This would be the thing that I’d worry about. The one time I came out of anesthesia (admittedly, it was twilight anesthesia), I was violently depressed. And this wasn’t a quality of life thing; I didn’t just decide that I couldn’t live without my wisdom teeth, you know?
If there’s an advance directive, that’s one thing; that’s presumably made in a calm, lucid frame of mind. But, you know, I know that I personally wouldn’t want to be asked that soon; my decision then might not be the decision that I–the normal, calm, lucid me–would make.
Which is exactly why, if you don’t have them already, you should be writing your Advance Directives now. And by now, I mean, now, right now, while you’re in a calm, lucid frame of mind. Because you never know what will happen in the next 10 minutes.
This is something I can personally relate to. Thirteen years ago I was injured (nearly fatally) in a car accident and underwent emergency surgery that ultimately left me paralyzed but also saved my life. One of the factors in my spinal cord injury/recovery that was relatively unique and is what I believe allowed me to come to terms with the reality of my injury and new life at my own pace and on my own terms was the fact that I was never-at any point-told that I was permanently paralyzed and would never walk again.
It was because the nature of my injury-it was a risk of the emergency surgery to repair my ruptured aorta-so after the surgery when I woke up in the hospital and couldn’t move my legs, I was just told that they’d have to “wait and see” what function would return. Given the fact that I had full sensation, I spent the next year and half or so waking up every morning thinking that would be the day I’d start walking again.
Obviously, that day never came. But holding on to that belief that I WAS going to walk again, at least during that initial time post-accident for the first year or so while I was acclimating to this new life is what I believe kept me emotionally whole and able to move forward with my life as a paraplegic. There is NO doubt whatsoever that if a doctor had informed me the day of my accident that I was going to spend the rest of my life in a wheelchair, I would want to fucking die, right then and there. WHO WOULDN’T?!
Being told you are never going to walk again, when you have JUST suffered a catastrophic, life-changing injury, is bordering on irresponsible, in my opinion. Not only does it rob the patient of any potential hope of a meaningful life, it also has the unintended consequence of making those patients who have been told they aren’t going to walk again yet DO make a recovery believe that it was because they prayed that hard to God. And it creates a sort of ‘cottage-industry’ of “pray away the wheelchair” nonsense that can be quite offensive to those who haven’t had such recovery.
I think docs should say, at most, something like, “We don’t know the extent of the damage to your spinal cord at this time. There does exist a possibility of you not walking again but it’s far too early to make any prognosis.”
I am a doc and I have sometimes been involved in situations where patients refused life saving treatment. It’s impossible to say based on the news reports if this guy was really in a sound mind to make these decisions. Maybe he was. However, I do think there are good reasons for being cautious in these situations.
For one thing, delirium is very common in ICU patients. Sometimes delirious people are very obviously agitated (the old term for this was “ICU psychosis”) but sometimes it is more subtle. Hopefully the doctors taking care of this guy did indeed assess his mental status and were convinced he was in his right mind.
Screening for depression is also important of course since for all we know this guy could have had a pre-existing history of depression with suicidal ideation. Ideally you would want a psychiatrist or psychologist to see him since not all doctors are good at doing a thorough mental health evaluation.
I do think that it is true that most people would need time to adjust to the news that they are paralyzed. I hope that this man and his family had the chance to talk to a PM&R doctor about the prognosis he faced and his likely rehab options (though I really doubt this happened since usually PM&R doesn’t get involved that early on after an injury). In most cases, you can’t really say a day after injury how someone will actually do. Some people may end up recovering more function after the swelling around the spinal cord goes down. It NOT black and white exactly how much function someone will recover, especially not just a day after the injury.
Here’s an interesting bit of info from an article I just ran across that discusses the ethics of these types of situations:
Yes, of course honoring a patient’s decision is important. However, I do think that ethically we have an obligation to make sure someone’s decision is well thought out.
It’s not just that he wasn’t going to be able to walk, though. He’d never be able to move his arms or breathe on his own.
If the doctors were nearly certain he would never be able to walk, then it seems to me that it would have been unethical for them to have equivocated about it. I know if I had been the guy, I would have appreciated the full strength truth.
I don’t think a lot of people would want to commit die if they suddenly couldn’t walk, especially if they just had a child and had gotten married. But the not-breathing-on-your-own thing would freak anyone out. I can imagine having a good life in a wheelchair. But I can’t imagine having a good life tied to a ventilator.
But what if that’s just not true? Can’t it sometimes known for sure right away that it’s permanent (as sure as anything can reasonably be)?
