Say someone (in the U.S.) without any family at all winds up at a hospital and goes comatose, needing to be on life support. Would they be on life support indefinitely or would anyone have the authority to ‘pull the plug’ so to speak? Sorry it’s kind of a dark question but these are the kinds of things keeping me up at night haha.
In: Biology
Insurance? Pull the plug
Hospitals have a medical ethics committee that would come in and make that decision. Pulling the plug, essentially removing the patient from a mechanical ventilator, is often seen as essentially allowing someone to pass away. Going a bit further, oftentimes it also means removal of life sustaining drugs for supporting adequate blood pressure and/or basic bodily functions (i.e., nutrition, electrolytes, blood products). I’ve seen patients die almost immediately, and I’ve seen patients linger for days once the ventilator is pulled. It’s always a weird situation for all bedside attendees, but the medical ethics committee essentially steps in when there is 0.00 quality or chance of life once care is removed.
In the UK, emergency decisions are a “best interests decision” and the medical professionals use their judgement. Once you are past the emergency phase, you then look to whether the patient has a legally appointed power of attorney or an advanced care plan.
If they do, you treat as per their instructions (within your own clinical judgement). If they don’t, then depending on the decision and whether everyone is is agreement (doctors, next of kin etc) and how life changing the decision is, you may either offer treatment or seek the courts to appoint a best interests advocate. You can also seek advice from ethics committees, however they cannot make decisions for you, only tell you if certain actions are ethical.
In a worst case scenario, where the family disagrees with the legal advocate, doctors and best interests decision and you worry about legal repercussions you can seek a legal ruling from a judge who will say whether a proposed plan of treatment is legal.
In the UK the consultant in charge of the patient will make the decisions re care and can decide to stop treatment if they think it is in the patients best interest.
In fact we can over rule families if we think that the family are causing the patient harm and not acting in their interest although this very rarely happens.
Curious also what happens if there’s no money to pay for care? Does the hospital foot the bill indefinitely?
As a member of my facility’s ethics committee, I can say that we will perform an exhaustive search for family. After that of money are found, we look for someone who knows the person and would have their best interests at heart. If we can find absolutely nobody, then, at least in the stat of California, we as a committee are able to decide for the patient what a reasonably prudent person would decide in that situation, keeping in mind the ethical principles of beneficence and non-malefiscence which are to “do good” and to “do no harm”. In my experience of patients in a comatose condition in full life support, we will be consulted after about a week and a half in order to determine the goals of care and code status.
There is something called Two Doc, which can force a consent if a patient is unable to consent and has no available family. Think stroke or major accident where the patient is not physically or cognitively able to give consent. The physicians must be acting in the best interest of the patient and go with standard or best practice treatment.
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