23 Sep, 16 | by miriamwood
by Professor Dominic Wilkinson, @Neonatalethics
Professor of Medical Ethics, Consultant Neonatologist
Our society has good reason to provide special treatment to people with severe brain injuries and their families.
But our current “special treatment” for a group of the most severely affected people with brain injuries leads to devastating, agonising, protracted and totally preventable suffering.
Consider the following cases:
Case 1. Sally has severe progressive dementia. She is no longer able to communicate, and does not recognize any of her family members. Sally had previously spoken with her family and told them that if she were ever in such a state and not likely to improve, that she would not want to be kept alive artificially. Sally’s doctor has been called to her nursing home because she has pneumonia. Although the infection could be treated with antibiotics, the doctor and family together decide not to. Sally dies a few days later.
Case 2. Sandra has suffered a severe head and spinal injury in a car accident. She has been in intensive care for several weeks, but there is no sign of improvement. Her brain scans show extensive damage, and it is likely that if she survives Sandra would be severely disabled. Sandra had previously spoken with her family and told them that if he were ever in such a state and not likely to improve, that she would not want to be kept alive artificially. Although Sandra could be kept alive for some time if treatment continues, the doctors and the family together decide to stop life support. Sandra dies a few minutes later.
Case 3. Susie suffered a severe brain injury months ago. She was left in a vegetative state. She has no response to those around her. Susie had previously spoken with her family and told them that if she were ever in such a state and not likely to improve, that she would not want to be kept alive artificially. Susie’s family wish to stop the artificial feeding that is keeping her alive, but her doctor explains that a decision would need to be made by the courts. There are long delays before and during the court application procedures. Four years after her brain injury, the court authorizes withdrawal of artificial feeding. Susie dies some days later.
These cases are fictional, though the last one (Susie) is based on a real case (Miss S), which went to the Court of Protection in England and Wales earlier this year. In the real case, a set of avoidable factors meant that decisions were delayed for more than three and a half years. An important paper, released today in the Journal of Medical Ethics, analyses the cause and consequences of the delays. The paper describes in vivid detail the distress and desperation of Miss S’s family.