Thammasat hospital introduces ‘Withhold Intubation’ rule in severe aging COVID-19 cases

[snoop1130]

Photo from Thammasat University Hospital for COVID-19

 

Due to the severe shortage of life-saving medical equipment, such as ventilators, the management of Thammasat University hospital has decided to apply a “Withhold Intubation Rule” for severe COVID-19 patients who are over 75 years old and who are also suffering from AIDS or incurable cancer or are at the end of life or in the last stage of clinical frailty state (increased vulnerability to poor resolution of homoeostasis after a stressor event, which increases the risk of adverse outcome).

 

The hospital’s management said in a statement yesterday that, due to the shortage of medical personnel and medical equipment in the wake of overcrowding in the hospital, doctors responsible for providing treatment will not put some severe cases of COVID-19 on ventilators, but will focus on palliative care under two conditions.

 

Firstly, in the case of patients who have drawn up a living will, verbally or in writing, or when there is a surrogate decision by family members that the patients do not want to be put on a ventilator. In case of the absence of advance instruction or a living will from the patients, the family members or close relatives will consult with medical experts over whether to use a ventilator or not.

 

Full Story: https://www.thaipbsworld.com/thammasat-hospital-introduces-withhold-intubation-rule-in-severe-aging-covid-19-cases/

 

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[Speedo1968]

What if one has drawn up a DNR letter ?
I did some years ago and carry with me along with copy of passport and drug allergy list, also posted in full view in my house.

I have had only one hospital to date that has accepted or questioned me regarding the form placed ( ? ) in my hospital file.    Hospitals have refused to accept / acknowledge the form in the past.

[IraqRon]

at a certain point in a medical situation I believe we have a duty to die.  Why waste resources keeping a person alive just for the sake of saying they aren't dead?  Resources that can go to the young, etc.

[Tropicalevo]

1 hour ago, Speedo1968 said:

What if one has drawn up a DNR letter ?
I did some years ago and carry with me along with copy of passport and drug allergy list, also posted in full view in my house.

I have had only one hospital to date that has accepted or questioned me regarding the form placed ( ? ) in my hospital file.    Hospitals have refused to accept / acknowledge the form in the past.

I have been talking to a number of doctors/hospitals here on Samui about this.

It is something that they do not really want to discuss.

One doctor promised to look into it for me but........ I am still waiting.

[cocoonclub]

1 hour ago, IraqRon said:

at a certain point in a medical situation I believe we have a duty to die.  Why waste resources keeping a person alive just for the sake of saying they aren't dead?  Resources that can go to the young, etc.

It’s the relatives and friends that don’t agree to this. 

[Tropicalevo]

1 minute ago, cocoonclub said:

It’s the relatives and friends that don’t agree to this. 

I understand what you are saying and you are correct, but my body, my choice surely.

[Tropicalevo]

3 minutes ago, cocoonclub said:

It’s the relatives and friends that don’t agree to this. 

My son, at age 37, had terminal brain cancer. He died over a period of two years.

His last year was not great, but his last six month were heart breaking for me to watch.

He was in a hospice and was basically in a vegetative state. He could do nothing.

The staff were brilliant, but he was not there. His brain had closed down.

I spoke to my D-I-L about it but her words were - I want to see him, and I want the children to see him, for as long as I can before he dies.

I understand where she was coming from, but it broke my heart.

DNR is my goal.

 

[cocoonclub]

33 minutes ago, Tropicalevo said:

My son, at age 37, had terminal brain cancer. He died over a period of two years.

His last year was not great, but his last six month were heart breaking for me to watch.

He was in a hospice and was basically in a vegetative state. He could do nothing.

The staff were brilliant, but he was not there. His brain had closed down.

I spoke to my D-I-L about it but her words were - I want to see him, and I want the children to see him, for as long as I can before he dies.

I understand where she was coming from, but it broke my heart.

DNR is my goal.

 

Sorry to hear about your loss and his suffering. Good that he got a bed in a hospice. My mom used to work in one after us kids were out of the house so I know a bit about it. It’s good they exist. 

[IraqRon]

54 minutes ago, Tropicalevo said:

I understand what you are saying and you are correct, but my body, my choice surely.

