Withdrawing life support

[Confused]

I am often in situations where families look to me for advice on what they should do when a loved one is on life support with almost no hope of any meaningful recovery. By meaningful, I mean they will never be off the ventilator, they will be fed through a tube in their stomach, they will never be able to show any signs of being conscious of their surroundings.

Looking at that persons living will, they request every effort be made to continue their life. Their living will is 20 years old and is no longer even valid. But the division between family members has created an ethical dilemma that forgets about what is in the patients best interests.

In such circumstances, what advice would you give the family as a whole? Recall, like it or not, you WILL influence this families decision.

Why would you give the advice you chose?

[WafflesFTW]

Realthinker is right. Too many are blinded by political correctness and the "morally right" thing which is most occasions, such as this, not morally correct. If you must care for your mother who is a vegetative state, you not only place taht burden upon yourself, but on the rest of your family. You hold a noble sentiment, but when you understand that cost applies to your whole family as well, most of which probably aren't as close, it is not so noble especially considering the person is brain-dead anyway. Sacrificing your family's welfare for the sake of an already dead person is not doing anyone a favor, not even the one you are "saving" because they are already dead.

[Confused]

If you think that the financial realities of long term invalid care are irrelevant you are remarkably naive. That financial cost spills over into the viability of the family. Should a family sacrifice their livelihood and the livelihood of the next generation for a single member who will never even appreciate what is being done for them? Is it responsible to introduce the kind of resentment that causes into a family? I don't care how much the patient is loved, when the money's gone and the kids don't get what they need and the college savings is spent keeping that person alive, there will be issues. What does it do to a marriage when the money is going to the nursing home instead of retirement? Second mortgages and second jobs don't help families, and the impact can last for generations.

I'm not putting a dollar figure on life. I'm talking about choices regarding who in the family gets to thrive and who does not, and at whose expense. The choice is about whether a few more months or years of unappreciated breathing is a fair trade off for possibly a lifetime's worth of education and stability for a family of children. Does one sacrifice one's self and the children to prolong the death of the parent?

I think you have completely missed the point of the OP. Go back and read it. You are not the family member.
If you care to address the thread, then do it in the context it was written.

[Confused]

Realthinker is right. Too many are blinded by political correctness and the "morally right" thing which is most occasions, such as this, not morally correct. If you must care for your mother who is a vegetative state, you not only place taht burden upon yourself, but on the rest of your family. You hold a noble sentiment, but when you understand that cost applies to your whole family as well, most of which probably aren't as close, it is not so noble especially considering the person is brain-dead anyway. Sacrificing your family's welfare for the sake of an already dead person is not doing anyone a favor, not even the one you are "saving" because they are already dead.

Congratulations. You have joined Realthinker in missing the point of the OP, but you have done it twice now.

[realthinker]

If you think that the financial realities of long term invalid care are irrelevant you are remarkably naive. That financial cost spills over into the viability of the family. Should a family sacrifice their livelihood and the livelihood of the next generation for a single member who will never even appreciate what is being done for them? Is it responsible to introduce the kind of resentment that causes into a family? I don't care how much the patient is loved, when the money's gone and the kids don't get what they need and the college savings is spent keeping that person alive, there will be issues. What does it do to a marriage when the money is going to the nursing home instead of retirement? Second mortgages and second jobs don't help families, and the impact can last for generations.

I'm not putting a dollar figure on life. I'm talking about choices regarding who in the family gets to thrive and who does not, and at whose expense. The choice is about whether a few more months or years of unappreciated breathing is a fair trade off for possibly a lifetime's worth of education and stability for a family of children. Does one sacrifice one's self and the children to prolong the death of the parent?

I think you have completely missed the point of the OP. Go back and read it. You are not the family member.
If you care to address the thread, then do it in the context it was written.

In the situation you describe, I think it is entirely appropriate to ask, "What is this going to do to your family?" If you're going to ask this question you should also make sure that the family understands it as fully as they might, which includes the financial aspect.

Very likely, the reason someone asks such a question is because they do not feel they can remove their focus on the immediate to understand the whole picture.

We are facing this sort of issue right now with my wife's grandmother. She's in her mid 80's and has horrible osteoporosis with disintegrated vertebra. She's now got a hip joint that is disintegrated. She's losing her hearing and she has heart problems. She needs to have her hip replaced but her health is so bad she's only got about half a chance to survive the operation. If she does, she may have less pain in her hip, but her back is still very painful, and there's nothing to do for that. She has medicaide, but that won't cover enough of it. My wife's dad is a doctor but won't contribute. Her aunt is wealthy but is bitter about having to sacrifice her time while her brother works. She resents anything anyone else wants to do to help because she wants to feel a proper martyr. No one is talking to one another because of all the resentment, mostly over money. That and the fact that nothing that can be done is going to do anything more than leave her in a bed with less pain in her hip until she dies. Once that's done it'll be open warfare between the aunt and my father-in-law and the daughters will be left to decide if there's anything to salvage there.

