end of life brings to each individual. Yes, it is a very individual process. While it would be shocking to look at the cost we all pay to try and "do everything" at the end, we now know that we cannot continue to allow everyone this choice. Perhaps it will come with an unfeeling "co-pay." There is a sense of entitlement related to the end of life, as no one wants to leave their loved ones behind and one would hate to say goodbye. It is the worst of emotional pain possible. The best we can do is respect others feelings and beliefs, give them as much information/knowledge as they are willing to accept at the time and be the best/most competent/caring nurse. It is a path we must all walk alone and we will all go through it, costs aside. Openly talk with close friends, inquire if they have ever thought about it and what it means to them. Talk to your parents and siblings. Add to your own knowledge base about what happens to the body as it begins to shut down. Perhaps this will help you on your own journey as well as others. And read "On Death & Dying."

Anne Overby, Regulatory - RN/Investigator, State Dept. of Health November 8, 2013 6:27 PM
Olympia WA

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