Removing Life Support

On Monday morning of this week, I received a call from my wife who said that my sixty-seven year old mother had collapsed at home and was in the hospital.  Mom had been immediately intubated and placed on a ventilator by the EMS crew before she was transported to the hospital.  Upon my arrival at the emergency room, my dad informed me that mom was disoriented, unable to breathe on her own, and in critical condition.  The doctor entered the room and told us that her organs were shutting down.  He advised that her chances of survival were low and that we should notify the family right away.  It is now Friday evening and she has not been weaned off the ventilator.  She has been diagnosed with a potentially fatal case of Legionella (Legionnaires’ Disease).  The hospital has asked for a copy of her Living Will.

Do you think it is acceptable to remove or withhold a ventilator from your mother in her condition, even if it means she will die sooner? If not, why not?  If so, under what circumstances is it acceptable?

Several years ago, my mother was scheduled for quintuple heart bypass surgery. I brought her to my attorney who prepared a complete set of estate documents for both her and my dad.  The document set included medical powers of attorney, which gave to each of them the power to make medical decisions for the other, if ever necessary.  I hold the contingent power of attorney position, should my dad be unwilling or unable to execute the duties described therein on behalf of my mom.  The attorney also prepared physician’s directives (known as living wills) which indicated to healthcare providers that if either of my parents was determined by a qualified physician to be in a permanent vegetative state while on life support with no hope of recovery, that they desired to be removed from life support and allowed to die a natural death.

So long as mom is alive but unable to make her own medical decisions, dad will have the authority to make her medical decisions for her under the authority of her medical power of attorney. Living wills, on the other hand, do not require anyone’s consent to remove life support, nor do they allow anyone to request the removal of life support.  The qualified attending physician has sole discretion to determine the existence of a permanent and hopeless vegetative state.  Should the attending physician rule in favor of the removal of life support, the family may not intervene.

It is perfectly acceptable for the physician to remove the ventilator if my mother’s condition becomes permanently vegetative and hopeless. Absent a living will, it would be equally acceptable for my father to make the decision on his own, under the authority of her medical power of attorney, or for me to make the decision on my own, should it fall to me.  Living wills serve several purposes, not the least of which is removing from the family the burden and guilt associated with having to make such decisions.  In cases where a hopeless and permanent vegetative state is unclear, a decision to remove life support could be ethically premature and, if so, would result in euthanasia.  Death comes to us all.  Wherever possible, we have an ethical obligation to seek to preserve life, even life that is deemed by some to be of low quality.  However, we are not ethically obligated to artificially maintain the mere physical functionality of a person’s otherwise useless body once medicine has failed to bring the body and mind back into a state of conscious life.  Human beings must be allowed to die a natural death with courtesy and dignity.

Do you believe that removing a ventilator would be killing your mother? Would it make you complicit in her death?  Why or why not?

Removing a ventilator would not be killing my mother, nor would it make me complicit in her death. My mother has Legionnaires’ Disease, which is a bacterial infection that causes severe and life-threatening pneumonia and attacks the liver and other organs.  If the disease debilitates her to the point of a hopeless and permanent vegetative state, with no means of continuing physical bodily functionality without life support by artificial means, it will be the disease that kills her, not the person who decided to discontinue the artificial life support.  Since a living will is in place, mom has made her own decision in advance.  If a living will was not in place, then dad or I would have to make the decision, should it come to it.  In either case, the goal of medicine is not to avoid death, for this would be impossible, but to promote health and extend life as long as reasonably possible.  Eventually, all human life comes to a natural end.

Your mother also does not want to be on the feeding tubes for her nutrition and hydration should she lose the ability to swallow. Would you consider feeding tubes the same as a ventilator, or are feeding tubes more basic care?  Would you say that removing feeding tubes is the same as starving someone to death?  Why or why not?

I would make no distinction between ventilator tubes and feeding tubes. The question is whether the person is determined by a qualified physician to be in a hopeless and permanent vegetative state.  If so, the removal of feeding tubes would be equivalent to the removal of a ventilator tube, allowing the life that has come to a natural and irreversible end to die a natural death.  Under such conditions, the removal of a feeding tube is no more the starving to death of an otherwise viable life than would the removal of a ventilator tube be the suffocating of same.

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