Life Support - How do you Pull the Plug?

[bluechocolate]

My mother is going through a very rough time at the moment.

 

Her brother, obviously my uncle, was admitted to hospital on Christmas Eve. He has been in an ICU & being kept alive by machines since. The hospital wants her to pull the plug. He can no longer breath of his own accord & his blood pressure is extremely low. Since April of this year he has been unable to eat & is being fed by tube directly into his stomach. The current crisis is a result of that. Food & liquid were getting into his lungs because the muscle closing the appropriate part of his esophagus stopped functioning properly & it can't be fixed.

 

The problem is he's lucid. He's awake and aware. She has asked him & he has said he doesn't want to die.

 

The doctor said, "If you throw a drowning man a rope, even when it's inevitable that he's going to die, he'll still try to grab the rope".

 

Mom would have no problem with this decision if he were in a coma, but he's not, and according to the doctors it's unlikely that he ever will be. Their stance is that he cannot remain on these machines for much longer. There is no chance he'll recover.

 

What a terrible position to be in. I really feel for her (as well as my uncle).

 

As a result of this she's told me that she is drawing up a living will. She does not want to be kept alive artificially when there is no chance of recovery & does not want to put another family member through this ordeal. I think I'm going to do the same.

 

What would you do? How do you look your brother in the eye & perform an action or give consent to an action, that will end his life?

[Outcast]

The doctor said, "If you throw a drowning man a rope, even when it's inevitable that he's going to die, he'll still try to grab the rope".

 

This is appalling Can she move him to another hospital? She needs to report this idiot to the AMA and even her local political representatives if she can.

 

If the man is lucid and wants to live, nobody but nobody should be allowed to put him to death - that certainly constitutes 'execution' rather than 'euthanasia'. In fact, she could possibly report that doctor to the police. Murder is murder.

 

They kept Terry Schiavo alive for years even though she was pretty much in the same state as your uncle. There is zero legal authority to end the life of a lucid, living human.

 

Unbelievable.

[Art_Critic]

Sorry for what your family is going thru.. My heart goes out to you and your family..

 

I have always had a living will since 18 and my brother gets to pull my plug and vise versa....Both of our wishes are in writing..

You want to pick someone as the power of attorney that really will go thru with your wishes..

 

I think if I was in a position where the person didn't have a living will I would weigh the future happiness and quality of life they would have on the machines verses my guilt and how I would live with the decision..As well as any leag matters that might arise.

 

 

A toughie...

 

God Bless...

[bluechocolate]

This is appalling Can she move him to another hospital? She needs to report this idiot to the AMA and even her local political representatives if she can.

 

That was my first reaction. The reality is he will not recover. My mother accepts that. His lungs are fried so even a respirator (ala Christopher Reeve) would not work for him. My understanding is that he can't stay on the machines for long, not because they need to free up space, but his body can't take it much longer.

 

My uncle has been paralysed down one side of his body for most of his adult life. Never the less, he's had a fairly normal existence, until now. The really hurtful thing for my mother is that she sees that what people see is a man who shouldn't be alive. Some people speak as if he isn't there or as if he's mentally retarded, which he isn't. Can you believe that one doctor told her that he's lived 50 years longer than he should have?

 

The next logical thing to say would be to wait until he dies whilst still on life support, which they say is inevitable. He can't have morphine because that slows your breathing, so no doubt he is in pain. If they take the life support off he will drown, which can take anywhere from an hour to a day! How horrible is that?!

[bluechocolate]

Sorry for what your family is going thru.. My heart goes out to you and your family..

 

A toughie...

 

God Bless...

 

Thanks Art_Critic. It is a toughie.

 

I haven't given a living will much thought, until now.

[EnigmaXOXO]

The problem is he's lucid. He's awake and aware. She has asked him & he has said he doesn't want to die.

 

Doesn't this indicate brain function, which means he can "feel"? To pull the plug now means an agonizing death from suffocation or slow starvation. Not to mention that the last moments of his life may very well be filled terror and fear.

