TW: death/injury When is it kinder to let someone die?

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I recently started watching Facebook videos and haven’t yet adjusted my preferences for content I want to see. I’ve been bombarded by videos of “feel good” stories. It’s largely about people in the US who have had life changing injuries. So for example, a shot gun wound where they lost most of their face, or someone who has had all of his body below the torso removed because of an accident. In all these cases the person nearly died but was saved by modern medicine.

I want to be clear I am disabled myself (and have a not great quality of life) and I think if people want to have surgeries/treatment they should have them on the NHS and be fully supported by the welfare state if needed. But, is it always ethical to
intervene? And is consent always needed?

I’d be really interested to hear from any medical professionals or people with firsthand experience what they think. Is it possible to put in place something on medical records to say in advance when we wouldn’t want treatment.

My experience is that the NHS/medicine is great at physically saving people but there is very little support for living with the impact of serious illnesses/injury. I assume it’s the same in the US.

YABU-we should always use medicine to save a life

YANBU- it’s more complicated and sometimes it’s kinder to let someone pass

Yes it’s awful, having been there with my mum. I’m going to have these discussions and if I know what loved ones want, I think it’ll feel less like brave and more carrying out their wishes

I’d be really interested if you could share any links/study names? I wonder (although that’s speculation) as to whether that research is limited to certain types of medical conditions are carers? So potentially for certain disabilities, for example, physical aids such as wheelchairs or prosthetics might enable the person to continue to do a lot of what they need to make them happy. Others, for example in my case where the disability lacks any good treatment options, it relies on management meaning I’m mainly housebound, often bed kind and can’t do a lot of things. So maybe the condition makes a difference, as well as other factors e.g. having the money to pay for additional equipment and support.

I keep hearing about a study where they mentioned happiness levels in people who had had a “catastrophic” event in life (I think things like becoming paralysed) that claimed your happiness levels return to their normal level after 3 months…I find this very dubious but would be interested if anyone knows more

You can have stuff in writing but in my experience trying to get the medical professionals to act ( or not) on it can be a fight

My mother had a catastrophic stroke. She also had an advance directive stating that she did not want treatment if she would be left disabled in any way.

But the hospital were arguing about this. And totally ignoring the dire give.

Bear in mind she was unable to swallow ( even a week later) couldn't sit up or move her left side at all and blind in the left eye. Her speech was not u understandable and needed to be tube fed
It didn't help that we were not allowed to go to the hospital at the time so it was difficult to advocate for her.

They kept pumping her full of antibiotics and tube feeding. Both things were stated as against her wishes in the directive.

Thankfully we eventually got someone to accept it and they stopped the antibiotics and feeding. Mum passed Peacefully a couple of days later. It's unacceptable that she was kept alive a fortnight to suffer though

I have worked as a nurse in ICU for over 10 years, I have sat with many a parent/child/sister/partner whose loved one isn't going to make it after a traumatic event and we are ending life supporting treatment for them to say, I wish they had never come to ICU, I wish you had never put them on the machine and they had just died at the scene.

Just because we can put people on ventilators doesn't mean we should, its tortuous to drag death out for as long as we can. And please don't get me started on Consultants who won't take brave decisions and take the easy way out

This is worrying if people are doing directives and they are ignored-you are the second person in this thread who has said this about a relative’s directive. Does anyone on here know the legal status of these things or why they are ignored? Is it a fear of litigation by hospitals? Or a drive to save life?

Just want to say thank you also to the medics who hade shared, it cannot be easy to have to work making these decisions x

I am very sorry to hear about your mum. Please see what I have written. I think its awful the way some people are treated with no one looking at the bigger picture and the actual patient.
Goes back to what I said, just because we can extend life, doesn't always mean we should

I'm so sorry to hear this It's exactly what we were afraid of happening to my mum

Both my children have told me they would not want to live if they had to be hooked up to machines to be kept alive, with no awareness and no quality of life.

