The Corner

Health Care

Why Families Should Decide When to ‘Pull Plugs’

(Photo:Dreamstime)

Doctors are incredibly knowledgeable. They understand when people are terminally ill or unlikely to survive a traumatic injury.

But they are not infallible. People don’t die by the numbers. Some patients prove unexpectedly resilient. Sometimes true miracles occur, or at least there are no scientific explanations for the disappearance of diseases or recovery from “non-survivable” injuries that occasionally take place.

Case in point: When Jovanna Calzadillas was shot in the head in the horrific Las Vegas mass shooting, doctors continually told her husband Frank there was no hope and that life support should be ended. From the Arizona Republic story:

Over the next day, their family began to arrive, 100 people filling Jovanna’s hospital room, the hallway outside and waiting rooms.

They had come to say goodbye.

Barb had prayed the whole way. But she couldn’t tell Frank what to do. She said it was up to him. Jovanna was his wife, the mother of his children.

It had to be Frank.

No one made it easy. Doctors pressed Frank for an answer. “It’s not a survivable injury,” they repeated like a mantra. She might never wake, they told him. Never regain speech. Never walk. Someone asked him to consider organ donation.

They are just waiting for her to die,” Frank thought.

He was waiting for her to wake up.

When Frank saw signs of life, doctors would dismiss his observation as a “reflex.” (How often I have heard that over 25 years of anti-euthanasia advocacy!) Even videos were not enough. (Sound familiar to people who pay attention to medical controversies in the news?)

At times over those first weeks, Frank thought he saw something. A look in Jovanna’s eyes. A squeeze of the hand. Her mouth trying to form words. But in an instant, it would be gone. He’d tell Prendergast, show her a video he captured. Jovanna smiling. Reaching toward him. Jovanna would sometimes wake up crying.

“OK, Frank,” Virginia would tell him. But she’d have to see it for herself.

You can guess the rest of the story. Frank was right and the MDs were wrong. Jovanna’s injury may not have been survivable, but she survived. More, she is now fully awake and in physical rehabilitation.

Why do I bring this up? Certainly not to criticize the doctors (except, perhaps, the seeming general  tendency to not believe families who claim to see signs of consciousness in cases such as this). I have little doubt that almost all people in Jovanna’s circumstance would have died.

Rather, I want to use Jovanna’s recovery to illustrate why public policies such as state “futile care” laws–which empower doctors to remove wanted life-sustaining treatment over the objections of family and/or patient–are unjust.

“Futile care” (AKA “inappropriate care”) must be distinguished from “medically ineffective” interventions. The latter category is a matter of biology. Antibiotics don’t impact viruses, for example, and doctors should certainly not be required to prescribe them to a patient with a viral infection simply because a patient wants it.

In contrast, futile care situations involve value judgments–that continuing to live is too burdensome on the patient or not worth the cost of care. Hence, futile care policies allow doctors and/or hospital bioethics committees to force patients off life-sustaining treatment based on their determination of ultimate non-survivability, permanent disability, “quality of life,” or resource management. And it generally is aimed at removing treatment because it is working–e.g., maintaining the patient’s life–based on subjective belief that the patient is better off dead.

Had a futile care determination been made in Jovanna’s case before she woke up–rather than to leave that decision properly to Frank as her doctors did–no one would ever have known she was fated to survive a non-survivable wound.

Don’t get me wrong. This is not an argument to disregard the advice of doctors about removing life support. But in the end, such ultimate decisions belong with families, not doctors–and certainly not bioethicists.

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