 

Whether pumped full of morphine or sedated, that's still murder if the man has already made clear his desire to live.

 

The doctor said, "If you throw a drowning man a rope, even when it's inevitable that he's going to die, he'll still try to grab the rope".

 

His ethics and bedside manner are appalling. I'd strap the ol' doc to your uncle's gurney, throw him in the river … then deny him his "rope."

 

I'm left wondering if what the hospital proposes to do (to free up a bed) would even be considered legal?

[JS17]

I'm sorry for what you're going through. What a gut wrenching thing to have to deal with.

[Outcast]

The next logical thing to say would be to wait until he dies whilst still on life support, which they say is inevitable.

 

Exactly. He has the option of nodding 'yes' at any time as long as he's lucid. Maybe the question which should be asked of him is whether he wants the deed done if he slips into a coma.

 

It is an awful situation and I'm sure she has a lot on her mind but I definitely think those callous physicians should suffer some repercussions.

[bluechocolate]

Doesn't this indicate brain function, which means he can "feel"? To pull the plug now means an agonizing death from suffocation or slow starvation. Not to mention that the last moments of his life may very well be filled terror and fear.

 

That is exactly what my mother is thinking.

 

It is an awful situation and I'm sure she has a lot on her mind but I definitely think those callous physicians should suffer some repercussions.

 

Doctors are a strange lot. Surgeons and specialists even more so. A friend of mine, who is an O.R. Nurse addresses them all Mr. God.

 

 

My mother is having a meeting with the head of ICU on New Years Day & they're going over it all again in detail.

 

My prayer is that he dies of his own accord before then.

[Outcast]

Doctors are a strange lot. Surgeons and specialists even more so. A friend of mine, who is an O.R. Nurse addresses them all Mr. God

 

Nonetheless, they aren't exempt from the law when the patient is lucid and able to indicate consent or lack thereof. I seriously would consider involving police. Dr. Dude may think he's God, but the law doesn't allow any human to declare himself so, even a physician. Imagine if your mom couldn't visit your uncle and he was left to the mercy of this idiot? There could be people there in that situation this very moment

[bluechocolate]

Nonetheless, they aren't exempt from the law when the patient is lucid and able to indicate consent or lack thereof.

 

That is a very good point, one which I will bring up with my mother when I speak to her tomorrow.

 

Yesterday he was getting upset (he can't talk clearly with numerous tubes in his mouth) and mom finally figured out that he wanted to go to the toilet and didn't want to s*** the bed! This is what she is dealing with (not the toilet part, but the fact that here is a man with enough dignity & clarity of mind to know that he doesn't want to soil the bed and a hospital which wants her to take an active part in ending his life).

 

What are your thoughts regarding a living will?

[HokeyReligions]

 

The doctor said, "If you throw a drowning man a rope, even when it's inevitable that he's going to die, he'll still try to grab the rope".

 

This is horrible! NO doctor should say something like that. Get a second and third opinion.

 

If your uncle is lucid and its his wish to continue to live then the decision is HIS and any doctor or medical facility must respect that.

 

I feel for you, I've been in that position before and have been going through a medical crisis with my own mother where we have discussed ending her life- she's been to the point of praying to die and wanting it to be over several times and we've been told it could be any time, but NO doctor has ever EVER hinted at withholding any of her treatments and even though she has a living will that directs no CPR or feeding tube or chest compressions, etc. if in the last second she says "save me" they will.

 

Hug your mom and stay with her. If she can't make the phone calls to get another opinion, then you make them. What about hospice care? Is your Uncle under any hospice? They have people who will help the family during this time and once under hospice your Uncle will see another doctor who will hopefully have a better bed-side manner and nurses with compassion and understand and know when to use a tough side and when not.

[Outcast]

I think living wills are brilliant - relatives want what their loved one wants but if the loved one isn't able to convey a message (unlike your uncle, who is), then you save them endless amounts of agony by being clear about what you want. They may not like what you want but they at least know what it is.