I can see not wanting to hit someone with that kind of information right off the bat and then encouraging them to make an immediate decision, but I don’t see how it could be considered ethical to lie to them either. Plus, there’s not some guarantee that he would have eventually been able to have a life worth living. He likely would have had a very low quality of life, forever. Huge difference between being a paraplegic and a quadriplegic on a ventilator.
But if he’d never stated his wishes before about what would happen if he ever got into this situation, I would think there was a high risk that he wasn’t in the right state of mind to make that decision so quickly. If he had, and then confirmed it then, I think it’s probably the best option. I know I wouldn’t want to live as a quadriplegic.
I agree that it seems very, very quick to make such a decision. And I would have expected a waiting period of some sort. But I don’t agree with the OP that he “killed himself.” There’s a big difference, ethically, morally, and legally, between actively killing yourself and agreeing to remove a device that is artificially keeping you alive.
In either event, it’s a horrible story and I wish the family all the best.
This young man made a verbal living will of sorts. Had he made these arrangements before hand, he likely would not have been ventilated (life support), in which case he would have expired. He just got the opportunity to make that decision post incident. That makes it appear like an assisted suicide. Which it’s not.
The unusual thing is he was conscious and in possession of his mental facilities and that he didn’t waiver from his decision.
Well, I wouldn’t. I’m pretty sure most people wouldn’t, in fact. It’s not like paraplegics don’t have a life, as you might know. But being paralyzed from the neck down and on ventilator (which means, I suppose, that you can’t even speak), on the other hand, is the stuff of nightmares. So much so that I don’t really have an issue with them letting him decide in a few hours.
You mean even if they know it’s patently false? I suspect I would hate them for giving me false hopes if it were the case. I definitely don’t want doctors to lie to me.
Unless I read it wrong they brought him out of sedation because being on a ventilator is most unpleasant. For me the situation would be pure hell on Earth. I literally can’t imagine a worse situation.
Fortunately, that’s not the case. When someone needs to be on a ventilator for a long time, they almost always are given a tracheostomy so that the tube is not in their mouth and they will be able to talk.
The problem with predicting someone’s functional abilities so early on is that, in many cases, the spinal cord is not completely severed when someone has a spinal cord injury. “Incomplete” injuries of the spinal cord may mean that the person will retain functions below the level of the injury since you still have parts of the spinal cord that are intact. That’s why you really can’t say for sure that the guy would never be able to use his arms or breathe without a vent. While most people picture someone with a high level spinal cord injury having absolutely no arm control, many people with cervical spine injuries do have some use of their arms and possibly hands.
Article said ‘from the shoulders down’. Might be the same I guess.
Here’s the thing:
[FONT=Arial][FONT=Arial]That doesn’t sound all that definite to me.
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At the very least, it appears he was able to talk. And the way I read this, he lasted five hours without the tube. They had time to sing and say prayers. WTF?
No brain damage and able to talk, would almost certainly get a trach so he doesn’t have the tube down his throat the whole time (did the doctors discuss this? Did they even have time to discuss this?)?
Do we know what his condition was like? Would he feel pain? Yes he may hate being a burden, yes medical bills might be an issue - but surely they should take a couple of days to fully come to grips with everything.
There’s no way in hell the doctors had enough time to really know what the situation was - I doubt the swelling from the surgery had even gone down. There’s no way in hell anyone in that family had remotely enough time to fully think out the situation and understand the long-term outlook. (I strongly suspect - but of course have no evidence - that the family & wife were convinced of what to do by the IC nurse sister).
Complete and utter bullshit. We’re not talking terminal illness here. You may want to sugar-coat it, but he killed himself just as surely as if he sucked the end of a shotgun and pulled the trigger.
I’m all for free will. I’m all for allowing the terminally ill a chance at a dignified death. Given adequate time and counseling with experts as to his long-term prognosis, I’m all for letting him make the decision to not rely on a machine to breath, if that’s what was required.
There’s no way there was near enough time for anyone to come to grips with anything. There’s no way the doctors could say with anything close to 100% certainly that he’d never be able to have a trach done to avoid the vent tube. There’s no way doctors could know with 100% that a surgery to help him at least sit up wouldn’t work.
It’s a disgrace. The doctors should be investigated by the state’s ethics board, and the family should be ashamed of themselves.
Given the choice, there’s no way in hell I’m dying before my child is born. I’ll endure ‘hell on earth’ for a while for the sake of my kid.
He was conscious. There’s no evidence that anyone did any sort of proper evaluation to determine that he was in full possession of his mental facilities, coming so soon after a life-altering accident, surgery, and had to be woken up from being sedated (in other words, he was drugged), and then being told he was paralyzed from the shoulders down.
Would -anyone- be in a proper frame of mind to make any sort of decision just a couple hours after all this happened?
