Hospital "Votes" To Ends Patient's Life Against Family's Wishes

[Bullypulpit]

If the patient and the family both want treatment to continue I don't see how its any of the hospitals business to make any decisions for them. Taking people off life support machines is quite common. It's the ethical cicumstances surrounding the process that causes people to rethink the situation.

If the patient is actively dying, despite anything which can be done, the hospital will make every attempt to honor the wishes of the patient and the family. All the while, the hospital chaplains, social workers and healthcare team will work with the family to give the information and the time needed to come to a decision which will bring a resolution to their quandary. If the patient is stable enough to transport to a skilled nursing facility, the hospital will make arrangements for the transfer and they will recieve the care they need there.

But all too often the patient simply cannot tolerate transport, and the patient remains where they are until nature takes its course, despite the best efforts of modern medicine.

Let me offer you an example from personal experience.

An 89 year old woman suffered a massive stroke at home. 911 was called, the patient was intubated on the scene and transported to the ER while being supported by ACLS. By the time she reached the ER, an irregular heart rhythm was achieved, she was unable to breath on her own, her EEG was flat as a strap. left to her own, she would have died a natural death moments after the ventilator was removed, which she later did with the vent in place.
When she reached the ICU where I worked, her pupils were fixed and dilated...her heart rate was irregular...her B/P via an a-line was 50's/30's...the ventilator was set at 20 BPM, she was not breathing on her own...her oxygen saturation was 70% despite the PO2 being set at 50%. In short, she was dead, and her body would have soon caught up with her had it been allowed. But the family was in denial, every so often, a muscle would spasm involuntarily, and her grandson would whisper, "Look, gramma moved!" An hour later she coded, and she was pronounced 20 minutes after that.

But the sad fact is that a nation fed a steady diet of ER episodes where the patient codes and is up and smiling an hour later has come to develop some seriously unrealistic expectations. The fact is that a majority of the patients who code don't make it. It's a painful thing to see those false expectations shattered.

 

[Bullypulpit]

Actually... I can see the logic in what you describe here. Treatment must be shifted from preserving life to ease pain and agony at some point. And it must be a tough job to handle the greif of both patients and family.
It was that last little paragraph you wrote about Gods will and pointing fingers that seemed almost a bit out of place. The mentioning of how doctors was portrayed as "playing god" and then refering to Gods will.

The situation referred to here is quite rare isn't it? I have never heard of anything like it.


I've thought about this a bit. I think sometimes "the best we can" isn't equal to sustain life. (I guess it isn't what you say here either)

Indeed, treament modalities often need to be shifted from the curative to the palliative but because of the misconceptions most people have about life and death, this option is all too often ignored. Until we, as a nation, come to a realistic assessment of life and death, we will continue to see tragedies such as Mrs. Clark's played out. And it happens every day.

 

[Diuretic]

Sober points indeed. And well made. Much to think of there.

 

[ErikViking]

If the patient and the family both want treatment to continue I don't see how its any of the hospitals business to make any decisions for them. Taking people off life support machines is quite common. It's the ethical cicumstances surrounding the process that causes people to rethink the situation.

I can't argue about that, but I think the question is a little too complex to be answered in just a few words. If I still would try I guess I would instead try to establish the required respect and devotion towards patients and families.

That something went wrong in this case is clear and there is a lesson to be learned. But I won't pretend to know exactly what.