[bluetuesday]

My prayer is that he dies of his own accord before then.

 

i will join you in this prayer, if i may.

 

oh choccy, this is an extremely upsetting story. i'm so sorry.

 

doctors' ethical and legal obligations are not negated when a patient is dying. terminally ill patients have as many rights as you and i while they can give their consent or not for treatment. that's british law (i assume you're still here?) and it's the oath this doctor will have sworn to follow.

 

i'm appalled at his comments and actions and would certainly consider making a complaint to the BMA or the hospital trust about it.

 

how frightened your poor uncle must be. it is heartbreaking. but while he remains conscious and lucid he is in control of what happens to him. it is only when that state has passed that your mother, or anyone else, should be asked to make such a difficult decision on his behalf.

 

of course he does not want to die. it's probably a moot point but has he been asked whether he wants to live - given the prognosis he must surely be aware of?

 

i don't know, it's just a thought. if he's conscious but limited in his responses, it's possible he would give a different answer to the question 'do you want to die?' than the question 'would you like me to help your last moments of life more bearable?'

 

if the life support is removed, i would assume he could then be given mophine, which would probably hasten the drowning process of his lungs failing but would remove any pain. and give your mum and the rest of the family the comfort that he didn't die a frightened man.

 

may god be with you all.

[bluechocolate]

Hoke & b/tuesday

 

thank you - I have to get some sleep now so will reply further tomorrow.

 

i will join you in this prayer, if i may.

 

 

Please do.

[Becoming]

This is unconscionable and quite possibly illegal. If the patient is lucid and can give or withhold consent, it is not your mother's place to make that decision; it's your uncle's. Indeed, your mother could be held liable for his death if she makes that decision when your uncle can do so.

 

I'd be contacting a lawyer. If you have access to hospice care, contact hospice. They're absolutely fantastic with end-of-life issues and support of the family.

 

More prayers, BC.

[suegail]

this whole thing just isn't right. And I don't understand the logic of not giving morphine due to his breathing problems....for goodness sake...the man is on a ventilator....you don't have to be concerned about slowing his respirations down because you're breathing for him. I'm a nurse...we do it all the time. You worry when someone who is very compromised is not tubed and you've got narcotics on board...yeah...then it's a problem.

 

And this just isn't right. People do live for years on end on ventilators. I just don't trust the judgement of the doctor your uncle is under the care of. I would certainly want another doctor to take over the case and maybe another hospital...I would want him transferred if they can't get someone with some common sense and some actual knowledge of what they're dealing with. Your mom is the only advocate he has right now....I hope and pray she'll start making some serious demands.

[933KJL]

I know where you are coming from. I had to essentially pull th eplug on my mom in October and it is never an easy decision. I am not sure that the doctor is guilty of anythign other than perhaps a horrible bedside manner. From what I gather, death is imminent on life support.

 

You say he is in pain without the morphine, so that is a horrible way to die.

 

I also recommend contacting Hospice if only for a consult--they are wonderful compassionate caring people. I imagine the solution will be to give him the morphine needed to ease the pain and let him die as peacefully as possible.

 

On your own business--yes a Living Will is a must have as well as a DNR (Do Not Resuscitate) Order.

 

I too am sorry you are going through this and my thoughts and prayers are with your family at this tought time. WHen you can, please keep us posted.

 

John'

[Lonestar]

I'm so sorry, blue. What a tough thing your family is going through. If I were in the same situation, I would not pull the plug. My brother died three years ago this month. He died in his sleep, so it was peaceful and he never knew, but if he was in a hospital telling me he didn't want to die and his brain was still functioning, I would let him fight death until natural causes took him away. Many humans want to go down fighting. Let him die fighting.

[bluechocolate]

Thank you people.

 

Good news - he started breathing on his own the other day and he's been moved out of ICU and into a regular room. He's off the respirator & getting oxygen via a mask. The really sick thing is had my mother done what the doctor requested he would now be dead! When she put this to the doctor his response was, "we were looking long term".

