Pulling the Plug. My ethical dilemma.
Discussion
I need advice concerning an ethical dilemma of the upmost importance.
About ten days ago my Father came out of a 25 day long coma, but so far remains unresponsive except for flickering eyes. He is now back on a ventilator as his lungs are in “very bad condition”.
He has undergone a series of neurological scans, the results and prognosis of which we are still awaiting.
I have twice been told this week by the medical team that it is getting to the point whereby I “have to make a difficult decision”, the ethics of which I’m struggling with.
At what point is an individual ‘deceased’, and I’m not talking legally here?
Is it when their brain can’t operate and function essential organs?
Is it when their brain no longer transmit neurones?
Or is it when the Dr says so?
Even from being a young kid I used to hear Dad say if he ever ended up paralysed then “to shoot him”. I doubt his opinions have changed.
From a sociological standpoint, if another life can be saved by utilising the manpower and resources currently being spent on my Father when he himself has little chance of recovery, then surely that’s a good thing.
What I’m struggling with is the ethics of this. As I don’t have any siblings and I alone are registered as next of kin, this is ultimately my decision to make.
But I don’t want to be responsible for sanctioning the death of my own Father. In his current state, is he even really alive?
About ten days ago my Father came out of a 25 day long coma, but so far remains unresponsive except for flickering eyes. He is now back on a ventilator as his lungs are in “very bad condition”.
He has undergone a series of neurological scans, the results and prognosis of which we are still awaiting.
I have twice been told this week by the medical team that it is getting to the point whereby I “have to make a difficult decision”, the ethics of which I’m struggling with.
At what point is an individual ‘deceased’, and I’m not talking legally here?
Is it when their brain can’t operate and function essential organs?
Is it when their brain no longer transmit neurones?
Or is it when the Dr says so?
Even from being a young kid I used to hear Dad say if he ever ended up paralysed then “to shoot him”. I doubt his opinions have changed.
From a sociological standpoint, if another life can be saved by utilising the manpower and resources currently being spent on my Father when he himself has little chance of recovery, then surely that’s a good thing.
What I’m struggling with is the ethics of this. As I don’t have any siblings and I alone are registered as next of kin, this is ultimately my decision to make.
But I don’t want to be responsible for sanctioning the death of my own Father. In his current state, is he even really alive?
I'm sorry to hear you have that dilema and I wouldn't want to be in your place.
Having said that, if you were in his position, what would you want to happen?
There is no easy answer as you've said and you can only decide based on the information or advice from the doctors.
All the best whatever you decide.
Having said that, if you were in his position, what would you want to happen?
There is no easy answer as you've said and you can only decide based on the information or advice from the doctors.
All the best whatever you decide.
ReverendCounter said:
So sorry for what you're going through. I don't have any useful answer. I just thought it a bit cowardly to read what you've written and just move on without saying something. What an awful, awful situation. My thoughts are with you.
Thank you Rev. Your comment actually means a lot.I feel for you OP, what a terrible situation to be in, and whatever option you chose, I think there's a chance you'll always second guess it.
My take - you know what your Dad wanted, try your best to reconcile what he wanted to what you do. I think this is the most ethical and courageous stand point, and one that you cannot be criticized for
Probably worth talking through the emotional costs with a professional or someone else who will listen. This is not going to be an easy time for you OP, and I wish you well.
My take - you know what your Dad wanted, try your best to reconcile what he wanted to what you do. I think this is the most ethical and courageous stand point, and one that you cannot be criticized for
Probably worth talking through the emotional costs with a professional or someone else who will listen. This is not going to be an easy time for you OP, and I wish you well.
Ozone said:
I'm sorry to hear you have that dilema and I wouldn't want to be in your place.
Having said that, if you were in his position, what would you want to happen?
There is no easy answer as you've said and you can only decide based on the information or advice from the doctors.
All the best whatever you decide.
That’s my concern though Ozone.Having said that, if you were in his position, what would you want to happen?
There is no easy answer as you've said and you can only decide based on the information or advice from the doctors.
All the best whatever you decide.
Whilst trying to be fair to the Doctors, they’ll understandingly be coming under pressure to free up the bed. At which point , how valid does their opinion or advice become?
Have the doctors actually said that you will be the one to make this decision? In my experience it is not, the medical staff will decide whether or not to withdraw support based on the outcome of the neurological tests.
This is why there are cases where parents have to go to court to stop doctors withdrawing support - it's not the parent's decision & they need the court to intervene.
This is why there are cases where parents have to go to court to stop doctors withdrawing support - it's not the parent's decision & they need the court to intervene.
Your doctors will not be looking to free up a bed. The viewpoint is not one of bedblocking or managing capacity, it is of looking after people and trying to return them to health.
In your fathers situation, your doctors will be concerned that he will not return to any level of autonomous functioning. He may well come off the ventilator, he may be able to lie in bed, but it strikes me that they are concerned he will be unable to drink for himself, feed, wash, and clothe himself if he were to get better.
When you have a chat with them, ask them what the prospects for returning to his pre-hospitalisation state is (it’s usually about 0-5% for the elderly in intensive care units) and how likely an improvement in his condition is if they persist treatment. The doctors will not have exact numbers but give generalised answers such as very unlikely, probable etc.
They want to know from you what your father consider to be his best interests in this sort of situation.
Without more clinical information it’s difficult to give more precise answers, but his prognosis and future do not sound very bright
In your fathers situation, your doctors will be concerned that he will not return to any level of autonomous functioning. He may well come off the ventilator, he may be able to lie in bed, but it strikes me that they are concerned he will be unable to drink for himself, feed, wash, and clothe himself if he were to get better.
