crimepoet Banggitin ko lang yung mga sinabi ng mga taong may pinag aralan about sa desisyon ng isa sa paraan ng pipiliin nya na paggagamot baka sakali maliwanagan ka.. baka sakali lang naman hehehe.
THE RIGHT TO CHOOSE TREATMENT
David C. Day, Q.C.: "All patients, as a general rule, have the right to receive treatment or to refuse to receive that treatment, after they've had full, open, and candid discussion with the treating physician.
Prof. Olivier Guillod: "I believe the basic element of patient's rights is the right of self-determination. That is, the right of any patient to decide what shall be done with his or her own body."
Narrator: Patient rights not withstanding, some have claimed that declining what they consider lifesaving medical treatment is irrational.
Prof. Timothy W. Harding: "It's wrong to equate a refusal of treatment with suicide, which is a conscious choice to end one's life."
Prof. Edward Keyserlingk: "There is always a legitimate question about a patient's competence. But just the mere refusal of blood, in itself, is not any kind of such indication."
Dr. Stephen M. Cohn: "I don't believe that refusal of treatment is irresponsible or irrational. I think that just because one person chooses to not take this pill, or that fluid, or this kind of solution, is their own personal choice."
Dr. Nicholas Namais: "We have patients who say that they don't want to be on a mechanical ventilator, they don't want a breathing tube."
Dr. Mark E. Boyd: "It's an everyday event for a patient who has malignancy or cancer to refuse some treatment or other. They don't want to have chemotherapy, they don't want to have radical surgery, so the idea that patients refuse treatment is something that I work with, not take it . . . don't take as a personal insult."
Narrator: These facts are often obscured by news stories claiming that someone died because he refused a blood transfusion.
Dr. Aryeh Shander: "To say that one has died because of refusal of blood, I think is a very general misleading statement."
Dr. Mark E. Boyd: "That's an oversimplification of the . . . of the tragic event."
Dr. Peter Carmel: "It's rarely, if ever, the case that a patient refused a blood transfusion and therefore died."
Dr. Aryeh Shander: "People die because of either a medical disease, or a consequence of trauma, or surgery where there has been complications."
Dr. Hooshang Bolooki: "I can tell you I have done over 200 Jehovah's Witness patients. I have never lost a patient because I could not give the patient blood."
Narrator: Why then does blood transfusion remain the standard treatment for serious blood loss?
Dr. Peter Carmel: "I think that physicians have been brought up with the idea that blood is the gift of life, and that, inherently, blood is good for you."
Dr. Avroy Fanaroff: "The refusal to accept a blood transfusion bothers and concerns many physicians because they're worried that without the transfusion, the well-being of the patient is jeopardized."
Narrator: To appreciate fully why physicians feel this way, one needs to understand a little about blood and why transfusions are given.
THE FLUID OF LIFE—BLOOD
Blood circulates through the body by means of an amazingly intricate system of conduits called veins and arteries. Arteries carry oxygenated blood away from the heart, eventually branching into tiny vessels called capillaries. These deliver the oxygen-rich red blood cells to every part of the body. Nutrients and oxygen are exchanged for carbon dioxide and other wastes at the cellular level. Veins then transport the oxygen-depleted blood back to the heart which pumps it to the lungs. There the carbon dioxide is exchanged for oxygen and the cycle begins anew. This cycle is absolutely essential to life.
Dr. Nicholas Namais: "If there's no blood to bring the oxygen to the cells, the cell dies, the body dies."
Narrator: When someone suffers severe blood loss, Doctors have two urgent priorities.
Dr. Edwin A. Deitch: "The most critical, immediate need is to stop the bleeding."
Dr. Nicholas Namais: "Everything takes back seat to stopping the bleeding."
Dr. Stephen M. Cohn: "And number two is to restore the volume within your system."
Narrator: "What can happen when a patient looses too much blood volume?
Dr. Edwin A. Deitch: "Then you don't deliver blood to the brain or the other organs and a person can die."
Dr. Nicholas Namais: "And what you need to do is restore volume, restore profusion, and restore oxygenation."
Dr. Edwin A. Deitch: "A way of correcting that decrease in blood volume is by giving other fluids intravenously. This can be done using any one of a number of fluid types, and doesn't necessarily require blood."
CHANGING ATTITUDES
Narrator: Increasing numbers of patients are opting to avoid blood transfusions for personal reasons.
Prof. Lawrence T. Goodnough: "If you've ever had a conversation with a patient the night before surgery, and you were to ask them if they had a preference, would they prefer to avoid a blood transfusion, the answer is always, Yes."
Prof. Roland Hetzer: "I would say that today, at least 80 percent of the patients, would strongly favor not to have blood transfusions."
Prof. Francesco Mercuriali: "Blood transfusion, traditionally considered a normal adjunct to surgery, presently is considered something that has to be avoided."
Dr. Willem de Groot: "There are real risks as far as transfusions are concerned."
Dr. Gerard A. Kaiser: "There are concerns about blood bore pathogens, and certainly the concern about AIDS."
Dr. Richard K. Spence: "It's a biological product. It can have diseases, etc. We screen for most of them, but there are some there we just don't know about."
Prof. Neil Blumberg: "We've certainly seen some horrendous new diseases in the form of HIV come along that probably didn't exist in the past. Whether the next disease will come along in 10 weeks, 10 years, or 100 years, nobody can say."
Dr. Concha Lawand: "We have Hepatitis C, Hepatitis B, transmitted, and the costs, social costs of that are very high."
Dr. Todd K. Rosengart: "There are transfusion reactions that occur, they are very rare, but they can be potentially dangerous or even life-threatening."
Dr. Richard K. Spence: "We can mix the blood up and cause catastrophe. Patients have died and do die from getting the wrong blood."
Prof. Donat R. Spahn: "It is interesting to realize now in the late 90's or early 2000's that the blood transfusion, to a certain extent, does not do what we always used blood transfusions for."
Prof. Neil Blumberg: "We've become persuaded, over the years, that many of the bad things that happen to patients after surgery, are in fact, not bad luck, are not a lack of surgical skills, but are in fact, the complications of transfusions."
ALTERNATIVE STRATEGIES
Narrator: These concerns have spurred the development of a wide range of alternative strategies, treatments that are acceptable to many of Jehovah's Witnesses, and others who also choose to avoid blood transfusions. Alternative strategies can be grouped around four organizing principles.
• Minimize Blood Loss
• Conserve Red Blood Cells
• Stimulate Blood Production
• Recover Lost Blood
