When to pull the plug ~ Is it ethical to stop life support?

[Lisa]

There has been a battle here in Winnipeg between a family and a hospital to keep their 84-year-old brain-injured father who cannot walk, speak, eat or breathe on his own, alive on life support. They are Jewish orthodox and believe that it is against their religion to "hasten his death" and that only god can decide when he should live or die. They received a court injunction back in January of this year which allowed the life support to continue. In recent news, doctors have quit because they feel treating this man is equivalent to "torturing" him as he has extensive bed sores that need treatment.

Now, I have compassion for the family and understanding of their religious beliefs but isn't keeping a man on life support taking "god's" choice away from him? This man is clearly unable to sustain life. To me it seems that they are going completely against the doctrine that they believe they are trying to uphold. It saddens me to think that this man is dying without dignity while his family pushes to keep him alive.

 

[terryl965]

Well back in 1988 I had to make that decission for then my 11 year old son and it was hard but the one thing that help was knowing he was brain dead and had no hope of surviving. I Belive that has alot to do with it. Nobody ever wants there relatives to suffer for the sake of sffering. So when it is clear that nothing good can come from it it is time. Just my opinion on this matter.

 

[Tez3]

It's always going to be difficult to know what to do, we can all have ideas about what is the right but I think this should always be an ethical/moral or even emotional decision never a decision that is made because of the cost of medical treatment which is something that does worry me.

 

[Live True]

They are Jewish orthodox and believe that it is against their religion to "hasten his death" and that only god can decide when he should live or die.

I have to agree with you, and I think these choices have become more difficult and controversial as our medical technologies increase. We can sustain a life far past the "normal" lifespan. 100 years ago, there would have been no debate, because we couldn't artificially keep someone alive. I think that's the important point..."artificially". If someone cannot live without mechanical assistance, you are not hastening death, you are postponing it, and that is diverting divine intent as well, at least to some degree.

I think the movie "dogma" kinda put that whole issue into an interesting perspective.

As said on another thread, this type of comfort is for the living, not the dead. I can't agree with the decision, but I would have a hard time arguing the case with a grieving family.

I

 

[Kacey]

Honestly? It's hard to say. In many ways, it depends on the circumstances.

About 20 years ago, my grandmother (mother's mother) went into respiratory distress, fell into a coma, and was placed on a respirator. She was 80 years old, had end-stage emphysema, Parkinson's Disease, and had contracted pneumonia (the cause of the respiratory distress). After 3 weeks, when her health had not improved, and with the blessing of the Reform rabbi of his congregation (although I suspect Grandpa would have done the same without that blessing), my grandfather had the doctors remove the respirator. The doctors had told him that she would die within minutes; she lived another day... and to this day, I am convinced that she knew the respirator was pulled on her birthday, and was determined to die on another date; she was a strong-willed woman. And I think it was the right decision in her case.

A few months later, my grandfather (father's father - so, the other side of the family) also contracted pneumonia. Because of multiple strokes, his mental capacities were limited - this also meant that he could not be placed on a respirator for his respiratory distress unless he was placed in an artificial coma, or even have an IV in place, because he would become agitated and remove them, with damage to himself. My grandmother was given the choice of treating the pneumonia and letting him die of dehydration (because of his mental state they couldn't hydrate him with an IV, and couldn't get him to drink enough either), or not treating him and letting the fluid in his lungs slowly suffocate him. The latter was deemed less painful and distressing, and that was the choice she made... again, with the support of the Reform rabbi (different Temple - different state, as well). They could have kept him alive - but it would have been existence, not living.

Fast forward to the present. My last living grandparent (my mother's father) is 98 (my other grandmother died in her sleep at 94), and is deaf, nearly blind, has arthritis in his hands and wrists so bad that he can't use his hands, can no longer stand, is incontinent, and suffers from depression, diabetes and high blood pressure. Several weeks ago, he developed a urinary tract infection as well. The nursing home contacted my uncle and aunt, told them about the infection and a couple of other things that had come up recently (such as refusing food), and offered two choices: provide authorization for life support in the future, or hospice care. With the accord of the family, he was placed in hospice, where he is being made comfortable, and the only medication he is still on is for his high blood pressure; he is awake rarely, and lucid even less rarely (my uncle - his son - has medical power of attorney) - we are waiting for him to die, and honestly, for his sake, I wish he would. He is not living now - he is existing - and that is all he has been doing for at least the last year. When Grandma was in the nursing home, Grandpa used to tell us that, before he reached that point, he would shoot himself - and if he couldn't we should do it for him... but that's not legal.

