The patient has presented with brain trauma but not brain death. They are unresponsive. Half of the family insists they would not want to live this way and should be taken off of life support while the other half insists that that is inhumane and some family members stand to gain a large inheritance if the patient is deceased.
Ethical Issues
The patient is considered brain dead; parts of the brain responsible for higher thinking are no longer functioning. According to Elizabeth Price-Foley’s article “Blurred Lines: Redefining Life and Death”, published in Brain: A Journal of Neurology, when an individual’s cerebral cortex shuts down, the person has lost the essence of who they were (1332). Memories, thinking, self-awareness, personality, and emotions are all ruined. Who the person was is effectively erased with no significant chance of retrieval. In this way they are also dead. The patient is a shell of the former being they once were, incapable of performing actions of their own volition. In this way, doctors are merely keeping alive a human casing. Foley asks in her article whether it is ethically sound to do this or if doctors sometimes do it for ulterior medical purposes, such as keeping organs fresh for other patients (1333). To do so would be ethically sound with the permission of the family but ethically remiss if done so without the family’s knowledge. Medically, their body is being kept alive by a machine.
While many consider it unethical to allow a patient in a vegetative state to continue to live, the preferred method of death is also considered unethical. Typically patient’s feeding tubes are withdrawn. The body is allowed to starve to death, and the patient dies. In this specific case this would be considered particularly inhumane because the patient is not showing signs of complete brain death. It is unclear if the patient can feel pain or not. To withdraw feeding tubes and allow the patient to starve to death could mean that the doctors are torturing the patient. Even if they are unaware, to do so is unethical. To withdraw feeding tubes or life support without the patient’s written consent or the consent of a significant other or guarding may also be considered unethical.
Legal Issues
The legal implications with such a case are sometimes dependent on the state in which the patient is receiving care. Sometimes it is also dependent on the state in which their body is in when they receive care or even their gender. In Texas it is a law that if a woman is pregnant, under no circumstances is she to be denied life-saving treatment. As a result, when a pregnant woman had blood clot in her lungs that resulted in brain damage leading to brain death, she was put on life support. Despite the fact that the damage to her brain and body has also damaged the developing fetus within her, and the fact that her husband had asked that she be removed from life support, because she was pregnant when she was brought to the hospital, her state laws superseded her husband’s wishes. The woman’s husband had to sue the hospital in order to ensure that his wishes were met.
In other cases, such as the infamous Terry Schiavo case,, documented in an article published in Annals of Internal Medicine, if no written request to be removed from life support exists it can make legalities an issue . Schiavo had no living will. A Right to Life case was held, wherein 18 witnesses were called in an effort to determine what Schiavo’s wishes would be if she were in a vegetative state. Her husband, Michael, insisted she would not want to be kept on life support. Her parents insisted she was a devout Roman Catholic who would never go against the church’s teachings on euthanasia (746). There were many variables to take into account. Perhaps Schiavo was a devout Roman Catholic in front of her parents and remained more loosened up around her husband. Or it may be the other way around and the way she acted around her husband was just an act. Her parents may have been emphasizing Schiavo’s involvement in the church to avoid losing their daughter while her husband could have been insisting she would never have wanted to be on life support in order to begin his own grieving process (747). Unless it is written in a living will by the individual, a court simply cannot know what they want. Several court cases involving diagnoses, diagnoses challenges, and the right to life may follow in order to decide if a person should be taken off of life support in the event that a living will is absent. With these factors in mind, legally the family has no recourse until a significant other, guardian, or lawyer steps forward.
Medical Care Issues
Medical care issues are important when considering life support. Keeping somebody in a persistent vegetative state on life support is expensive. This concept seems harsh and inhumane to many; it is almost improper to mention because it sounds too much like putting a price on a human life, but it is simply a fact. Medical care is very expensive and medical care around the clock is incredibly expensive. To keep a person in a persistent vegetative state on life support for one day can cost $10,000, as reported by the National Center for Health Statistics in 2011 . It can be difficult to think of money when a loved when is in a persistent vegetative state but it is also important to remember who is going to pay for their medical care. If you are paying for it, it may be prudent to consider what they would have wanted and if they will recover. Most neurologists concede that after brain death, recovery is unlikely. They often advise that the patient be removed from life support . If is truly up to the family they should do what is best for the patient, not what is best for their wallets in terms of the suspected inheritance. However, considering the expense of medical care is not out of the realm of consideration.
Personal Actions
Firstly I would create a living will, outlining my wishes if I should ever find myself in an unfortunate position such as a vegetative state. I would want to spare my family the grief and legal hassle. If I were to find myself making the decision for another person I would hope they would have left me instructions. In the event that they did not, I would compile what I knew about them with the chance of recovery and make a decision based on that. If there was a reasonable chance that they would recover I would leave them on life support. If there was no chance of recovery I would not want them to only live as a shell of who they once were; I would allow them to die so their body could be at peace.
References
Fernandez, Manny. "Texas Woman Is Taken Off Life Support After Order." New York Times 26 January 2014.
Perry, Joshua E., Larry R. Churchill and Howard S. Kirshner. "The Terri Schiavo Case: Legal, Ethical, and Medical Perspectives." Annals of Internal Medicine (2005): 744-748.
Price-Foley, Elizabeth. "Blurred Lines: Redefining Life and Death." Brain: A Journal of Neorology (2012): 1332-1334.
"Special Feature on Death and Dying." February 2011. National Center for Health Statistics. 5 March 2014 <http://www.ncbi.nlm.nih.gov/books/NBK54374/>.
