How long would you vegetate before having the plug pulled?

In My Humble Opinion
1

My sister and I are drawing up living wills in which we will name each other as the executor. I need some ideas for the “pull the plug under xyz comditions” parts. My inclination is to say, “Gimme 30 days under any conditions and another 30 days if reccommended by the primary care physician, and that’s it.” However I think I should allow the time to be shorter under some circumstances – if my condition were sufficiently hopeless and there was an organ recipient who could use something of mine, for example.

What are your terms?

2

I’ve been discussing this with my parents (closest relatives and likely to be making the decisions if anything bad happens in the next 20 years or so). My preference would be to rely on the judgement of the primary physician. If he or she says the chances of me pulling out of my current state are less than about 5%, start cutting my body up for parts as soon as possible, cos I ain’t home no more. I’ve seen the difference an organ transplant can make to somebody’s life and my personal opinion is that tying up organs on a life support machine is a waste of money and effort when somebody else could be granted a whole new lease of life with them.

3

D/C life support systems if brain function scans show that I’m equivalent to a decaying fig (without the fruit flies). :wink: If they can detect some hamsters a-runnin’ I’d be inclined to see if there is improvement within a month. If it’s still status quo, get that hambone out and wake up the hounds-it’s time to drag me off.

4

What dwc said. Modern technology is sufficient to determine brain death. Once that happens, carve me up and bury the rest in a shoebox in the backyard. Or cremate me and scatter my ashes over whatever stadium the Cowboys are using at the time.

Robin

5

Twenty-eight years, so far. Twenty-nine by the end of October.

6

I can conceive that a brain scan would reveal some ambiguous brain activity, but I would just continue to snooze on indefinitely. That’s why I think there needs to be a time limit.

Oh yes, and a Democratic state government, because keeping the undead on life-support is about the only social safety net the Pubbies are interested in. :stuck_out_tongue: Would you want your state government messing with your next of kin over this?

7

The question is not how long have I been in a vegetative state. The question is how long will I be in a vegetative state. It seem to me that when competent medical authority – like for instance Mayo Clinic or Cleveland Clinic or Johns Hopkins University Hospitals, all of whom are happy to consult on this sort of thing – says there is no reasonable chance that I’m going to snap out of it then its time to pull the plug or jerk out the tubes or put the big fluffy pillow over my face and sit on it.

I’m not particularly frightened at being prematurely terminated, but I’m concerned that the expense of keeping and otherwise inert sack of protoplasm fresh may pauperize my survivors. I don’t want my legacy to my wife, daughters and grandchildren to be the potential of a Chapter 7 Bankruptcy because of the cost of a prolonged and expensive heroic measures taken on the off chance that I might revive or because some preacher thinks God wants it that way.

8

No document will be able to cover every potential situation. For this reason, living wills are often not worth the paper they’re printed on; if there is anything about the situation that isn’t addressed in the document, and there always will be, then the family is right back to making the decisions that you’re trying to keep them from having to make.

A health care power of attorney (or whatever they’re called in your state) is a much stronger option. The HCPOA gives clear authority to someone to make decisions regarding your care when you are unable to do so. As the name implies, it applies only to health care decisions; power of attorney for financial matters, etc., is a totally different document.

My suggestion would be for you and your sister to declare one another as HCPOA, with backups in the event that she cannot make the decision for you. I would include some extremely general language in the document about your wishes, but nothing that limits the decisions she would be able to make.

After this is done, the important thing is making sure that she understands your wishes. Some specific issues that you might want to discuss:

–In what circumstances do you want to be intubated and mechanically ventilated? This is probably the big one, since when this decision needs to be made, it must be made fairly quickly. Ventilation is usually temporary, unless you are already in the latter stages of a disease, but most people (IME) would not want to go on the machine at all if there were little or no chance that they would ever come off and breathe on their own again.

–Similarly, in what circumstances would you want drugs used or withheld that would sustain a fatally dropping blood pressure (aka “pressors”)? I won’t get into a detailed discussion of what these drugs do, but if they are being used, it means that you are extremely sick and your recovery will probably be lengthy and demanding.

–If your heart stopped or went into a fatal rhythm, in what situations do you want attempts at resuscitation to be withheld? This would include chest compressions, electricity, and various drugs.

–If you were unresponsive and ventilated and clearly not improving or getting worse, at what point would you want the ventilator stopped?

–Similarly, if you were unresponsive and clearly not improving or getting worse, with no sign that you might improve anytime soon, would you want a feeding tube placed?

–What do you consider to be a tolerable quality of life?

Unless there are specific interventions you are uncomfortable with, I would think of these things very generally. For instance–I am young and healthy, so if I am collapsing in any way, I want everything done. If I am brain dead, don’t even think about keeping me alive. If I could return to a reasonable quality of life, then push on; if the best I can hope for is to be totally dependent on others for my basic needs, or if I would not be able to eat, or read, or do the other basic things that bring me everyday pleasure, then I’m not interested.

You have to trust your HCPOA to make these decisions for you, but ultimately someone is going to be making them, living will or not. This allows you to name someone to have the final say and to make sure that person understands your wishes.

I’m sure there is a good book on all this, but I don’t know of one to recommend.

9

While I agree that having a health care proxy is ultimately the best way to go, I think that living wills have their place, as well. It enables the discussion to be opened and gives a written reference for the person acting as proxy. When you are actually put in a position of making those decisions, it’s obviously going to be a high stress and emotional time and to be able to refer to a written document could reduce the questions in your mind. I was my father’s health care proxy and I was fortunate that he was able to pretty much make his own decisions right til the end, but there were several points where I had to make minor decisions and even though my father and I had discussed things, it was difficult to remember everything we’d discussed and also to separate what he wanted and what I wanted from an emotional standpoint.
Maybe a living will isn’t necessary, but some sort of documentation of the discussion is really helpful.

That’s an excellent list of discussion points, Dr.J.

10

Personally, I see a major difference between pulling the plug on a ventilator and withholding food and water (with or without a feeding tube).

The one is letting nature take its course, the other is actively killing the patient. My wife and I are in agreement on this one, and, should it become necessary, will take action accordingly.

11

True, in a limited fashion. My concern would be that the living will fails to anticipate a particular situation and locks my HCPOA into a course of action that would be contrary to my ultimate desires.

For instance, say I put in my living will that I did not want to be intubated, period, because I assumed that if I went on the ventilator I would never come off. If I had an illness that I would be able to recover from within a few days, my HCPOA might understand that intubation in this case would not be ultimately contrary to my wishes, the living will obligates her to withhold it.

That’s an extreme case, of course, but there are always situations that one does not anticipate.

That’s interesting–I see them as exactly equivalent. The ventilator provides oxygen and ventilation when the patient cannot breathe on his own, and the feeding tube provides nutrition and hydration when the patient cannot eat or drink on his own. Both are contrary to “the course of nature”.

12

IANA lawyer, but I don’t think even the most explicitly drawn living will removes all facets of human judgement from the decision making process. You are providing guidelines to those capable of decision making in for you while you are unable to do so. I’ve never heard of a living will overriding the judgement of both the family AND the health care provider, should all parties agree that your choice as stated in the will was wrong or flawed for whatever reason.

Which makes it all the more important that you and your executor have as clear as possible an understanding. You are designating that person as your advocate, and you have very little recourse should their wishes diverge from yours.

13

IMHO the value of a living will is in its spirit, not in its details. It gives the person making the desicion some guidelines as to what one would decide if capable of doing so.

I’ve been in the decision maker position twice. It sure helps to have an understanding of the patient’s feelings on the matter when those feelings have been expressed while in a state of good health.