When you have a chat with them, ask them what the prospects for returning to his pre-hospitalisation state is (it’s usually about 0-5% for the elderly in intensive care units) and how likely an improvement in his condition is if they persist treatment. The doctors will not have exact numbers but give generalised answers such as very unlikely, probable etc.
They want to know from you what your father consider to be his best interests in this sort of situation.
Without more clinical information it’s difficult to give more precise answers, but his prognosis and future do not sound very bright
My Dad was in a similar position and the decision fell to me. I looked for some comprehensive advice from the medical team and found none. I deliberated for a while and (there's a lot of back story here which I won't go into) eventually decided to switch off life support.
It is a decision I have never come to terms with. It's been 12 years and I still don't know if it was the right thing to have done. My mother and brothers support my decision 100% but I feel guilt and still wish I could talk to my Dad and ask him what he thinks of my decision.
I suspect there will rarely be a 100% "right" decision here. The best you can expect is that you can live with it. I do, even though I constantly question what I did.
It is a decision I have never come to terms with. It's been 12 years and I still don't know if it was the right thing to have done. My mother and brothers support my decision 100% but I feel guilt and still wish I could talk to my Dad and ask him what he thinks of my decision.
I suspect there will rarely be a 100% "right" decision here. The best you can expect is that you can live with it. I do, even though I constantly question what I did.
bearman68 said:
I feel for you OP, what a terrible situation to be in, and whatever option you chose, I think there's a chance you'll always second guess it.
My take - you know what your Dad wanted, try your best to reconcile what he wanted to what you do. I think this is the most ethical and courageous stand point, and one that you cannot be criticized for.
Probably worth talking through the emotional costs with a professional or someone else who will listen. This is not going to be an easy time for you OP, and I wish you well.
Even though my parents are divorced, I’ve sought my Mothers council. She’s expressed her opinion without me informing her of my thoughts in case I somehow influence her decision.My take - you know what your Dad wanted, try your best to reconcile what he wanted to what you do. I think this is the most ethical and courageous stand point, and one that you cannot be criticized for.
Probably worth talking through the emotional costs with a professional or someone else who will listen. This is not going to be an easy time for you OP, and I wish you well.
My Auntie, (my Fathers sole remaining sibling), is of a different opinion to my Mother. No matter which decision I make, it will cause ruptions.
In terms of criticism, it is self criticism, or rather guilt that is inevitable.
If Dad does make a slight recovery, then his standard of life will be so bad that he’ll likely wish we hadn’t bothered.
On the other hand if I give the go ahead then I’ve sanctioned my own Fathers death.
I just can’t understand how his health has deteriorated so badly over the last 8 months. First a cancerous growth removed, then a dodgy prostate, then ICU with Coronavirus, then this.
Mr Pointy said:
Have the doctors actually said that you will be the one to make this decision? In my experience it is not, the medical staff will decide whether or not to withdraw support based on the outcome of the neurological tests.
This is why there are cases where parents have to go to court to stop doctors withdrawing support - it's not the parent's decision & they need the court to intervene.
They have told me that “I will have a difficult decision to make”. My Father is in Spain, so I can only assume that the rules are different over there. I’ll email his Lawyer that question later on.This is why there are cases where parents have to go to court to stop doctors withdrawing support - it's not the parent's decision & they need the court to intervene.
Mars said:
It is a decision I have never come to terms with. It's been 12 years and I still don't know if it was the right thing to have done. My mother and brothers support my decision 100% but I feel guilt and still wish I could talk to my Dad and ask him what he thinks of my decision.
Chuffin hell 
You’ll have to give me a minute. I’ve got a lump in my throat.
Thank you for your input and I’m sorry you found yourself in the position that you did do.
How awful for you.
Different situation I know, but having watched my Grandmother wither and die a slow and painful death I wish I could have helped her on her way a year earlier.
If your father said that he wouldn't want to live if he was like this then you already know the answer.
What ever you decide it will come from the right place so there is nothing to fear.
Different situation I know, but having watched my Grandmother wither and die a slow and painful death I wish I could have helped her on her way a year earlier.
If your father said that he wouldn't want to live if he was like this then you already know the answer.
What ever you decide it will come from the right place so there is nothing to fear.
gasman712 said:
If he’s moving his eyes or blinking, he’s not brain-dead.
I’m going to assume, based upon the information you’ve posted, that you’re a medical professional as opposed to a gas fitter?As I’ve stated, Dad is in Denia, Spain. Conversations with the Spanish Doctors is challenging. Their English isn’t much better than my Spanish. Exact details and answers to specific questions are very hard to come by.
If Dads eyes are flickering but he remains otherwise non-responsive, what would be the likely issue there, (he’s been out of the coma for about 12 days now).
Mars said:
It is a decision I have never come to terms with. It's been 12 years and I still don't know if it was the right thing to have done. My mother and brothers support my decision 100% but I feel guilt and still wish I could talk to my Dad and ask him what he thinks of my decision.
This will always be on your mind, as it is ours. We are 18 months down the line, and it still haunts me.C2Red said:
Mars said:
It is a decision I have never come to terms with. It's been 12 years and I still don't know if it was the right thing to have done. My mother and brothers support my decision 100% but I feel guilt and still wish I could talk to my Dad and ask him what he thinks of my decision.
This will always be on your mind, as it is ours. We are 18 months down the line, and it still haunts me.Was it seeking council from family members?
Comments your Fathers had made in the past?
Trying to subjectively assess medical prognosis?
Advice from spiritual leaders?
Feel free to PM if you prefer.
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