User:Detrue/Heroic measure

Examples of Heroic Measures

• Chemotherapy
• Military Doctors and treating soldiers
• Palliative Care
• Spine surgeries

Additional Search Terms: Advanced Care Planning

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Heroic measure - original article text

In medicine, heroic treatment or course of therapy is one which possesses a high risk of causing further damage to a person's health but is undertaken as a last resort because no other viable treatment options are available.

Heroic measures are often taken in cases of life-threatening situations, as a last-ditch attempt to save life, limb, or eyesight. Examples include emergency trauma surgery conducted outside the operating room (such as "on-scene" surgical amputation, cricothyroidotomy, or thoracotomy), or administration of medication (such as certain antibiotics and chemotherapy drugs) at dosage levels high enough to potentially cause serious or fatal side effects.

Cardiopulmonary resuscitation (CPR) is a particularly well-known heroic measure; vigorous chest compressions often result in fracturing one or more of the patient's ribs, but since the alternative is certain death, the technique is accepted as necessary.

People with advanced acquired immunodeficiency syndrome (AIDS) and concomitant pneumocystis pneumonia (PCP) are in serious danger of acute respiratory distress syndrome (ARDS). A heroic rescue could use the chemotherapeutic drug trimetrexate, which would destroy bone marrow as well as the PCP, although leucovorin can protect the marrow.

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In the context of medicine, heroic measures refer to any course of treatment or therapy aimed at saving or prolonging a person's life despite the potential harm that treatment may come with. Heroic measures are almost always used in the scenario of life-threatening situations when all other viable treatment options have failed prior or there is no better treatment option available. The term is not explicitly defined, but rather associated with broader umbrella terms such as advanced care planning and end-of-life care.

Examples

1. CPR

Cardiopulmonary resuscitations (CPR) serves as a popular example of a heroic measure. CPR is an emergency potentially life-saving procedure used when a person’s heart stops beating or is not breathing that involves chest compressions and rescue breathing. While CPR can be considered a standard of care in the healthcare setting, it is often seen as a last-ditch attempt to save a person's life in an emergency. Suppose a person suffers cardiac arrest and is not near adequate medical attention, CPR can be seen as the only viable option to revive the person. Potential consequences of CPR include sternum fracture, rib fracture, lung contusion, artery rupture, and hemorrhage but when the other option is death of the individual, one can argue that CPR was a medically necessary action.

2. Chemotherapy and Radiation

Oftentimes, treatments like chemotherapy and radiation are also considered examples of heroic measures. Chemotherapy is a treatment that uses drugs to target and destroy rapidly-growing cells, like cancer cells. Radiation therapy uses high-energy x-rays to kill cancer cells. In medicine, chemotherapy and radiation is commonly used to treat cancer. Though it can be a very effective treatment for cancer, it does not come without its side effects—some of which are more serious than others. For example, some common side effects of chemotherapy and radiation include: fatigue, hair loss, nausea and vomiting, diarrhea, skin changes, and more. These side effects occur because chemotherapy and radiation kill not only cancer cells, but also normal, healthy cells in the body as well. Some more serious side effects that can also occur as a result of these treatments is damage to other organs in the body like the lungs, kidneys, nerves, heart, or reproductive organs. It is even possible for a second cancer to develop many years after chemotherapy. Although chemotherapy and radiation are commonly used as cancer treatments, there is potential harm to the body that can occur as a result of these treatments. However, sometimes there are no other treatment options available to to treat the cancer and it is necessary to use chemotherapy or radiation in attempts to treat a person with cancer and save their life despite the side effects that can occur.

1. Chemotherapy - especially experimental
2. Transplant
3. Orphan diseases
4. Emergency limb surgeries - reattachment and amputation

Amputations of the limbs depending on the situation is considered heroic measures as the situations often call for drastic measures. In the event that an limb gets physically crushed or is damaged beyond repair, the only to save the body is to remove the affected limbs, similar to the greater good principle. For example, persons with diabetes are at risk of nerve damage if they consistently have high blood sugar. This leaves the affected area at risk for infection and if the infected limb is not removed, it can infect the rest of the body which will most often lead to death. This is also the case with people who leave dangerous infections untreated, the tissue of that limb will begin to die out since there is not enough oxygen to replenish and amputation is the only way to save the person since they will die of sepsis if the infection spreads to the rest of the body. However, one can argue the use of prosthesis after amputations would disqualify this method as an heroic measure but there are also limitations & consequences when to the applications of these. This is more prevalent in isloated areas where medical attention is very far away.

1. Cancer and Geriatrics EOL planning

Often when cancer patients are unsuccessful after experimental chemotherapies, end-of-life planning begins to start since that is usually the last line of resort for the person. Although there are arguments on whether end of life planning should be considered heroic since it does not prolong or save a person's life, similar to throwing the surrender flag up in the air. However, the topic is still relevant as unsuccessful heroic measures will usually lead to certain death as they are last resort. There has been concern for Oncology doctors preferring to introduce end-of-life planning later when others argue that it should be emphasized before experimental chemotherapy starts

Ethical Considerations

Oftentimes, the use of heroic measures is considered when a person is nearing the end of their life. Many healthcare providers try to work with individuals nearing the end of life to discuss ‘end of life planning”, also known as advanced care planning, to get a better understanding of the treatment that person would like to receive. There are many factors that individuals, families, and healthcare teams must consider when choosing a treatment plan for end-of-life care. The topic of a person’s end of life can be a very difficult subject for these individuals, family members, and healthcare providers to discuss, so there can often be misunderstanding between these parties on what type of treatment is best for the patient. Advanced care planning may be difficult for individuals to consider, but it can be a useful tool for families and healthcare providers when determining treatment and the use of heroic measures in the case when the individual is no longer able to make a decision themselves. Generally, taking a heroic measure in attempts to save someone's life towards the end is more costly than pursuing non-heroic measures for treatment. Overall, this raises questions and concerns regarding the cost of a person's life and if this is a factor that should be taken into consideration during end-of-life planning. Additionally, heroic measures taken during end-of-life tend to be more aggressive and raises concerns about quality of life after and if that is worth being compromised to save a life. Given that the use of heroic measures can also be challenging for healthcare providers to discuss, many institutions now have training and certificate programs specially designed to help healthcare providers overcome barriers associated with end-of-life decision-making.