I guess that the solution to this type of thing is a living will which should override the wishes of family frineds, etc.

My older brother and his wife had to care for a completely gone from alzheimers for over 15 years as her sister couldn't bear to sign a dnl form yet this person never visited her mother ever.  Very stressful on my bro and his wife.  I would imagine her "religion" had something to do with it.

[connda]

Thammasat hospital introduces ‘Withhold Intubation’ rule in severe aging COVID-19 cases

Now that's called eugenics.
80 years ago that would have been called - well, something different.

We're here! 

[connda]

We have finally arrived at the door of a totalitarian society which fully embraces genocide and eugenics by calling it? 
A shortage of capacity. 

Murder the elderly.  It's fine!  Why not?  But it's still murder. 
We have arrived people.  Wake up.

[connda]

3 minutes ago, connda said:

We have finally arrived at the door of a totalitarian society which fully embraces genocide and eugenics by calling it? 
A shortage of capacity. 

Murder the elderly.  It's fine!  Why not?  But it's still murder. 
We have arrived people.  Wake up.

My God.  Your inhuman Connda.  Young people must live even if it means killing the elderly. 

Yeah.  Just take the elderly to the top floor and toss them off.

But you really have no idea.  Vent are pretty much a death sentence.  The fact that people are being put on vents is a testament the the incompetence of the medical system. 
Hey, I know - pump them up with Green Chirreta and Creat.  Heck.  Hundreds of scientific studies prove those TTMs are a Covid cure.

Caveat - I am  "The Elderly" officially.  I'll never be put on a vent.  Living Will.  I'll die first because vents are a death sentence. No vents, no ICU, no extraordinary measures.  I'm a eugenicist's dream.  Willing to depart this earthly coil.  So don't go having a hissy-fit about Connda taking the life of some 45 year old obese diabetic.  They can have my vent.  A better exercise in life is introspection. - Why are 90% of you pissing yourself about getting Covid and dying?  I'm not.  We all die.  Given my age - pretty soon. 
Covid?  Maybe.  Pneumonia? Maybe.  Heart attack while humping my gik.  Maybe? 
I simply don't get it.  What the hell are you people so afraid of?
Wake up!

[elcaro]

Running the risk to get on your ignore list by asking, but are you schizophrenic @connda?

 

In every post you always seem to be replying to yourself?

[NotYourBusiness]

What will be their cause of death for the statistics?

[connda]

2 hours ago, elcaro said:

Running the risk to get on your ignore list by asking, but are you schizophrenic @connda?

 

In every post you always seem to be replying to yourself?

It's a deliberate writing style.  A sort of Socratic inquiry to empathize a point.  But considering the path the world is taking.
War is peace?  Freedom is slavery?  Ignorance is strength?
Sanity is insanity?

Claiming dissenting voices are insane historically has been an effective method of silencing critics.  Study Soviet history.
So no.  No multiple personality disorders or schizophrenia.  Unless a satirical worldview is considered a mental disorder.  Which given the way things are transpiring globally may soon come to pass.

[connda]

15 hours ago, Speedo1968 said:

I have had only one hospital to date that has accepted or questioned me regarding the form placed ( ? ) in my hospital file.    Hospitals have refused to accept / acknowledge the form in the past.

They are legally obligated to honor a living will. It is codified in Thai law.

[unblocktheplanet]

When I was 70, I prepared a Living Will including DNR & no intubation orders. I put it on file with my public hospital.

 

On Sept 27, I have an appt with a gerontologist to emphasise my decisions.

 

The world belongs to the young. We all have an expiration date.

[connda]

3 hours ago, unblocktheplanet said:

When I was 70, I prepared a Living Will including DNR & no intubation orders. I put it on file with my public hospital.

 

On Sept 27, I have an appt with a gerontologist to emphasise my decisions.

 

The world belongs to the young. We all have an expiration date.

If we chose to check out due to our age as we acknowledge that we have lived long productive lives and continuing in a body that is breaking down doesn't make sense to us personally - then that's fine imho.  I'm in that category as is my wife and a few others on this forum.  Btw, making a decision like this in Thailand is no small matter as this country does not know what a hospice is and their palliative care is 50 years behind the rest of the world if not more.  It's a difficult decision to make at a majority of Thai doctors are quite fine with you dying in agony because - "it's your karma."  This is where I'd prefer to have a Western trained secular humanist for an attending physician with no qualms about providing palliative end-of-life care. 

