Human Exceptionalism

Not Futile Care but a Failure to Communicate

I am assuming that the descriptions in this story are accurate for purposes of analysis. According to the Atlanta Journal Constitution:

Alicia Fennell had just one hour to save her husband’s life. Doctors at Emory Eastside Medical Center in Snellville said he was brain dead and being kept alive by life support. She and her children doubted the diagnosis, sensing that somehow Donald Fennell was still aware.

This is awful writing that seeds terrible confusion. To be declared brain dead is–assuming accurate diagnosis–dead. It is not to be declared unconscious. It is to be declared dead. Hence, if true, Mrs. Fennell didn’t have one hour to save his life because he was already deceased.

This may seem to be a case of futile care theory in action, but it wasn’t if Mr. Fennell was truly dead. However, the problem here was not caused by Mrs. Fennell. She wanted her husband to be maintained because the hospital did a terrible job of communicating fully with her–as a consequence of which she brought the case to court:

[Judge] Davis called everyone back into court at 11:30 a.m. the following day. He asked Chief Medical Officer Michael Heisler at Emory Eastside to bring CAT scans and explain the test results to the family in a way they could understand. He also consulted with a chief administrator for the VA hospital in Decatur, who said it was unlikely they would accept someone in Fennell’s condition for a transfer. Alicia Fennell says that until the court hearing, doctors had never fully explained her husband’s condition. It was also the first time she’d seen CAT scans. Previously, hospital workers told the family the machine wasn’t working, she said.

Good grief! If this is true, it is unconscionable.

Declarations of death by neurological criteria are tricky enough without an arrogance or neglect that treats a grieving woman like an unwanted spectator to what happens to her husband. It also points to the desperate need for uniform procedures both to determine death by neurological criteria and how to help families deal with the diagnosis with regard to ceasing intervention.

Futile care theory is about imposing institutional or physician subjective value judgments on unwilling patients/families. If the patient is dead–which appears to be the case here–the desired treatment is physiologically futile–and it is not wrong to stop treatment that can no longer help the patient. Physiological futility is not part of the Futile Care Theory problem that this way comes. That imposition is known as qualitative futility. It is crucial to understand the difference between the two.

In this case, again assuming the story is reported accurately, the hospital caused needless fear and suffering to a desperate woman–which resulted in bad reporting sowing confusion about both brain death and futile care among the general public.


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