In this case there's no question. She must have treatment. But its' an example of how the financial aspect of things works to destroy a family. No one is going to the poor house over it, but even the subject causes resentment. It'll last the rest of their lives.

[realthinker]

If you think that the financial realities of long term invalid care are irrelevant you are remarkably naive. That financial cost spills over into the viability of the family. Should a family sacrifice their livelihood and the livelihood of the next generation for a single member who will never even appreciate what is being done for them? Is it responsible to introduce the kind of resentment that causes into a family? I don't care how much the patient is loved, when the money's gone and the kids don't get what they need and the college savings is spent keeping that person alive, there will be issues. What does it do to a marriage when the money is going to the nursing home instead of retirement? Second mortgages and second jobs don't help families, and the impact can last for generations.

I'm not putting a dollar figure on life. I'm talking about choices regarding who in the family gets to thrive and who does not, and at whose expense. The choice is about whether a few more months or years of unappreciated breathing is a fair trade off for possibly a lifetime's worth of education and stability for a family of children. Does one sacrifice one's self and the children to prolong the death of the parent?

I think you have completely missed the point of the OP. Go back and read it. You are not the family member.
If you care to address the thread, then do it in the context it was written.

I never tried to respond to the OP. I was responding to the statement in Goat's reply that the decision wasn't about those making it but about the patient. You then went on about how financial issues aren't important, which I think is a naive perspective. My point is that the patient isn't the only one who will have consequences from this decision, and that if you're ignoring those consequences in giving advice you may be doing it at the expense of the surviving family.

[Confused]

If you think that the financial realities of long term invalid care are irrelevant you are remarkably naive. That financial cost spills over into the viability of the family. Should a family sacrifice their livelihood and the livelihood of the next generation for a single member who will never even appreciate what is being done for them? Is it responsible to introduce the kind of resentment that causes into a family? I don't care how much the patient is loved, when the money's gone and the kids don't get what they need and the college savings is spent keeping that person alive, there will be issues. What does it do to a marriage when the money is going to the nursing home instead of retirement? Second mortgages and second jobs don't help families, and the impact can last for generations.

I'm not putting a dollar figure on life. I'm talking about choices regarding who in the family gets to thrive and who does not, and at whose expense. The choice is about whether a few more months or years of unappreciated breathing is a fair trade off for possibly a lifetime's worth of education and stability for a family of children. Does one sacrifice one's self and the children to prolong the death of the parent?

I think you have completely missed the point of the OP. Go back and read it. You are not the family member.
If you care to address the thread, then do it in the context it was written.

I never tried to respond to the OP. I was responding to the statement in Goat's reply that the decision wasn't about those making it but about the patient. You then went on about how financial issues aren't important, which I think is a naive perspective. My point is that the patient isn't the only one who will have consequences from this decision, and that if you're ignoring those consequences in giving advice you may be doing it at the expense of the surviving family.

You are free to consider my perspective naive or experienced and it doesn't really affect me one way or the other. However, your response is not reflective of anything in the OP nor anything Goat has said in response to the OP. If you don't want to address the OP, then don't post in it. I don't find that to be unreasonable. What I do find unreasonable is when one topic is raised and another poster decides they want to address a different topic instead. In all my years of nursing, never in my life would I encourage a family member to discontinue life support on a loved one based on their bank account. If you feel comfortable in doing so, then by all means, go for it. I find it to be completely unethical. But since you never tried to respond to the OP, then I think it is safe to assume that you will just not post anything here again and none of this will be relevant.

[realthinker]

If you think that the financial realities of long term invalid care are irrelevant you are remarkably naive. That financial cost spills over into the viability of the family. Should a family sacrifice their livelihood and the livelihood of the next generation for a single member who will never even appreciate what is being done for them? Is it responsible to introduce the kind of resentment that causes into a family? I don't care how much the patient is loved, when the money's gone and the kids don't get what they need and the college savings is spent keeping that person alive, there will be issues. What does it do to a marriage when the money is going to the nursing home instead of retirement? Second mortgages and second jobs don't help families, and the impact can last for generations.

