Unplug or not unplug, that is the question. (Coma)

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Discussion Overview

The discussion revolves around the ethical and medical considerations of unplugging life support for individuals in a coma, particularly focusing on the definitions and implications of brain death, the role of medical professionals, and the wishes of family members. It touches on theoretical, ethical, and personal experiences related to end-of-life decisions.

Discussion Character

  • Debate/contested
  • Conceptual clarification
  • Personal narrative

Main Points Raised

  • Some participants question the authority of doctors to unplug life support, especially in cases where chances of recovery are low or nil.
  • Others argue that once only the hindbrain remains, the individual is essentially lost, citing rare cases of recovery as likely misdiagnoses.
  • One participant suggests that the decision to unplug should be left to immediate relatives, emphasizing the emotional and ethical implications of such decisions.
  • There is mention of the importance of living wills, with participants sharing personal experiences regarding family dynamics and decision-making in critical situations.
  • Some participants discuss the medical definitions and criteria for brain death, noting that the determination process typically involves nonintrusive tests rather than invasive procedures like biopsies.
  • Concerns are raised about the variability of policies regarding end-of-life care across different regions, indicating a lack of consensus on best practices.

Areas of Agreement / Disagreement

Participants express differing views on the authority of doctors versus the wishes of family members regarding life support decisions. There is no consensus on the ethical implications or the medical definitions of brain death, and the discussion remains unresolved on these points.

Contextual Notes

Limitations include varying definitions of brain death, the potential for misdiagnosis, and the emotional complexities involved in making end-of-life decisions. The discussion reflects diverse perspectives on medical ethics and personal values.

alingy1
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There is a hypothetical case of a coma.
I want to know if doctors have the right to unplug the person.
What happens when the chances of waking up are very nil?
What happens when the chances of waking up are low and it can take several years for the person to wake up?
I read this article which says medically futile life sustaining treatments are left to the doctor's choice. http://www.fammed.ouhsc.edu/Palliative-Care/documents/Medically Futile Care.ppt

But, I heard doctors cannot unplug people like that. What's the deal?
 
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Once all that remains is the hindbrain, then it's just autonomous functions (heart/lungs). The person is essentially lost. I have heard stories of people "coming back" from brain death (such as Suzanne Chin) but they are very rare and are most likely cases of misdiagnosis rather than genuine recovery.

While Dr Kwek said he could not comment as he did not know the full details of Ms Chin's case, he reiterated that it is not possible to recover and regain consciousness after brain death has occurred.
He added that no such case has ever been reported in medical journals.
"So if anyone were to claim so, it would only be logical to presume that either the diagnosis of brain death had been made in error, or that the patient's family had misunderstood what had been told to them by the doctors," he said.

http://yourhealth.asiaone.com/content/meet-brain-death-expert#sthash.KuKl0Jw7.dpuf
 
I say one should leave the choice to immediate relatives. Personally, I would not take a relative off of life-support. Arguments that keeping 'brain dead' people alive are straining the system are fundamentally wrong because tax-funded medicine should not have taken up that responsibility (if they would later claim that the comatose are straining the budget.)
 
Pythagorean said:
... most likely cases of misdiagnosis rather than genuine recovery.
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do you know if a biopsy is performed during diagnosis?
 
This would be a great time to explore the value of a living will. Would you want extreme efforts made to prolong your life, and under what circumstances? My mother was vegetative (at best) for a week before our family could come to grips with the situation. Not good. Internal strife in the family was horrible, at best.

My wife and I have living wills drawn up by a lawyer friend of ours, and at least they give some guidance to family as to our wishes should really bad stuff come down.

Good luck.
 
I need to get another living will done and hide it from Evo Child, she destroyed the last DNR I had drawn up. She says she will not let then pull the plug on me. :( I want no extraordinary measures taken to try to resuscitate me. I don't want my family paying to keep me on life support.
 
alingy1 said:
I read this article which says medically futile life sustaining treatments are left to the doctor's choice. http://www.fammed.ouhsc.edu/Palliative-Care/documents/Medically Futile Care.ppt
That's not really what it says. It says that futile treatments can be refused, but only in two states and only after attempting to transfer the patient to another facility willing to comply with the patient's/power of attorney holder's wishes.
 
'roidbreaker said:
do you know if a biopsy is performed during diagnosis?

Not that I'm aware of:

In 1968, an ad hoc committee at Harvard Medical School reexamined the definition of brain death and defined irreversible coma, or brain death, as unresponsiveness and lack of receptivity, the absence of movement and breathing, the absence of brain-stem reflexes, and coma whose cause has been identified.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772257/

The above review also includes a lengthy description of the determination process; I haven't read it word-for-word, but it looks like it's mostly nonintrusive tests and a blood sample. Basically, a properly functioning brain should still reproduce standard reflexes that can be tested behaviorally.
 
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