What I find criminal is the act of effectively murdering an older person who for whatever reason wishes to keep plodding along.
To withhold medical treatment against that person's will is genocide of the elderly and a eugenicist's policy.  Personally I don't care what excuse is used - it's a form of state sanctioned murder which is prone to be found in totalitarian societies. 

[connda]

Thammasat hospital introduces ‘Withhold Intubation’ rule in severe aging COVID-19 cases

And I guarantee this does not apply to the wealthy, the military elite, the government elite, or the corporate elite here in Thailand. 
This is strictly death sentences for elderly commoners.

[Speedo1968]

On 7/23/2021 at 7:47 PM, cocoonclub said:

It’s the relatives and friends that don’t agree to this. 

My children and friends here are well aware and understand my DNR request which I made some years ago.

[Speedo1968]

On 7/23/2021 at 7:58 PM, Tropicalevo said:

My son, at age 37, had terminal brain cancer. He died over a period of two years.

His last year was not great, but his last six month were heart breaking for me to watch.

He was in a hospice and was basically in a vegetative state. He could do nothing.

The staff were brilliant, but he was not there. His brain had closed down.

I spoke to my D-I-L about it but her words were - I want to see him, and I want the children to see him, for as long as I can before he dies.

I understand where she was coming from, but it broke my heart.

DNR is my goal.

 

I sympathise with you, your family and your loss.
A DNR should not be a goal but a statement in writing, if it is a goal then you are not ready.

[Speedo1968]

On 7/23/2021 at 7:48 PM, Tropicalevo said:

I understand what you are saying and you are correct, but my body, my choice surely.

Yes it is your choice but perhaps in the future it will be more common due to an overloaded shortage of facilities and staff.      You could always consider donating your body for transplants.

[Speedo1968]

On 7/24/2021 at 10:11 AM, connda said:

They are legally obligated to honor a living will. It is codified in Thai law.

Yes they are and perhaps we who made a DNR and have tried having it recorded in or hospital files should get a signed statement from the hospital ( e.g. copy of DNR ) that it has been accepted or not.
When I had a major stroke and I was first taken to the local hospital my friend gave them a copy ofmy DNR ( which had a copy of my DNR a long time previously ), they would not accept it until I "came to" which they did when I was able to talk.
Later taken to a hospital in Khon Kaen the doctor accepted - no problem.

[mickyr55]

On 7/23/2021 at 9:35 PM, connda said:

Heart attack while humping my gik.  Maybe? 

Surely that should read HOPEFULLY 

[elcaro]

Nice, well written reply @connda. Credit where credit is due ????

[KKr]

On 7/23/2021 at 5:14 PM, snoop1130 said:

Firstly, in the case of patients who have drawn up a living will, verbally or in writing, or when there is a surrogate decision by family members that the patients do not want to be put on a ventilator.
In case of the absence of advance instruction or a living will from the patients, the family members or close relatives will consult with medical experts over whether to use a ventilator or not.

It seems that a lot of posters, while being quite opinionated, did not read the above, last, paragraph.
Sadly enough, I am aware of a case where the Family had to decide.
For sure, an advance Directive would have made the decision easier.

 

Edited July 25, 2021 by KKr

[Tropicalevo]

11 hours ago, Speedo1968 said:

I sympathise with you, your family and your loss.
A DNR should not be a goal but a statement in writing, if it is a goal then you are not ready.

It is not a goal.

I worked with computers for more than 35 years. I am very logical and pragmatic.

My view -

I have lived a wonderful, full and enjoyable life. No regrets.

However, if my being in a hospital bed or an ICU unit deprives someone who has not had the chance or opportunity to live a life such as mine - then please kick me out and look after them.

[Tropicalevo]

11 hours ago, Speedo1968 said:

Yes it is your choice but perhaps in the future it will be more common due to an overloaded shortage of facilities and staff.      You could always consider donating your body for transplants.

I have donation cards in my wallet.

[Alwaysthailand]

....go into the light grasshopper....