Adrenaline or salt water. Changes to the way heart attack patients are treated.

[Darkesteyes]

Just seen a report on Newsnight. Instead of injecting with adrenaline some patients (but we wont know which ones until afterwards) will be injected with saltwater as a placebo. It is to see if adrenaline causes more harm than good.
DH has heart disease. He called this an experiment. And i certainly see his point. He says its obviously to "kill some people off" He got quite upset. What do MNers think of this?

How do you remove the risk that people declining for the data to be included skews the results and therefore makes the whole trial useless?

Why should you have to opt out? What about those from outside the area/don't speak English/for other reasons don't know about it? Why can't these people just act in an ethical and professional manner? Its called common courtesy, but then the NHS doesn't understand that, does it? It would rather use dead people for research without consent and knowledge of relatives. The NHS never learns.

But the whole point is it is about saving someone's life , it is about saving everyone's life should they be in the situation of being in cardiac arrest , it is about ensuring everyone gets the best known treatment in that situation , how in any way can you perceive that as being a bad thing ?
I am honestly struggling to understand where you are coming from when the data is confidential anyway .

Odd - people have the right to decline. Its tough. If it skews the data, tough. Perhaps if the NHS treated people with respect, perhaps people would be happy to help.

I think we should just withdraw it's use altogether. As we do not know if it is beneficial that is really the only ethical thing to do.

Well that's what happened with atropine.

It will probably also happen with amiodarone.

The NHS does learn , which is exactly why they want to do this , to improve the outcomes for everyone .

And the risk of skewing the data should also not be used by researchers as an excuse not to seek consent.

frumpet - the NHS does not learn about treating people with respect. There has been Inquiry after Inquiry where patients have been treated like crap. And this occasion is where it is the Ethics Committee themselves are doing it. Those who should be responsible for looking after patients' dignity.

If I was in cardiac arrest I would not want my nok to have the right to withhold data that may help other people. Have you thought of a way of allowing for this? It would wreck my personal autonomy if they did have that right.

I guess we will have to disagree ethically psuedonym , my leaning has always been towards the greater good for all .

NCIS - do whatever with adrenaline. I couldn't care less. Just don't involve me in research without asking me (or my NoK if the NHS has killed me...)

You also have not answered my suggestion that we withdraw the use of adrenaline in ALS as it has not been clinically proven to be of benefit so following your reasoning Pseudonym99 it cannot be ethical to continue to use it. After all, no one consents to it's use at present.

frumptet - we will have to disagree. I would much rather I was looked after above the masses, but in return I will always do what I can for others if given my own free will and asked first.

NCIS - a NoK is more likely to know your wishes than a stranger would. It would be your problem if you are willing to stay with someone who would not be willing to act in your best interests. But also, a NoK's opinion may also be important to a patient, as the patient may incluse the NoK's wishes in their decision making process.

If you couldn't care less then your arguments have no value. It really doesn't matter what we do, and we wouldn't have to spend time and money on research.

So if you suffer a cardiac arrest on the street the NHS is responsible for killing you ?

The person you 'stay with' is not necessarily your legal NOK.

Or is it just a case of everyone who dies whilst in hospital is killed by the NHS ?

NCIS, to be honest, in the current climate in the move away from asking people for consent, such as Summary Care Records, care.data, Presumed consent for organ donation in Wales, I would rather not be given anything if I hadn't been asked first. Regardless of the likely outcome.

If it wasn't for people like me kicking up a fuss, we wouldn't even have Ethics Committes, and researchers would have a free reign to do whatever they wanted.

NCIS, there i

If you request consent afterwards you risk changing the nature of the sample which may make the research inadequate.

You are also asking for consent after they have participated in the trial which makes it pretty pointless, regardless of whether their data is used.

One last point. How would you go about sitting down with the parent of someone who has just been killed in an accident and asking them, alongside whether their son or daughter's organs can be used for transplantation, whether you can use the fact that their son or daughter was used in a clinical trial, for which it was impossible to obtain prior consent, to collect data for a clinical trial to help those who survive the very thing that just killed their child?

IMO that would be unnecessarily distressing and highly unethical and would make the trial impossible to carry out.

The issues that have arisen when NOK's can make decisions about organ donation regardless of donor cards etc plainly show that your wishes may hold little sway with nok post death.

Plus you have been asked first about this, if you can't be bothered to decide then that is your problem. Perhaps if you have a cardiac arrest we won't cannulate/intubate/use a lucas device on you. After all you haven't consented. Relatives are often very adverse to a Lucas device being used as it looks barbaric despite it offering the very best compressions so perhaps they should be allowed to withhold consent.

NCIS, there is no legal definition of NoK.

If it wasn't for people like me kicking up a fuss, we wouldn't even have Ethics Committes,

Quite possibly true but it doesn't mean you are always right

I think the presumed consent thing with regards organ donation is because NOK often went against the direct wishes of their relative reardless of the evidence of the wishes . That subject is always going to be an emotive one though because you are rarely dealing with people at their most lucid given the grief that they are experiencing .