Taking a child off life support

Darth Nightingale · May 19, 2006

... either way isn't it ultimately up to the family and not the hospital to withdrawl life support. i mean as soon as the patient stabilizes enough, he should be able to go to a long term facility on the vent, if mom wants to keep the poor kid alive.
http://www.thekansascitychannel.com/health/9219847/detail.html

what is life and what is death are legal and politically answered... sad but true. as health care professionals (or future health care professionals) we do have to come to grips with this fact... and react politically, most importantly by how we vote.

i think we are going to face more and more situations like this as technology increases and the population age increases too. i see this being much more of a political issue in the next ten years. hopefully then it will be settled.

the cost issue is a valid issue. resources are limit a money and time spent on one pt.. is less money and time spent on another... another sad but true.

with that said... i'm sure it's infinitely easier to write a post about this drama than to actually be one of the players in it... so i'm definitely not judging anyone.

mom23RN · May 20, 2006

This boy was just taken off of life support in the past hour. A doctor from outside of KUMed agreed with the hospital and the mother agreed to take him off of life support.
T

I'm so glad that seh finally came to an "understanding" if there is such a thing. She did what was right for her son. As I said in my earlier post, as parents we would take them anyway we could have them, but it's usually not fair to the child.

I am so saddened for her loss.

Nurse Robin · May 20, 2006

What do you think? This 14 year old boy accidently shot himself in the neck. The local news is reporting that the hospital is trying to take the patient off life support without parents approval. The mom wants to transfer the patient to another hospital but no one will accept the brain dead child. Stating there is nothing else that can be done. Mom reports the patient responds to her, tries to open his eyes and squeezes her hand. Either way isn't it ultimately up to the family and not the hospital to withdrawl life support. I mean as soon as the patient stabilizes enough, he should be able to go to a long term facility on the vent, if mom wants to keep the poor kid alive.
http://www.thekansascitychannel.com/health/9219847/detail.html

I feel for the parents, the pain would be unbearable. But even before I became a nurse I understood when life has ended. I can never understand why a child would play with a gun, especially at 14 years old. Were they playing? Who will ever know? In these crazy times you wonder.

Mermaid4 · May 20, 2006

This is so sad but I am wondering if the child is brain dead, how he can be squeezing moms hand, etc.

Pediatric Critical Care Columnist · May 21, 2006

This is so sad but I am wondering if the child is brain dead, how he can be squeezing moms hand, etc.

Brain death isn't an event, it's a process. It's possible that in the first hours after his injury that he had enough cognitive or reflex function left to do the things family members said he did. But as the brain swells and displaces itself those functions fail. Once the brain is irreversibly damaged to the point that brain death is being assessed, other functions have failed as well, such as respiratory drive, temperature regulation, fluid and electrolyte regulation, hemodynamic regulation and so on. The heart will beat indefinitely as long as there is ventilation. I've cared for many severely brain injured children; of those who survived some of them have recovered almost completely but most of them are left with a quality of life I would not wish on my worst enemy. It's very hard to care for these kids, knowing what their outcome will be, but it isn't really the caring for the child that's hard, it's the caring for the ones left behind. In these situations I talk myself hoorifice explaining everything to families so they understand what has happened to the child and what will happen next. Years ago, I was unfortunately given the task of explaining brain death to my daughter (then 15 years old) and her friends when one of her close buddies wrapped his car around a pole. They had all been in to see Chris in the ICU and couldn't understand how he could be dead when he looked so alive. They needed to be sure that there was no mistake and that Chris's organs weren't being given away prematurely. That experience gave me the opportunity to practice what I say to others now and although I regret every day that Chris died, I admire his parents for their strength and compassion.

As for this case, I feel great sympathy for the mom, but I also feel empathy for the hospital staff who cared for Mike while he was in their unit. It's unlikely that Mike's mom would ever have considered organ donation, and the prolonged period between determination of brain death and the eventual withdrawal of ventilation likely rendered them too damaged to be transplanted. A tragedy on many levels.

