Those of us who work in health care know how many decisions we are faced with every day. MDs and pharmacists determine the best pharmaceuticals for patients. Nurses monitor a patient's status to know if they are stable enough for discharge or require more medical care. Therapists (along with the patient) determine and establish an appropriate plan of care to reach a patient's goals for mobility and comfort. We make countless decisions every day and each one impacts our patient's care.
After working in the ICU for the last month, one question continues to present itself. Who should decide when enough is enough? What if the patient is unresponsive and hadn't verbalized their wishes to family previously? What role should health care providers have? An unrelated, third party can offer a perspective which could be considered both good and bad.
The role of the ethics team in a hospital setting is a dynamic, ever-changing conversation. I call it a conversation because that's what it is - an open discussion considering every side to the patient's case. With so many things to consider, including prior function, comorbidities, motivation and other treatment options, these decisions don't come easily. In some cases patients have the luxury of time; other patients aren't as lucky.
There are a few patients who have come into the ICU on full vent support, with minimal active movements, who remain unresponsive and with very poor prognoses. As I walk by their rooms and see families waiting at their bedside, I can't help but wonder what thoughts plague their minds. I will never be able to understand the positions of these families and patients and my heart goes out to anyone in those situations.
This debate obviously surpasses the role of physical therapy. But we need to take a role in these decisions to the best of our ability. Providing patients and families with skilled stretching, range of motion, positioning, postural drainage with percussions, and even education regarding their diagnoses can add substantial quality of life during the most critical times. We need to be accountable in providing the best care, at all times, for our patients - even when life-sized decisions await.