I'm not putting a dollar figure on life. I'm talking about choices regarding who in the family gets to thrive and who does not, and at whose expense. The choice is about whether a few more months or years of unappreciated breathing is a fair trade off for possibly a lifetime's worth of education and stability for a family of children. Does one sacrifice one's self and the children to prolong the death of the parent?

I think you have completely missed the point of the OP. Go back and read it. You are not the family member.
If you care to address the thread, then do it in the context it was written.

I never tried to respond to the OP. I was responding to the statement in Goat's reply that the decision wasn't about those making it but about the patient. You then went on about how financial issues aren't important, which I think is a naive perspective. My point is that the patient isn't the only one who will have consequences from this decision, and that if you're ignoring those consequences in giving advice you may be doing it at the expense of the surviving family.

You are free to consider my perspective naive or experienced and it doesn't really affect me one way or the other. However, your response is not reflective of anything in the OP nor anything Goat has said in response to the OP. If you don't want to address the OP, then don't post in it. I don't find that to be unreasonable. What I do find unreasonable is when one topic is raised and another poster decides they want to address a different topic instead. In all my years of nursing, never in my life would I encourage a family member to discontinue life support on a loved one based on their bank account. If you feel comfortable in doing so, then by all means, go for it. I find it to be completely unethical. But since you never tried to respond to the OP, then I think it is safe to assume that you will just not post anything here again and none of this will be relevant.

Rebuttal is not legitimate in the debate of your topics? An observer of cannot challenge the legitimacy of an idea that is fundamental to a reply without taking a position with respect to the topic? Please, for the rest of us who understand this to be about the exchange of ideas, who expect to challenge and be challenged in what we post, point out the revised rules of debate under which we are expected to participate in your threads or with respect to your postings, or with respect to postings of people you feel you need to protect. In fact, you can assume that for all your posturing I'll feel free to respond to any argument I don't feel is correct. Your failure to acknowledge the challenge or to understand the significance is no limit on my right to submit that challenge.

[Confused]

If you think that the financial realities of long term invalid care are irrelevant you are remarkably naive. That financial cost spills over into the viability of the family. Should a family sacrifice their livelihood and the livelihood of the next generation for a single member who will never even appreciate what is being done for them? Is it responsible to introduce the kind of resentment that causes into a family? I don't care how much the patient is loved, when the money's gone and the kids don't get what they need and the college savings is spent keeping that person alive, there will be issues. What does it do to a marriage when the money is going to the nursing home instead of retirement? Second mortgages and second jobs don't help families, and the impact can last for generations.

I'm not putting a dollar figure on life. I'm talking about choices regarding who in the family gets to thrive and who does not, and at whose expense. The choice is about whether a few more months or years of unappreciated breathing is a fair trade off for possibly a lifetime's worth of education and stability for a family of children. Does one sacrifice one's self and the children to prolong the death of the parent?

I think you have completely missed the point of the OP. Go back and read it. You are not the family member.
If you care to address the thread, then do it in the context it was written.

I never tried to respond to the OP. I was responding to the statement in Goat's reply that the decision wasn't about those making it but about the patient. You then went on about how financial issues aren't important, which I think is a naive perspective. My point is that the patient isn't the only one who will have consequences from this decision, and that if you're ignoring those consequences in giving advice you may be doing it at the expense of the surviving family.

You are free to consider my perspective naive or experienced and it doesn't really affect me one way or the other. However, your response is not reflective of anything in the OP nor anything Goat has said in response to the OP. If you don't want to address the OP, then don't post in it. I don't find that to be unreasonable. What I do find unreasonable is when one topic is raised and another poster decides they want to address a different topic instead. In all my years of nursing, never in my life would I encourage a family member to discontinue life support on a loved one based on their bank account. If you feel comfortable in doing so, then by all means, go for it. I find it to be completely unethical. But since you never tried to respond to the OP, then I think it is safe to assume that you will just not post anything here again and none of this will be relevant.

Rebuttal is not legitimate in the debate of your topics? An observer of cannot challenge the legitimacy of an idea that is fundamental to a reply without taking a position with respect to the topic? Please, for the rest of us who understand this to be about the exchange of ideas, who expect to challenge and be challenged in what we post, point out the revised rules of debate under which we are expected to participate in your threads or with respect to your postings, or with respect to postings of people you feel you need to protect. In fact, you can assume that for all your posturing I'll feel free to respond to any argument I don't feel is correct. Your failure to acknowledge the challenge or to understand the significance is no limit on my right to submit that challenge.

