Probably one of the lengthiest legal struggles that involved prolonged life support would be the Terri Schiavo case. In February 25, 1990, she collapsed in her home due to full cardiac arrest. The lack of oxygen resulted in a massive brain damage that kept her in a coma. After two and a half months, she was declared in a vegetative state. Two years after her diagnosis was changed, Michael Schiavo, Terri’s husband, petitioned to the Sixth Circuit Court of Florida (Pinellas County) that her feeding tube be removed. Her parents opposed and a lengthy legal battle ensued.
From 1992 to 2005 there had been numerous appeals, motions and petitions involved, including suits in federal district court, and denials of certiorari from the Supreme Court of the United States, which totaled 14 in all. A federal legislation, the Palm Sunday Compromise, was even passed so that Terri’s case is moved to a federal court. It was only in March 18, 2005 when the original appeal to remove the feeding tube was finally upheld and carried out. 13 days later Terri died.
Because the appeals, motions and petitions were a battle between the husband and parents, whatever ties that bound them together have likely been severed. Through it all, Terry was in the hospital with no idea of what is going on. Terry’s husband thought that she wouldn’t want to be in a “persistent vegetative state” where the brain is only showing some signs of activity. This is why he decided to withdraw life support. Terry’s parents, however, argued that she was still conscious, and they were likely to be holding on to the hope that she will come out of her unconscious state.
Whichever way you look at it, pain and suffering is a common denominator in a battle regarding life support. Even the patient is likely to be suffering as well. This is why family and relatives of the patient should look into the pros and cons of life support before making a decision to have it carried out.
List of the Pros of Life Support
1. Increase the chances of survival.
When a patient is brain dead or no longer conscious, the decision to initiate life support falls on the hands of the surrogates (family or relatives). Most of the time, the decision to put someone on life support revolves around the idea that a patient is given the chance to live longer or recover fully, which means that, denying them the treatment, would be equivalent to killing them.
The extended time frame that the life-sustaining treatment provides allows the family to have hope, come to terms with the traumatic event, accept the situation, and have more time to grieve. This also gives doctors a chance to continue to evaluate the patient and provide newly discovered treatment if, there is any. There have been cases that a patient fully recovers, after being put on life support, but the percentage of this happening is not that high. Nonetheless, the time given for the family to hope and for the patient to survive is invaluable.
2. Grant a patient’s wishes.
Some people who have written a living will usually specify their express wish to be allowed to fight every minute of their illness, regardless of the pain and suffering that they go through. Even when a similar request is given verbally, it is the surrogate’s duty to carry out a patient’s wish. It is in their best interest, after all. The only downside to this situation is that it will be difficult to determine when enough is enough. When is the right time to pull the plug? Take for instance the case of Elaine Esposito who never woke up from her appendectomy. She was on life support for over 36 years but eventually died. This is a very long time of waiting and fighting for everyone concerned.
The only time that a debate about life support is unnecessary is when a family member has a DNR in place. Even then, the decision to follow a love one’s request would be difficult. In the event that a person fails to verbalize his wishes beforehand, loved ones would have to look into a patient’s overall attitude regarding life support.
3. Allow families to come to terms with death.
Most of the time, it is the hope that a patient will recover that motivates surrogates to initiate life-sustaining treatment. Over time, they will experience different stages of grief, until they can fully accept the fact that a loved one have little to no chance of surviving. They will reach a point when letting go and death becomes the only sensible option for them and for the patient. At this stage, deciding to unplug the machines would not be as difficult. Although they would still grieve over the loss, they would not have any regrets, considering the time they have allowed for a recovery to happen. They would not have to spend their time thinking about the ‘what ifs’.
4. Organ donation.
The case of a 6-month old baby in Florida who is on life support may be horrible and heartbreaking, especially for the parents, but there is a silver lining in the midst of the grief and shock. This is because Owen Skodje’s misfortune could be some other child’s fortune. According to his parents, he will be providing his material shell to help heal others, giving them the gift of life.
Organ donation is probably the most positive aspect of life support. This gives surrogates the opportunity to help others, despite the grief and the loss of a loved one. There are thousands of people just waiting for organ donors, and patients on life-sustaining treatments could be their only chance at a new lease on life. While not everyone on life support will be an organ donor, increasing the amount of organs that will be donated each year is a godsend. A lot of people will surely benefit from patients being kept alive until they are ready to donate their organs.
List of Cons of Life Support
1. Prolonged agony.
It is a common argument that putting patients on life support only prolongs their agony. Life support, as defined in USLegal as a medical treatment that, “when applied to the patient, would only serve to prolong the dying process where the patient has a terminal illness or injury, or would serve only to maintain the patient in a condition of permanent unconsciousness”. However, it does not include administration of medication that will provide comfort to the patient or even alleviate pain.
