[ebkayaker]

I know this is a hot topic these days among the medical community and I am not trying to impose any values on anybody. I have a research paper due and I am just looking for some help. Here is a brief summary of a detailed situation.
I had a situation in which the pt. was brain dead, declared by two docs, and the family did not want to take her off life support. Ethics committee met and decided that because there is either a state law or federal law that says after a patient is clinically brain dead by two docs they can take them off life support despite the family not wanting them to.
Is anybody familiar with this situation or what kind of law regards this time fram of a doctor being able to take a patient off the vent even if the family is saying no?? Any help would be greatly appreciated. Thanks.

[Ricu]

I don't think the law dictates a timeframe. Since there is a specific set of criteria that must be met in order to declare brain death, once that is determined, there is no reversing it. Furthermore, you mentioned an ethics committee meeting which you infer, supported the physicians' declaration. That's a lot of activity. Is there concern about upcoming litigation over medical care? An accident? Once in a while a case comes up where the family fights like this but I think it's relatively rare. Generally in these circumstances, I have discovered that family responds not to the litany of medical facts and statistics but to the compassionate handling of their emotional state and grief processing. It's not only possible for medical professionals to function inside of the grief process but beneficial. Everyone involved is served, patient, family, nurses, therapists, and the physicians themselves. We involve our palliative care team in all of these situations and they function in a very complementary way with the critical care team. It's an uncomfortable situation when the medical community and family are on opposite sides of this issue. Good luck with your paper.

R

[syudent1010@aol.com]

A question I would also want to know about this situation is Did all of the family members not want to withdraw life support or just the next of kin or family members that legally have no say in what happens. I just got done doing a clinical rotation in a trauma ICU and had quite a few cases of young people involved in traumatic events and they were brain dead, and the decision of taking them off the vent was a issue. In the cases I observed the next of kin were told by the MD's in a very straight foreward manner the extent of the person's injury, but in a caring attitude for their grief. The next of kin usually understood the fact that their loved ones were not going to get better and that the only reason they were still breathing was because they were on the vent, but other family members wanted to keep them on the vent because they didn't want to accept the reality of the person being gone. I think how the MD's handle the situation has a lot to do with how the family reacts. Also the family just might need a little time for the reality of the situation to settle in. I know in my state from what I heard the staff on the TICU say, only two physicians are needed to declare a patient brain dead by performing certain tests.