 

Bad news - there is no hope of a recovery, one lung is useless, the other only working at something like 50%, so she'll probably be going through this again soon. All of the life support machinery was very traumatic on him & I don't think she's going to want to put him through that again. But as she says, "we'll cross the road when we get to it".

 

More bad news - it doesn't rain but it pours. One of my Aunt's, this time on my father side, died this morning.

 

I'm thinking of bulk-buying sympathy cards.

[Becoming]

While your uncle's cognizant, he needs to sign papers regarding what he wants done--a do not resucitate order, for example.

 

What about the morphine issue? Will he be allowed to go gently and pain free?

[EnigmaXOXO]

Thanks for the update, Blue.

 

I know doctors are always under the obligation to inform relatives to prepare them for the worst so as not to give false hope. Age, physical condition and the willingness of the patient to carry on has a lot to do with the quality and length of time they have left.

 

As a side note … my mother was diagnosed with terminal lung and brain cancer and was given 6 months to a year to live. That was in 1986, and she has been in full remission ever since. The excellent medical team at John's Hopkins never gave up on her in spite of the bleak prognosis … and being given 'no hope' was the catalyst she needed to keep fighting. Even it were only to squeeze out another full year.

 

My parents have since drafted a living will and have requested no life support should it come to that. Without it, I don't think I could ever make the decision to pull the plug on my own, especially after witnessing my mother's miraculous come back.

[EnigmaXOXO]

:o

 

By the way, Blue. I hope you don't mind my bad humor and poor attempt to make you smile:

 

But if I were your Uncle and had a doc with an itchy trigger finger … I'll be darned if I wouldn't use my good lung to unstrap myself from that gurney; grab my IV pole; and run for the exit too!

[NatoPMT]

Blue - my thoughts are with you

 

The hospitals are about turnover and turnaround, its not the right environment for him to be in, can you make enquiries about him being moved to a hospice now he is in a less critical state?

 

When my aunt died, i knew what time the plug was being pulled and even though i am not overly religious, i walked for 2 miles in the rain trying to find an open church, eventually, i knocked on a vicarge door and the vicars wife said a prayer with me to receive my aunt. I felt Id done something for her even though i couldnt do anything.

 

hope that helps some way

[bluechocolate]

:o

 

By the way, Blue. I hope you don't mind my bad humor and poor attempt to make you smile:

 

But if I were your Uncle and had a doc with an itchy trigger finger … I'll be darned if I wouldn't use my good lung to unstrap myself from that gurney; grab my IV pole; and run for the exit too!

No worries !

 

He's a feisty bugger, always has been. He has one good arm & 2 days ago really starting banging the bed & trying to pull tubes out. They had to strap him down. If he could he would probably bash the doctors & the nurses before running for the exit.

 

It's been really tough on him 'cause he's being fed directly into his stomach since April & he's always loved his food! At least he can start listening to radio again & watching movies.

 

The hospitals are about turnover and turnaround, its not the right environment for him to be in, can you make enquiries about him being moved to a hospice now he is in a less critical state?

That is what I feel about hospitals. I've mentioned hospice care to my Mother but we haven't really gotten into too much. Now that he's out of ICU we should be able to consider more options.

 

With my Father's sister dying suddenly this morning I'm afraid Mom is going to be even more stretched. Dad has always been a wuss about this kind of stuff.

 

Thanks for the link - it looks like a good start.

While your uncle's cognizant, he needs to sign papers regarding what he wants done--a do not resuscitate order, for example.

 

What about the morphine issue? Will he be allowed to go gently and pain free?

I'm going to ask her again about his legal capacity. Even though he could communicate whilst in ICU, albeit only nodding & pointing, he was considered mentally incapacitated. I'm not sure what the situation with that is now.

 

And yes, he will be able to go gently & pain free.

 

 

Thanks again folks.