{"id":1521,"date":"2012-02-15T11:17:44","date_gmt":"2012-02-15T10:17:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=1521"},"modified":"2012-02-15T11:18:13","modified_gmt":"2012-02-15T10:18:13","slug":"back-from-the-grave-should-we-allow-elective-ventilation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2012\/02\/15\/back-from-the-grave-should-we-allow-elective-ventilation\/","title":{"rendered":"Back from the Grave: Should we Allow Elective Ventilation?"},"content":{"rendered":"

Guest post by Dominic Wilkinson<\/strong><\/p>\n

(Cross-posted from Practical Ethics<\/a>)<\/p>\n

Mary is 62 years old. She is brought to hospital after she collapsed suddenly at home. Her neighbour found her unconscious, and called the ambulance. When they arrived she was deeply unconscious and at risk of choking on her own secretions. They put a breathing tube in her airway, and transported her urgently to hospital.<\/p>\n

When Mary arrives she is found to have suffered a massive stroke. A brain scan shows very severe bleeding inside her brain. In fact the picture on the scan and her clinical state is described by the x-ray specialist as \u2018devastating\u2019. She is not clinically brain dead, but there is no hope. The emergency department doctors have contacted the neurosurgical team, but they have decided not to proceed with surgery as her chance of recovery is so poor.<\/p>\n

In Mary\u2019s situation, the usual course of events is to contact family members urgently, to explain to them that there is nothing more that can be done, and to remove her breathing tube in the emergency department. She would be likely to die within minutes or hours. She would not be admitted to the intensive care unit \u2013 if called, the ICU team would be likely to say that she is not a \u201ccandidate\u201d for intensive care. However, new guidance<\/a>\u00a0from the National Institute of Clinical Effectiveness, released late last year, and endorsed in a new British Medical Association working paper<\/a>, has proposed a radical change to this usual course of events.<\/p>\n

Instead of the above course of events, Mary would be admitted to intensive care. Extra tubes would be inserted into Mary\u2019s blood vessels, breathingmachines started, and blood pressure medicines provided \u2013 until there had been a chance to talk to Mary\u2019s family about the possibility of organ donation. The idea is that this may provide enough time to find out whether Mary would have liked to donate her organs. This may take some hours, or perhaps even a little longer. If Mary\u2019s family take a while to agree to organ donation, she may have become brain dead in the meantime. Alternatively, intensive care can be withdrawn in controlled circumstances, allowing her organs to be retrieved after her heart has stopped beating. It it turns out that the family decline donation, life support will be stopped in intensive care.<\/p>\n

This proposal is a version of a practise called “elective ventilation”<\/a>. This euphemism refers to the idea of “electing” to provide intensive care for a patient who is not thought to be able to benefit from it \u2013 in order that they might donate their organs. In the late 80s and early 1990s, this approach was used by doctors in Exeter to increase the number of organs available for donation. At the time, the main focus was on patients becoming \u2018brain dead\u2019. The practise largely, if not entirely disappeared in the UK because of advice that it was illegal to provide treatment that was not in patients\u2019 best interests.<\/p>\n

But elective ventilation has been resuscitated. The critical shortfall in organs has led NICE and now the BMA to seriously countenance a major change in the approach to provision of intensive care for seriously brain injured, critically ill patients.<\/p>\n

Is this the right approach?<\/p>\n

Is it ethical to prolong the death of patients until their (and their family\u2019s) wishes about organ donation are known?<\/p>\n

Is it legal?<\/p>\n

Let us know your thoughts<\/p>\n

In the coming months, the Journal of Medical Ethics<\/em> is going to have a mini-symposium on the rejuvenation of Elective Ventilation. Papers on any aspect of the ethics of Elective Ventilation are welcome. In the meantime comments here are welcome. What are the key objections to Elective Ventilation, and do they stand up?<\/p>\n","protected":false},"excerpt":{"rendered":"

Guest post by Dominic Wilkinson (Cross-posted from Practical Ethics) Mary is 62 years old. She is brought to hospital after she collapsed suddenly at home. Her neighbour found her unconscious, and called the ambulance. When they arrived she was deeply unconscious and at risk of choking on her own secretions. They put a breathing tube […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,443,591],"tags":[],"class_list":["post-1521","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-jme","category-life-and-death"],"yoast_head":"\nBack from the Grave: Should we Allow Elective Ventilation? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2012\/02\/15\/back-from-the-grave-should-we-allow-elective-ventilation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Back from the Grave: Should we Allow Elective Ventilation? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest post by Dominic Wilkinson (Cross-posted from Practical Ethics) Mary is 62 years old. 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