Based on the definition, it is clear that life support may only cause the patient unnecessary suffering. This explains why some people would have a DNR in place or tell love ones beforehand not to put them on life support. What is the point if a person is diagnosed with persistent vegetative state, anyway?
Unfortunately there are plenty of misconceptions about life support, especially on brain death, according to Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center. In the case of Jahi McMath who was brain dead following a surgery to remove her tonsils, he believed that doctors should have been more transparent with regards to the finality of brain death. This is to avoid a situation where the parents don’t really understand what is going on and would resist any removal of machines, or that they have the “impression that dead people can come back to life”.
2. Devastating side effects.
There are different life support treatments to help prolong the life of a patient. There are medical devices to aid breathing, provide food and water, and for administering medications. But they all have benefits and disadvantages. In some cases, they alleviate one condition but exacerbate another. Artificial nutrition and hydration, for instance, use tubes that can damage the esophagus, stomach, intestine, and even erode the lining of nasal passage. When surgery is needed to insert the tubes, the risk of bleeding or infection is high. When fluid leaks out of intravenous lines and on to the skin, it can also lead to inflammation and infection. Overly frail patients are also at risk of fluid overload that may lead to difficulty in breathing, and dangerous infections when TPN enters the blood stream.
Cramps, diarrhea and abdominal bloating may also happen to patients receiving artificial nutrition and hydration through NG or G-Tube. What’s worse, because patients are brain dead and would be unable to report any discomfort or illness, their condition could worsen when they are not given careful attention by health care providers.
Ventilators, on the other hand, are good while a patient is using it. It is only when it is removed that side effects are likely to manifest, especially when there are sedatives used. Discontinued use of a ventilator can result in a drop in blood pressure, abnormal heartbeat, weakened muscles, busted ear drums, dental problems, or severe respiratory problems.
3. Drains resources.
One of the reasons that a person is taken out of life support is when the family can no longer afford the monetary costs of the treatments. Good enough if the U.S. has a Life Support Rebate that is being offered in NSW, which can help surrogates pay up their electrical bills. Anyone can just imagine the amount of hospital bills that Elaine Esposito’s family racked up during her 36 years on life support.
The cost is undoubtedly astronomical. Aside from the machines, a patient would also need doctors, nurses and other personnel needed to provide complete hospital care. Between their professional fees and hospital bills, the total amount is often staggering. If, during the course of treatment, there are legal battles that need to be fought, the overall cost will surely take a toll on anyone’s finances.
Because life support does not guarantee that a patient will recover, it is often a lose-lose situation. The family will end up broke and the patient will die. This is because it is almost always a guarantee that someone on life-sustaining treatment will breathe their last once a machine is removed. It is usually just a matter of days or may be minutes when a ventilator or a cardiopulmonary resuscitation is removed that a patient will die.
4. Ethical issues.
When life support first came out, it was perceived as something good, special and a real life-saving procedure. These days, people are divided between different ethical issues, especially with the number of landmark cases that fueled debates to be carried on until today. Some of the concerns being raised include:
– Quality vs. the quantity of life: It may be true that life support can prolong the life of patients, but are they really living without the discomfort or indignity? Are surrogates really thinking about the welfare of their patients or simply holding on to the hope of a full recovery?
– Giving doctors autonomy: If family members answer yes to a doctor’s question of “do you want us to do everything”, they are highly likely to be setting themselves up for unethical practices. Although doctors are bound by their ethical and legal obligations to provide treatments in the context that can best help the patients and their families, some make decisions without consulting surrogates, while others don’t even provide a clear and comprehensive explanation as to what is really involved in the process.
– Withholding and withdrawal of life support: When is enough really enough? The principle behind withholding and withdrawal of life support states that treatment may not be initiated if the patient or surrogate refuses. There have been cases, however, when physicians suggest for treatments to be withdrawn, but the patient’s parents strongly argued against it.
Due to the many advantages and disadvantages of life support, it is vital that the family or relative of a patient evaluate the situation carefully. They should consider the many factors at play, which include:
- The patients’ quality of life if they do recover from their coma. Will they be brain dead, in pain, etc?
- The chances of a patient surviving.
- The available treatment plans other than life support.
- The length of time and the costs associated with life-sustaining treatments.
- The wishes of the patient versus the wishes of the surrogates.
- The possibility of doctors finding a cure while a patient is on life support.
- The decision to withhold life-support treatments and when.
Natalie Regoli is a child of God, devoted wife, and mother of two boys. She has a Master's Degree in Law from The University of Texas. Natalie has been published in several national journals and has been practicing law for 18 years.