WHEN TO END LIFE SUPPORT
Jessica Russo
Many people have different views on life support and if a certain person, such as their loved ones should stay on life support until a “miracle” happens and they wake up, or take the other option and let them pass. But there are different types of issues that should be considered when it is necessary to end life support to those who are in comas. A coma is an unresponsiveness from the patient that cannot be aroused. Meaning, the person is not awake and does not react to stimuli, light or sound. If the person with a brain injury remains in a comatose state (coma), and there is no clear reason for this, it is likely for them to get out of the coma and get a good evaluation. The evaluation is to distinguish
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While in this state they lose their higher brain functions but other important functions such a breathing and circulation remain. They are unable to understand or respond to commands and cannot talk. They also do not have any control over their bowel movements. This type of issue can be considered in decisions to ending life support.
Another issue that can be considered is brain death. Brain death is the complete loss of brain function. Some signs to brain death is the patient’s pupils not responding to light or their body not showing a reaction to pain. They also lose gagging reflexes when something touches the back of their throat. Even though this type of issue is not the same as a coma since the person is considered “dead” and when someone is in a coma they are still alive, this could be a consideration to end the life support as well.
The best way for someone to see the brain activity and how it is functioning to tell future decisions, is a PET scan. A PET scan is short for positron emission tomography which shows how the brain and tissues are working. It is a radioactive substances that tracks injuries or diseases within the brain. Another scan that can be used is an MRI. An MRI is short for magnetic resonance imaging which is a scan in the head to be able to see trauma to the brain which shows as bleeding or
Death is a frequent visitor of the intensive care unit; patients in this area are at the very peak of their illnesses, many of them being nonverbal. As well as figuring out how to communicate with your patients, one might also have to accept the fact that the case could be medically futile and nothing can be done other than make the patient as comfortable as you can for the remainder of their stay. Recent news headlines have brought this topic closer to home, often if you are not in the health care field or studying to enter the health care field you may hear about these topics on television or the radio but they do not take up place in your conscious thoughts. Hearing about Brittany Maynard made me stop and ask myself what would I do, if I were in her shoes, or if I was a nurse in the hospital that was treating her, and the answer is I do not know. Ethical dilemmas such as this are complicated and there is often not a black and white answer, we live in the gray areas, it is about finding what is right for that patient and being able to accept the fact that their beliefs may not be the same as your
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
Until this century, it was rare that brain-dead patients could be kept alive for long periods of time. However, as technological prowess has increased, it has recently become possible to keep a patient alive without higher brain functioning for years and even decades. But, as is always the case with new technology and knowledge, previously unknown ethical issues arise, and thus we have the difficult ethical problems of the Karen Ann Quinlan case.
It is important that patients and family members understand the conditions under which the patient is suffering from. People have an obligation of preparing themselves for end of live. This can be done by writing a will or an Advance Directive to guide the medical personnel and family members on what the patient wants. It can also be done by assigning a medical care proxy to decide on the patients behalf (Groopman and Hartzband, 2011). Medical personnel need to consider the patients wish and act as per the law when deciding on end-life options. Most of the decisions made by terminally ill patients are biased and compromised.
Ethics are always going to be an issue because of the different race, belief, etc. But should pulling the plug on life-support be a part of that issue? Absolutely not.
There are places where patients receive Euthanasia, and although the people in the vegetative state cannot see, the peace is something that you don’t need to see to feel it. Also, Euthanasia will save money to the family, as reported by The New York State Department of Health, “Under any new system of health care delivery, as at present, it will be far less costly to give a lethal injection than to care for a patient throughout the dying process." Besides, there is no reason to keep a person alive if there is not a possibility of recover it would only affect the economy. As stated by the Medical Billing Advocates of America, “as many people have seen, the final cost associated with life support can be an enormous burden once that loved one has passed away.” Contrasting the cost of Euthanasia with the cost of keeping someone alive, the results show a considerable difference of spend that if possible should be avoided. Nevertheless, there are cases where it is worthy to spend all this money, for example, if there is hope of a recovery, the family will never consider any amount of money too much for a second chance in their relative
Advance directives might have many guidelines for patient’s preferences with regard to any number of life-affecting, or end of life situations, such as chronic disease or accident resulting in traumatic injury. It can include directions for other health situations, such as short-term unconsciousness, impairment by Alzheimer disease or dementia. These guidelines may consider do-not- resuscitate (DNR) orders if the heart or breathing stops, tube-feeding, or organ and tissue donation. The directive might name a specific person, or proxy, to direct care or may be very general with only basic instructions given for treatment in time of the incapacitation of a patient. Some states say that if you do not have a written directive, a spoken directive is acceptable.
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Others will argue that if a patient is terminally ill, they are not in the correct mindset to make that decision. Although, what opposers fail to recognize or acknowledge is what the person is going through. Like how I mentioned earlier that the pain they are experiencing is unimaginable. When you are in pain, you want it to be over as soon as possible. We all know when enough is enough. This kind of pain is prolonged and more severe like the heart racing. There are other ways for stopping pain, minimal pain, but this pain is way too severe to stop with some medication. The only way to stop it is to end it all at
...e that is breathing for them, or allowing someone to be in coma with no brain waves and simply existing is counterproductive to technology. We need to have a human say in when technology is simply enabling us to exist as machines. In those times, we need the right to say it is time to die.
The term brain death is defined as loss of function to the brain that is irreversible in all parts, even the brain stem. Brain death can happen to someone who has suffered a massive head injury. There is a series of tests, if result positively, can mean that the person is clinically deceased. First, there is a look at medical history to find prior brain dysfunctions. The cause of the possible brain death is then looked at to determine if it is possible to be reversed. If there is no evidence of medications being the cause of the brain death, there is a complete neurological exam taken. This exam includes: checking to see if there is a response to stimuli, not including spinal reflexes, pupils are absent and have no response to light, there are no facial or eye movements, no gag ...
Assisted suicide brings up one of the biggest moral debates currently circulating in America. Physician assisted suicide allows a patient to be informed, including counseling about and prescribing lethal doses of drugs, and allowed to decide, with the help of a doctor, to commit suicide. There are so many questions about assisted suicide and no clear answers. Should assisted suicide be allowed only for the terminally ill, or for everyone? What does it actually mean to assist in a suicide? What will the consequences of legalizing assisted suicide be? What protection will there be to protect innocent people? Is it (morally) right or wrong? Those who are considered “pro-death”, believe that being able to choose how one dies is one’s own right.
There are many legal aspects that go into declaring what is and what is not brain death. In today’s society, many people, including medical professionals, judges and attorneys struggle to identify what exactly constitutes as brain death. According to, Smith“ the concept of brain death came about during the 1950’s when, as a consequence of developments in critical care, clinicians were faced for the first time with the prospect of an apparently ‘alive’ patient sustained by mechanical ventilation long after brain function had ceased”(Smith, 2011).
hospital bed oblivious to the world around you, unable to move or show any signs
According to the Pittsburg Protocol, death is currently defined as the irreversible cessation of neurological or cardiopulmonary function.1 More specifically, brain death is defined as the irreversible cessation of the entire brain (including the brain stem), and cardiac death is defined as irreversible cessation of circulatory and respiratory functions.1 Even though the definitions seem clearly defined, issues have developed in regards to the amount of time allotted before declaration of death after cardiac arrest and regarding the possibility of resuscitation.