Have you made a living will? Would you want to be kept alive at all costs even though you are not aware of your surroundings and the chance of recovery is next to nothing? The issues surrounding life support can be quite controversial.
Medpage today reports on a case where doctors were ordered to continue end-of-life care for one Samuel Golubchuk. Samuel was an 84 year old man admitted to a hospital in October of 2007 with pneumonia and pulmonary hypertension, as his health deteriorated he was moved to the ICU. Samuel, who was placed on life support, grew progressively worse.
Samuel’s attending physician spent 10 days discussing the issue with family members – however the family refused to withdraw life-support sharing that to do so is essentially murder. The family was able to get continued treatment for Samuel by court order.
Samuel eventually died on June 25th, after approximately eight months on life support. During that time he “developed pressure sores because his failing circulatory system couldn’t provide enough blood flow to the affected areas.” Dr Kumar revels in an email interview that “I thought it was quite likely he would die from this if not aggressively and routinely debrided. However, if the kind of debridement he needed was provided, by the end he would have had little flesh left between his knees and the small of his back”. According to Dr. Kumar this procedure is tantamount to torture, as it was both painful and medically futile.
What can be done in situations such as these? First of all, have a living will. Let friends and family members know exactly what you would want to happen if you were to be in a similar state. According to the article in MedPage today, there is a lot of gray area when it comes to these types of situations. The College of Physicians and Surgeons of Manitoba guidelines leaves the decision to end life support with the treating physician. The American Medical Association doesn’t state who has the responsibility of determining whether or not to continue life support – it does however: “enjoins its members to respect patient autonomy and to make ‘reasonable efforts’ to figure out what a patient would have wanted, including consulting family members or other patient surrogates, asking ethics committees, or even going to court.”
Texas on the other hand does back up its doctors. Under the Texas Advance Directives Act, “a doctor can refuse to continue ‘inappropriate’ life-support. The issue is then referred to an ethics committee and if the committee agrees with the doctor, the patient’s surrogate has 10 days to either accept the ruling or find another facility that will continue the life-support.”
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