There are as many other possible scenarios as there are people involved in them. As far as life support - I have a DNR (do not resuscitate) on file with my doctor. If it's temporary - say, during surgery - that's okay with me. But I don't want to live that way - and I don't particularly want to linger on, as 3 of my 4 grandparents have done.

The problem with making the decision for someone else is that it is a very emotional decision; in addition, it's a slippery slope to allow life support to be removed at all (as much as I agree that it could - maybe even should - be done so in the case in the article). Where do you draw the line? Who makes the decision? Who decides if a person cannot recover? Is there an age limit? What if the person has no relatives, or they disagree? What if the person's insurance runs out, or they don't have any? What if the insurance will pay indefinitely? What if you know that the person would like the supports removed, but have no written documentation? What if there's a DNR and it's not followed? What about if emergency life support is provided at an accident in violation of a DNR, because the EMTs didn't know about it?

 

[CuongNhuka]

Well, live true basicly said everything I wanted to say. Except, during the Terry Shivo (sp) incidence, my mom told me that if she was in a coma for more then 6 months, she wants the plug pulled. She also wanted the plug pulled if she was brain dead, or unable to move on her own (that is, paralyzed from the neck down). I gotta say, she makes a good point.

 

[Lisa]

I watched my father suffer for 3 1/2 months in intensive care after his surgery. The doctors tried their best to get him back to a sustainable life but he was too weak to do it. I loved him greatly and it still brings a tear to my eye when I think about how much I miss him. That being said, those 3 1/2 months were horrible to go through. Watching him fade away with every breath and watching other members of my family hold on to all hope is nothing I wish on anybody. In the end he asked for things to be turned off and we complied with his wishes. I just wonder what this man would say if he could talk. I bet he is really really tired, just like my dad was.

 

[CoryKS]

Interesting. When Terry Schiavo's parents wanted to stop them from pulling the plug, they were told that they had no legal right because her husband was her legal guardian and had sole right to decide the best course of action.

In this case, the family who has legal guardianship wants to keep him alive, but are told they don't get to make that decision.

Guess the Schiavo's could have saved a lot of money by not indulging the kabuki theater that is our court system, since the doctors are going to do whatever the hell they want to anyway.

 

[Lisa]

Interesting. When Terry Schiavo's parents wanted to stop them from pulling the plug, they were told that they had no legal right because her husband was her legal guardian and had sole right to decide the best course of action.

In this case, the family who has legal guardianship wants to keep him alive, but are told they don't get to make that decision.

Guess the Schiavo's could have saved a lot of money by not indulging the kabuki theater that is our court system, since the doctors are going to do whatever the hell they want to anyway.

Was Schiavo on "life support" or just a feeding tube? I am sorry, but I don't remember. She also had some brain function IIRC, this man has none, although his children claim he squeezes their hand.

 

[CoryKS]

Was Schiavo on "life support" or just a feeding tube? I am sorry, but I don't remember. She also had some brain function IIRC, this man has none, although his children claim he squeezes their hand.

I believe it was a feeding tube. Her brain function was debated as well.

I'm curious about how the doctors can say that keeping him alive is tantamount to torture, while at the same time saying that he has no brain activity. ???

 

[morph4me]

I believe that there's a difference between living, and being alive. I would not want to live and be a burden on my family if I had a machine keeping me alive,unless it was a very temporary thing, that isn't living. When my father was wasting away with pancreatic cancer, it was amazingly easy for my mother and I to sign a DNR for him, easier than watching him suffer and deteriorate. I hope someone would do the same for me.

 

[Live True]

Kacey and others, thank you for sharing such personal and painful memories. My husband and I are currently watching his mother go throught the last stages of Alzheimers, and she is existing, not truly living. It's a sad and painful thing to watch, and I imagine...if she were fully aware (my most horrified fear is that a small part of her is)....that she would not wish to go on this way. I think, with our situation, and so many others....it's just hard to know when to say goodbye.

