Thursday, December 13, 2007

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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3 Comments:

At December 13, 2007 , Blogger James said...

Wesley,

I read the article. An interesting situation. I did notice one important note about this whole situation in the article:

"Then, long after the courthouse had closed, the judge took another unusual step. He accompanied the family to Fennell's bedside at 11 p.m. to personally assess his condition."

If you recall in the Schiavo case, Judge Greer precided over the case for 5 years.

Judge Greer absolutely refused to go and see Terri Schiavo even though he was asked time and time again to witness Terri Schiavo interacting with parents.

I always thought that is was one of many travesties of justice in the Schiavo case.

Just one of many.

At least this Judge had the kindness to go and see the patient.

 
At December 13, 2007 , Blogger James said...

Wesley,

I read the article. An interesting situation. I did notice one important note about this whole situation in the article:

"Then, long after the courthouse had closed, the judge took another unusual step. He accompanied the family to Fennell's bedside at 11 p.m. to personally assess his condition."

If you recall in the Schiavo case, Judge Greer precided over the case for 5 years.

Judge Greer absolutely refused to go and see Terri Schiavo even though he was asked time and time again to witness Terri Schiavo interacting with parents.

I always thought that is was one of many travesties of justice in the Schiavo case.

Just one of many.

At least this Judge had the kindness to go and see the patient.

 
At December 14, 2007 , Blogger LifeEthics.org said...

That's a good judge.

Such a young man, too. I'm praying for his family.

The reporter is a very bad communicator, too. I wonder about the whole story because of the reporter's terms: "he was brain dead and being kept alive by life support.""Brain dead" patients are not alive and they're not on "life support." The docs are using "ventilation support." They don't "pass away" when the ventilator is stopped. Then, there's the use of "pull the plug."

Way down at the bottom, the article actually says, "The next day, doctors told the family the stroke caused massive bleeding in Donald's brain. Four different physicians examined Fennell and his brain scans and determined his brain, including the brain stem which controls basic bodily functions like breathing, had ceased to function, according to court and patient records."

However, the problem started with the nurse who called security to have the family removed from the hospital. It's hard to talk to people who are shouting, but it's harder to talk to them when the police won't let them in the building.

I'm trying to get my head around the medico-legal problem of delaying the declaration of death by the docs, scheduling a time to turn off the ventilator, and the comment about the machines being broken.

 

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