Pulling the Plug

Withdrawing life support from a patient is an ethical concern that should require the perspective of physician and family alike.

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The last days of life are moments that are held onto dearly. Every day, people in hospitals are teetering between life and death, with some having spent months and maybe even years connected to machines. The patients in intensive care units (ICUs) are those who are considered to be in critical condition and need specialized medical attention. Health conditions or injuries often found in the ICU include respiratory failure, organ transplants, and severe burns. On some occasions, the conditions can be so severe that they require the assistance of life support.

Life support encompasses machinery and technology that keep the body alive by either replacing or supporting vital bodily functions. Some examples include dialysis for kidney failure, mechanical ventilation to help a patient breathe, and feeding tubes or IVs to supply nutrition and water to the body. These techniques are incorporated together if a patient struggles with more than one bodily function. For instance, someone in a coma may need to be on both a ventilator and a feeding tube since they would not be able to breathe autonomously or feed themselves. A patient is usually placed on life support to better their condition and sustain their life for an extended period of time until doctors can determine whether full recovery is probable. This means that being on life support is not something meant to last forever—either the patient successfully recovers or doctors have to pull the plug.

The term “pulling the plug” refers to discontinuing life support when it seems impossible for a patient to recover. This decision is usually a collaborative effort made by the family and healthcare professionals. The patient’s age, race, and chances of effectively functioning afterward are all factors that physicians take into consideration. Cost is another main reason why hospitals withdraw life support—keeping a patient on life support costs the hospital about two to four thousand dollars a day, which some hospitals deem excessive if the possibility of recovery for a patient is not sufficiently high.

During the height of the COVID-19 pandemic, there was an unprecedented influx of patients in ICUs. As a result, with the pressure to maximize lives saved and to run ICUs with enough beds and ventilators imminent, ethical concerns arose. One such concern regarded the morals behind accelerating the termination of patients’ life support. Moreover, during this time, the levels of communication between families and physicians rapidly deteriorated. At its worst, the pandemic made it so that hospitals could not allow family members of patients into ICUs due to the risk of infection. Family members were not able to observe the patient’s condition firsthand, thus relying mainly on the physicians’ records. The lack of communication between family, patient, and hospital staff was a major obstacle when it came to deciding on whether to pull the plug.

Recently, there has been an imbalance between the responsibility of both hospital staff and family members in making this decision. In most states, including New York, it is standard for both parties to engage in the conversation about withdrawing life support, and families are likely to win if they go to court to stop a hospital from pulling the plug. On the other hand, the state of Texas gives life-and-death powers to hospitals regardless of what families want, which leads to further conflicts between families and hospitals. One such case occurred in 2005, when George Pickering’s adult son was declared brain dead and was to be cut off from life support. It was only when Pickering came into the hospital with an armed weapon that the hospital staff changed their minds.

Alternatively, there are ways in which the patient still has some say in their own life, even when they are on life support and are not able to make decisions by themselves. Before a person undergoes surgery or another medical procedure, hospitals in each state have their own set of legal forms allowing patients to inform the medical staff of their advanced directive, which entails a patient’s wishes regarding how the hospital should proceed should their condition worsen or should complications arise during surgery. Additionally, in New Jersey, the recent passing of the Medical Aid in Dying for the Terminally Ill Act, also known as MAID, allows adult New Jersey residents to acquire medication to self-administer their death if deemed terminally ill by consulting physicians. As per MAID, not only do the family and physician collaborate to decide on whether to “pull the plug” or make any other life-dependent decisions, but the patient also has a say in the discussion.

When making these important decisions, communication between the patient’s family and the medical facility is integral. In hospitals such as those in Texas, the decision to place all the responsibility on the physician to judge whether to withdraw life support takes a toll on family members and sometimes patients as well. With the medical knowledge possessed by physicians and the intimate knowledge possessed by family members, it takes more than one party to decide on an important issue such as cutting off life support. Effective communication and relay of information will lead to a decision that both family and hospital can be satisfied with. In all scenarios, the patient’s best interest must be kept in mind.