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End of Life: Your questions answered Add to ...

Jamie, your question helps highlight some really important issues. First, your husband raises a key point: what one person considers to be acceptable can really change dramatically over a lifetime, whether we are discussing treatments or potential outcomes.

This has been repeatedly observed among patients who become quadriplegic, for example, who prior to an accident may have indicated that they would never want to live without movement but later manage to accept their condition and even have a good quality of life. For this reason, all physicians and nurses will appreciate that it is one’s right to change their feelings about a “do not resuscitate” order, depending on the context and their circumstances. The challenge that often arises, however, is that the person that needs to be resuscitated is often too sick to help make these decisions because of the very illness or accident that makes the resuscitation indicated.

Ultimately, we rely very heavily on families to help us estimate the patient’s wishes, because most critically ill patients are too sick to talk to us themselves. So, we always recommend that people have these “what if” discussions far in advance – when they are healthy – so that their loved ones can help us understand what they would or wouldn’t want done.

In your experience, how often is a patient kept alive when they have no brain function? do they literally just keep living in their bed on a machine until old age eventually takes them? - Kevin

Kevin, if physicians actually determine that there is absolutely no brain function – not even brain reflexes – then the patient can be declared dead because they meet criteria for brain death, and life support is stopped. In these situations, the family will often be approached to consider the option of organ donation (which can save the lives of several other people).

However, I think you are probably referring to situations that are much more common, where there is severe brain damage but not enough for the person to be declared dead according to these brain death criteria.

In these situations, we will meet with family members to help us understand what the person would have wanted us to do. In my experience, most people wouldn’t want to be “kept alive” on machines when there is very little or no chance of waking up.

For these patients, we will stop life support and focus on providing palliative care and ensuring that they are comfortable, but with the understanding that many of these patients will ultimately die.

In the less common situation, where a decision is made to keep someone living on life support indefinitely (yet knowing their brain function will not recover), things can go on for some time. However, being hooked up to prolonged life support inevitably leads to other complications, for example pneumonia or other infections, and these can often ultimately lead to death.

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