Taking a child off life support

fergus51 · May 16, 2006

I agree with Timothy. I provide futile care at work on a regular basis and it's just heartbreaking to see those families cling to any little bit of hope when you know their child will not survive. I feel terrible for them, but I also feel terrible for the baby who has to suffer longer because their parents can't accept the reality of the situation.

MarySunshine · May 17, 2006

Am I missing something? I've heard of people in persistive vegetative states who are kept alive indefinitely, and it's arguably the family's right to decide to do that. But you can't keep a brain dead person alive. That's an oxymoron -- they're already dead. We keep a lot of near dead people alive in the neuro ICU I work in, but I have never heard of a brain dead person being kept on the vent for more than 72 hours in my facility. We give the family approx 24 hours (if they need it) to say "goodbye" and we give the needed time to harvest the organs if that's going to happen. Then we turn off all mechanical support.

No one has the right to keep a dead body on a ventilator at high cost to the public. In fact, the death certificate is filled out for the day of declared brain death, not the day the body is taken off the ventilator. How is this even an issue, other than the mother is accusing them of lying about his brain death (which I highly doubt)? I certainly have compassion for her, but I don't think the grief sticken, senseless anger of a mother should have gotten this sort of press. She's not in her right mind...I certainly wouldn't be.

Fergus, I completely understand what you're saying. But in this case the person isn't even suffering -- they're dead. As a doornail. There is no way of justifying continuing mechanical support of a corpse.

heartICU · May 17, 2006

Am I missing something? I've heard of people in persistive vegetative states who are kept alive indefinitely, and it's arguably the family's right to decide to do that. But you can't keep a brain dead person alive. That's an oxymoron -- they're already dead. We keep a lot of near dead people alive in the neuro ICU I work in, but I have never heard of a brain dead person being kept on the vent for more than 72 hours in my facility. We give the family approx 24 hours (if they need it) to say "goodbye" and we give the needed time to harvest the organs if that's going to happen. Then we turn off all mechanical support.
No one has the right to keep a dead body on a ventilator at high cost to the public. In fact, the death certificate is filled out for the day of declared brain death, not the day the body is taken off the ventilator. How is this even an issue, other than the mother is accusing them of lying about his brain death (which I highly doubt)? I certainly have compassion for her, but I don't think the grief sticken, senseless anger of a mother should have gotten this sort of press. She's not in her right mind...I certainly wouldn't be.
Fergus, I completely understand what you're saying. But in this case the person isn't even suffering -- they're dead. As a doornail. There is no way of justifying continuing mechanical support of a corpse.

I agree. If you have ever done an organ harvest for a patient who is clinically "brain-dead," the time of death is listed as the time that brain death was determined, not the time the heart actually stopped beating. Brain-dead = dead, and you would not be withdrawing "life support" because the vent is not supporting life. It is simply maintaining organ perfusion. It is important to make that distinction.

It is not the family's choice to decide whether to withdraw anything - dead is dead - there is nothing to withdraw!

Babarnurse · May 17, 2006

I had to sound harsh, but who is paying for the child to be on life support??? I bet it isn't the mother.

new_mom26 · May 17, 2006

In October my sister in law and niece and nephews were in a car accident on I-24 outside of nashville tennessee.. My youngest nephew was on life support and it was very painful to find out that he was brain dead. It ripped my heart out..

subee, MSN, CRNA · May 17, 2006

Not necessarily -- it sounds like more of a medical decision to me, and, as QuilterLPN point out, no physician or hospital is obligated to provide futile care. Even if it were purely an ethical decision rather than a medical one, the family does not always have the final say. Many factors must be considered -- this is why hospitals are required by state and Federal rules to have ethics committees, to make these kind of difficult decisions (now, I'm certainly not saying that every hospital's committee does a great job every time, but ...).

Families have lost cases trying to keep their loved ones on life support. In actuality, the court decides with input from family and hospital.

caroladybelle, BSN, RN · May 17, 2006

What I am about to say will sound cold and heartless. Be aware that I truly feel saddened by what has happened. However, we have to look at the facts.

Currently, our system has determined that "brain death" is defining of death.

Dead is dead, the process is completed. What remains now is a technicality.

Ventilator plus IV, plus drugs, plus feeding tube, plus body does not "equal" life.

Is the family in denial? Probably. When a family has someone die quickly or slowly, in the best of circumstances or the worst of circumstances, there will be denial. Loved ones do not see the patient as an individual that is ill, they continue to see the patient as they were and deal with all the unresolved issues in their relationship. They often misinterpret actions to suit their views.

Will this be painful to them? Sooner or later, they will still grieve.

Is the facility obligated to keep a brain dead child on life support - quite clearly, No. Because brain death is "Dead".

15-20 years ago, there was a case like this in Sarasota, FL. The patient was transferred to home care, and her body "died" a few monthes later.

In the state of Texas under (former Gov, now president) GW Bush, legislation was signed that the facility is not required to maintain futile treatment. A small child was taken off life support against the mother's wishes. Thus far said legislation has held up.

As a healthcare provider, I have had loved ones that get angry and ask us to rescusitate a recently deceased patient. Loved ones who are grief stricken are not the best judges of what is ethical and appropriate.

Unless the family is paying completely for this care of the "deceased", the facility is being burdened financially, physically for this. If they are unwilling to care for the "deceased", then it is up to the family to find someone able and willing to do so.

Many places will not push this issue because it is bad PR. But, if per the Ethics committee, the MDs and appropriate consultants have determined that they are providing "futile" care, they have the right to decline to continue to do so. While a good faith effort to find another provider would be prudent, it may not be possible.

HM2VikingRN, RN · May 17, 2006

It is a horrible situation for the family. However if the brain is gone so is the person. I just hope that the providers can find a way to help the family in their time of grief.

elkpark · May 17, 2006

Families have lost cases trying to keep their loved ones on life support. In actuality, the court decides with input from family and hospital.

That's true if the case is conflicted and contested enough that it goes to court -- but most of these cases don't ever involve the courts.

fergus51 · May 18, 2006

Fergus, I completely understand what you're saying. But in this case the person isn't even suffering -- they're dead. As a doornail. There is no way of justifying continuing mechanical support of a corpse.

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.

rhinojogger · May 18, 2006

Sounds like Teri Schaivo all over again :-(

ForensicRN99 · May 18, 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