Ho hum. Your rants are getting old. Feel free to puff your feathers and play "great white hunter cave man" if you wish. But this is the second go around with you, just a different thread and it is old.

[Nick_A]

I am often in situations where families look to me for advice on what they should do when a loved one is on life support with almost no hope of any meaningful recovery. By meaningful, I mean they will never be off the ventilator, they will be fed through a tube in their stomach, they will never be able to show any signs of being conscious of their surroundings.

Looking at that persons living will, they request every effort be made to continue their life. Their living will is 20 years old and is no longer even valid. But the division between family members has created an ethical dilemma that forgets about what is in the patients best interests.

In such circumstances, what advice would you give the family as a whole? Recall, like it or not, you WILL influence this families decision.

Why would you give the advice you chose?

If the decision wasn't hard enough we've complicated with our naive cruelty. When I read the decision on the Terri Schiavo case I was amazed that only a few thought realistically enough to see how far we are from allowing mercy to transcend politics.

Reading the autopsy results it became obvious that the odds of her being conscious of her dehydration and starvation were probably around 60/40 against. The area of the brain concerned with higher conscious functions was functioning and pain centers are all over the brain. It doesn't take a rocket scientist to conclude that there was a chance she was conscious during the whole painful and terrible experience of being killed by dehydration.

If they wanted to kill her why not just put her to sleep as one would a dog or put her into a coma? Of course politics made it impossible leaving only the inhuman alternative of a possible slow painful death for this truly unfortunate person. Even if the odds were only 80/20 against how can people do this with a clear conscience other than through naive ignorance.

So if the basic decision of life and death isn't hard enough we have to worsen it with our cruel stupidity and force a person to risk the slow painful death of a conscious person though not legally recognized as such at the time. One woman wrote a book on this because she was like Terri and only because of her husband's fight to preserve her life was she able to awaken from the vegetable state the doctors defined her as in.

I'm not saying that Terri could have recovered but only that she was possibly conscious to some degree of her plight and to condemn someone to a slow death where the diagnoses is in dispute is horrible. We call ourselves an intelligent species and this is the best solution we could come up with. With intelligence like this, how does one define stupidity?

Giving advice then has to include this possibility making it tougher on the family

[Confused]

I am often in situations where families look to me for advice on what they should do when a loved one is on life support with almost no hope of any meaningful recovery. By meaningful, I mean they will never be off the ventilator, they will be fed through a tube in their stomach, they will never be able to show any signs of being conscious of their surroundings.

Looking at that persons living will, they request every effort be made to continue their life. Their living will is 20 years old and is no longer even valid. But the division between family members has created an ethical dilemma that forgets about what is in the patients best interests.

In such circumstances, what advice would you give the family as a whole? Recall, like it or not, you WILL influence this families decision.

Why would you give the advice you chose?

If the decision wasn't hard enough we've complicated with our naive cruelty. When I read the decision on the Terri Schiavo case I was amazed that only a few thought realistically enough to see how far we are from allowing mercy to transcend politics.

Reading the autopsy results it became obvious that the odds of her being conscious of her dehydration and starvation were probably around 60/40 against. The area of the brain concerned with higher conscious functions was functioning and pain centers are all over the brain. It doesn't take a rocket scientist to conclude that there was a chance she was conscious during the whole painful and terrible experience of being killed by dehydration.

If they wanted to kill her why not just put her to sleep as one would a dog or put her into a coma? Of course politics made it impossible leaving only the inhuman alternative of a possible slow painful death for this truly unfortunate person. Even if the odds were only 80/20 against how can people do this with a clear conscience other than through naive ignorance.

So if the basic decision of life and death isn't hard enough we have to worsen it with our cruel stupidity and force a person to risk the slow painful death of a conscious person though not legally recognized as such at the time. One woman wrote a book on this because she was like Terri and only because of her husband's fight to preserve her life was she able to awaken from the vegetable state the doctors defined her as in.

I'm not saying that Terri could have recovered but only that she was possibly conscious to some degree of her plight and to condemn someone to a slow death where the diagnoses is in dispute is horrible. We call ourselves an intelligent species and this is the best solution we could come up with. With intelligence like this, how does one define stupidity?

Giving advice then has to include this possibility making it tougher on the family

I would tend to agree with you here. Often, we get them past the acute phase but they end up in the chronic state in which the case of Terri was. Many neurosurgeons I know will opt for discussing withdrawal of life support in cases in which the outcome is grim. The challenge becomes deciding when to make such a conclusion.
But overall, I think you captured the dilemma quite nicely.