LilPeanut, MSN, RN, NP · May 21, 2006

We see futile care frequently in the NICUs, sadly. We have a baby right now whose apgars were 0/0/0. We have another one who is in septic shock and was in status epilepticus for 1-2 hours and is on a 3.5 epi drip. Prolonging their suffering is not helping the patient.

imenid37 · May 21, 2006

I hope it is resolved quickly and the child doesn't have to be maintained on life support for months or longer. It makes me ill to think that "pro-lifeers" are protesting thie hospital. The poor child is dead. There is nothing more that can be done for him in this life. It is terrible for mom. I wholeheartedly agree. It is also awful for the staff and awful that resources and staff are being utilized to give futile care and take away from other patients. I think it is unethical to keep a person "alive" on life support like this.

Pediatric Critical Care Columnist · May 21, 2006

Mike Todd was taken off the ventilator yesterday afternoon (May 19) and would have experienced cardiac arrest within minutes. His body has now joined his soul and the rest of the players are left to pick up the pieces.

MarySunshine · May 25, 2006

I get that and agree with your stance on not continuing treatment when it's futile. I just still consider it suffering to treat any person like that whether they are brain dead or not. I've said it before at work and it sounds terrible, but sometimes I feel like I'm being paid to torture and desecrate a corpse in the name of respecting their parents' wishes. And I do it... but knowing they are not alive in any meaningful sense doesn't change the fact that a baby is in front of me and he or she is still a baby. It's hard for me to justify doing unpleasant procedures on them.

I understand EXACTLY what you are saying.

MarySunshine · May 25, 2006

Having lived through this, I can honestly say there is nothing harder than a mother saying good bye to a child, and even though we are nurses and sometimes build up a wall in order not to get emotionally involved with our patients we have to validate the mother's feelings and not worry about who will be paying the bill, I think that is the most insensitive remark I have ever read. I had lost a child, and to this day 21 years later, I can still remember the feeling of lost and emptiness I felt, and thank God for the good nurses who had cared for him during the three days of his life, and am glad that the nurses weren't worried about who will be paying for the bill. I am sorry if I am coming off strong, but children hold a special place in my heart

Nurses aren't concerned, in a selfish sense, about who would be footing the bill. I cannot image any nurse giving different care to a patient because of the billing arragements. That would NEVER happen! It's exactly what another poster stated -- finite resources. Is it morally acceptable to keep a brain dead person on a vent when a LIVING person is in the ER needing an ICU bed? Probably not.

I've lost children, too. I'm so sorry for your loss. Mine was 5 years ago, and I have no doubt that I will always feel the same as you do about the feeling of the loss.

buddiage · May 25, 2006

Good posts.

The real question, is it ethical and moral to provide futile care regardless of the amount of resources a hospital has?

In other words, if every bed was empty, would it then be okay somehow to keep the body of a dead child (or adult for that matter) alive? No.

Yes, you could bring up resources, paying the bill, amount of staff, etc... But that ultimately doesn't have anything to do with the first question.

NO, it is not okay to prolong a complete death, period. I look at that as when "one door closes and another opens" kind of thing.

carolinapooh, BSN, RN · Jun 1, 2006

Let me talk to you viewing this issue through the eyes of a mom who has been there. I lost my oldest son following a ATV accident not quite three years ago. He died in my arms on a country road not far from our home. I realized that nothing could be done for him, spoke to him and comforted him as he passed on. I am sure he was nearly gone by the time I got there, but...... My point is this-- it is so easy to say that we should not "waste" resources or that it is foolish to try to keep the child alive just because the parents want us to. Yet, please put yourself into their place. I know of no parent who would want to change places with them. I personally could not have imagined the pain that a parent goes through. In time, most folks would be able to assimilate the trauma of the situation and would come to the appropriate decision-- to let God have their child. But, you must let them get through the process. It is the most difficult thing you would ever have to endure. We waste many resources in healthcare -- take a look around you. Let's not forget the humanity of our profession.

God help me - I mean you no harm, and I feel privileged that you shared your horrible experience with us. But if someone is brain dead, I think God already has him or her. The person - even if someone has no religious background at all and doesn't believe in a soul - the person and the personality are gone forever. The person isn't coming back; they're already gone, medically and I'd dare say spiritually as well. I think when we removed life support from my dad and let him go peacefully, we truly allowed God to take him. But if he had been brain dead, then God would have already intervened, no matter how badly we might have wanted to believe otherwise.

I grieve for this woman and CANNOT imagine how she must feel. I also know how easy it is to be sideline coaches and quarterbacks...

I think God took your son while you were there. I'm so glad you were there for that; I have no doubt how hard it was but I'm glad you were there. God bless you and your family, and above all your son.