I also see those videos. Especially of the pro lifers with extremely disabled babies and children.

my opinion is if the person is still mentally competent it is their choice. But bringing some of these babies into the world to suffer and less than exist is cruel. When someone has an accident and can no longer function with no meaningful brain activity, keeping them alive with no hope of recovery can be cruel. It’s just keeping a shell in existence for the benefit of others.

Not exactly the same but I was the one to say to the ICU doctor that we did not wish them to attempt to resuscitate ventilated DF (covid) - the doctor asked what our wishes were and i said he absolutely would not want to live with life changing disability ie being permanently reliant on oxygen. She confirmed this would certainly be the case if he survived. He was 66. It honestly feels like the most selfless thing I've ever done- i adored my DF and wanted to keep him around forever - but not at the expense of his quality of life and happiness 💔

From Wikipedia on hemicorpectomies:

7]
Emergency rooms and ambulance service policies advise against the resuscitation of such patients. The UK's National Health Service, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy (along with decapitation) as "unequivocally associated with death" and that such injuries should be considered "incompatible with life" in patients under 18.[8] The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine if patients are to be considered unresuscitatable.[9]

So presumably there will be other conditions that have been deemed as incompatible with life, unless the patient is conscious and can express a wish.

Some units have follow up clinics whereby patients are invited back to the unit to see where there bed was, meet the staff etc. It can help with their recovery.
As a member of staff I rarely recognise the pt ( the relative yes ) as they look so different.

Have patients with life changing injuries etc shared with you their thoughts on being saved? I understand that they might well not do that though especially if they are unhappy but don’t want to appear ungrateful to medical staff

Interesting thanks for sharing. I genuinely wouldn’t be surprised if in a few years we are able to reattach heads and do so because we technically can, whereas the science/support for living with the after affects such as brain damage haven’t kept up

I haven't been involved with them if I am honest.

Decompression cranie or something else?

My husband had a huge bleed. This saved his life and despite warnings of terrible outcome. He is back playing in his squash tournaments, back at work running his business, going on holiday. I thank those people making those decisions every day that I have my husband back. He is "almost" the same as before

I'm afraid I agree. There are people I know who have been kept alive after severe illnesses, or severe disability from birth. They have no quality of life at all - dependent on oxygen etc, one of them has been kept alive and cannot walk, talk, sit up, is tube fed etc. I do not believe in keeping someone alive at all costs.

V impressive! Ive not meet any that can communicate/eat/tracheostomy and not totally dependent on others for everything. Always have to have hope

If the person doesn't have capacity to consent then you have a meeting of all concerned and discuss what is in their best interests. This is sometimes difficult to decide. Best interests doesn't always mean treatment, especially if they are likely to not cooperate or the treatment will be distressing, risky or futile. In serious cases where there is a difference of opinion at the best interests meeting, a court can decide.

I think fear of litigation is a strong driving force.
There was a recent case of someone with a do not attempt resuscitation order who choked.
They were not resuscitated when they had cardiac arrest due to choking.
The team were successfully sued ( by patients family)for not resuscitating as it was argued to be a potentially reversible situation.
The problem is, any cardiac arrest could be potentially reversible, even though highly unlikely most of the time. How could you know at the time
The solicitors I see say to approach all of this with caution, even the dnar orders.

I watch a family of a friend living through this.
Their sibling was involved in a catastrophic accident in their late teens, now mid 30’s. They have been totally paralysed ever since, non verbal, totally dependent on two carers 24hrs a day. No one is really sure if they have any awareness of what’s going on around them. In the first few years there was hope that they would improve, that there would be new treatments, but nothing has helped. No one ever expected them to live this long.
It’s very hard on their family, and I often wonder how they do it.

Unfortunately doctors and other medical have to provide the best care possible to keep patients alive, even if it will result in life changing complications. There are many that would rather this didn't happen but also plenty who would rather be alive no matter what. Doctors can't make that decision for you.

That’s good to know. Although I would probably be categorised as non compliant with medication. So not sure what they would think of me!

91% YANBU - which is the way I voted. Let me go, I don’t want to prolong things.

It’s so personal though- my aunt wanted to live any which way how, unless she was in pain.