I know I have discussed with my closest freinds and family (especially husband) my own personal wishes, and I have a living will that I need to sit down and finish. I think that is truly the only way your personal wishes can be known and followed. Make sure your family and closest freinds know your wishes, and then put it in writing. That spares them some of the mental anguish of having to make a decisions, when they are already in pain, and it also makes it more likely that your own wishes will be followed.

If things such as this must happen, then hopefully we can at least find some way to learn from it.

 

[shesulsa]

My mother has been in and out of hospice care, in and out of the hospital and I am watching her ever-so-slowly fade away. She has dementia and congestive heart failure - slow but sure deaths. I *know* without a shadow of a doubt that if she could stand outside herself and witness her existence now, she would ask to die. We've had the talk many times.

Wanting to do the right thing for someone, wanting the right thing to be done are admirable qualities ... but few are prepared, I think, for the moment when the decision must be made.

My mom's life is in my hands (see my myspace blog) and it's a tremendous honor and responsibility.

It most certainly is ethical, IMO, to allow a person as dignified death as they wish. God bless us all.

 

[tshadowchaser]

Sorry if I repeat what others may have said. I have not read the other responses.

Having been placed in this situation I can only say that the answer will be different for each of us depending on our religious believes, our person life experiences( including our work history), and perhaps the circumstances of the event. Each of us has developed in our minds through our lives what we believe to be ethical and moral, and those may not even be the same.
What I think is based on a life time of my personal experience and will differ greatly from what others think. If you are 16, 28, 40, 60 or 90 will change your thought on this subject.
If you have been in the health field, a gardener, a police officer, a military person, or a electrician may all affect the way you see this as will if you where brought up in a strict religious family of one faith or another as compared to someone not brought up so

 

[MA-Caver]

Well back in 1988 I had to make that decission for then my 11 year old son and it was hard but the one thing that help was knowing he was brain dead and had no hope of surviving. I believe that has a lot to do with it. Nobody ever wants there relatives to suffer for the sake of suffering. So when it is clear that nothing good can come from it it is time. Just my opinion on this matter.

Agreed Terry. Bows low respectfully.

To me if a body cannot sustain itself while OFF life support then it's only prolonging death and not life. I can understand the family wanting to obey God and allowing God's will to work in their lives but they're probably prolonging the father's death rather his life. They're doing it for their sake and not for the father on the hospital bed. They don't want to let go. Understandably it's the hardest thing for a lot of people to do but if it's time then it's time. Artificially sustaining life when the body/mind no longer can function on it's own is not a kind thing. It's only kind to the family/friends. To me it's a selfish act.
Let them go, grieve fully and always remember fondly the happiest of memories of your time with that person. In that way they live forever.

 

[cdunn]

This is something I occasionally struggle with in my own concience. I have had the discussion with my mother about under what conditions she wishes DNR. But as someone who has personally benefitted from the order to 'keep him alive at all costs', the emotional impact is somewhat higher.

There is a point at which a person's body is failing massively, and it's time to let go. There is a point at which a human body is just an empty shell, with a few automatic functions left and it's time to let go. We owe these people every effort to find out if there is a sentient human being left in there. If there is, they deserve the right to decide for themselves. If there is not, then, I believe that Caver is correct.

This puts me in a very, very strange position. I do not know how many medical opionins my parents sought out, but had multiple, experienced doctors from other hospitals, unaffiliated with the one I was born at, had the same prognosis for me as the first, now, as a rational adult, I would have ordered myself taken off the respiratory aids and let myself asphyxiate. Mother chose to fight it. In retrospect, it was the better decision for me to be kept alive; instead of the life-as-an-inanimate-object that was medically expected of me, I am a (reasonably) healthy and productive individual. Even so, I cannot consider the circumstances, and say that it would have been wrong for me to have been allowed to die.

 

[Empty Hands]

We all have to go sometime, what is the wisdom of extending physical function for a few months while nothing mental is there? Or of keeping someone alive against their wishes? Where is the dignity in that? We are a curious species, in that we treat our pets with more compassion and dignity than we do our loved ones.