Improving medical students

End of Life Decisions

Posted by medliorator on February 24, 2008

When families are coping with the decision whether to forgo or to remove life support for a loved one, I have seen two consistent sticking points in the decision. First, families often feel that by stopping a ventilator or by failing to put their family member on a ventilator, they are “killing” their loved one.

To get families past this idea, I remind them that if “nature took its course,” the patient would already have died. By using all the ventilator/medications/etc., we are able to “cheat death,” but we can’t do so forever. The advanced technology has allowed the patient to stay alive long enough so that other family members could say their goodbyes. But as sad as it is when someone dies, people were not meant to stay alive by machines.

The second, and sometimes more difficult, sticking point is that families want their loved one to continue “living.” If I hear this, I describe what I believe to be the difference between “life” and “living.”

“Life” is a heartbeat and a pulse. Active metabolism. Nothing more. People who are brain dead on a ventilator are “alive” because the cardiac monitor says so. But preserving “life” can sometimes be cruel. Patients kept alive in a comatose state can develop chronic bedsores, contractures, cancer pain, broken bones, infections, and other maladies.

“Living” is the ability to appreciate and enjoy life. Someone who is alive can communicate. They can savor the smell of apple pancakes in the morning, enjoy listening to their grandchild’s first words, and reminisce about watching Roger Maris hit home run number 61. Maybe it’s the wink of an eye when you’re feeling down, maybe it is only the ability to smile and to feel comfort in the touch of another, but living allows someone to interact with the world around them.

Ultimately, families are supposed to make a decision based upon what their loved one would want to do if the loved one were able to make the decision. This is the question that I present to families having difficulty making the decision whether to maintain their loved one on life support: Would this person be content with life on a machine, even if it meant that he was no longer living?

The Difference Between Live and Living [WhiteCoat Rants]


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