Advanced Life Support: Love or Torture?

Medical madness is a part of my daily life since I work in a critical care center. We have a life support unit where the patients are all mechanically Ventilated ( on a breathing machine). Many of them will eventually be able to wean off the ventilator and will breathe on their own. Then there are those who will die in spite of all the technology and amazing medical procedures available. In fact some of these patients never wanted to be on life support to begin with. Their families over-ride their advance directives and demand that the patient be placed on life support or they will sue the doctors and the hospitals.

I will give you and actual example of an out of control family and their dying mother. The patient is 84 years old and has suffered a massive stroke and has pneumonia. This unfortunate woman is on life support and will never regain full consciousness. Her lungs cannot function without a ventilator and she has a pacemaker to keep her heart beating. The kidney's have shut down and dialysis is done daily. She has coded several times. The EEG, electroencephalogram: a graphical record of electrical activity of the brain, has resulted in readings indicative of severe damage to the brain.

This poor woman's skin has began to deteriorate almost to the point of decay. The odor is horrific. The family intends to keep her in this state as long as they can. They don't come to see her because they"can't stand to see her in this condition". Yet they refuse to allow the doctor to discontinue life support and let this woman die in peace. Massive amounts of narcotics are required to keep her from suffering horrible pain.The family has requested that the pain medication be with- held because they want her to know that they are calling her each day when they have staff hold the phone to her ear so they can talk to her. The doctor refused to discontinue the medication and the family threatened to sue. Saying he was going to cause their mother to over dose.

This morning as I started my work day, I entered into this woman's room and observed her trying to scream. Of course there is no sound due to the tracheostomy tube in her throat. As I began to check her wounds I realised that they were significantly worse then yesterday. The odor of decaying flesh was overwhelming and I could barely keep myself from vomiting.

I find this whole situation to be a moral and ethical dilemma, since She has an advance directive that states she did not want live support.

The reason I'm writing this is to let people know that keeping someone on life support when they don't want it is cruel and selfish on the part of those who are over- riding the wishes of the patient. They always claim they are doing it because they love the person. I certainly hope that no one will force me to exist on machines while suffering unspeakable agony. Some how I just can't call that love.

If this type of Painful "torture was forced upon any helpless person by their family in any other setting It would be considered a horrible crime. However, since the family is insisting it be done in a medical setting even though there is no hope of any result other then a horrible death, it is somehow justified in their minds as a loving thing to do.

Is it ok to ignore a loved ones wishes and cause them to suffer and endure unspeakable agony because we " never can say goodbye?" Just because we have the technology does that mean we should always use it?

What is the point of an advanced directive if your family can just ignore it and do whatever they want?

These are serious questions and The moral and ethical implications are continuing to perplex those who work with the critical patients in hospitals across the nation.