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Ethical Scenario 20
How would you go about making the decision on whether or not to discontinue life support for a brain-dead patient?
The core issue here is lack of patient consent - without knowing what the patient would want, or have wanted, the decision falls to relatives and the doctor’s clinical judgement. Clinical guidance documents in general assert the importance of the doctor’s judgement when withholding futile treatment. However, in practice the consent of the patient’s relatives or proxies is normally ethically required.
Therefore, when considering whether to withdraw life support, one should carefully weigh the potential benefits of continuing treatment, vs the futility of continuing it. In this instance, with a braindead patient, recovery is impossible. Continued treatment is futile. However, a discussion needs to be had with the relatives, to ensure their understanding of the position is clear and complete.
I would like to highlight are that I’m taking ‘braindead’ to mean brain stem death in this answer. Recovery from brain stem death is impossible, and as such a doctor can terminate life support without recourse to courts if necessary. Persistent vegetative state could often be labelled as ‘braindead’ in the media.
If the patient’s family refused to allow the patient to die, and there was no urgent need for the equipment the braindead patient is using, then discussions can continue until they’re happy letting the patient go. However, if the equipment is urgently needed, the doctor’s autonomy prevails over the rights of the patient’s surrogates.