When Life Support Is Questioned Early in the Care of Patients With Cervical-Level Quadriplegia
Patterson, David R.
McCormick, Thomas R.
Hudson, Leonard D.
New England Journal of Medicine. 1993 Feb 18; 328(7): 506-509.
Some patients with cervical spinal cord injuries ask to die. It is generally held that a competent, informed adult has the right to forgo medical treatment, even life-sustaining therapy. Furthermore, respect for patients' autonomy is not only a fundamental ethical principle, but is also sanctioned by law. In particular, there are a number of published accounts of patients with high-level cervical injuries who have been granted permission by the courts to discontinue life support. In all these cases, the patients were beyond the acute phase of their injury when they made their decisions. In this article, we focus instead on cases in which the question of terminating life support is raised by the patient, a staff member, or a family member soon after a complete cervical spinal cord injury, while the patient is still in the intensive care unit. This situation presents a number of special problems. Patients frequently have a diminished capacity to make important decisions during the first several months after an injury, and they are often not adequately exposed to the types of information needed. Furthermore, professionals working in this segment of the care continuum may have biases that increase the possibility of a too-hasty decision. When such problems are not appreciated or are addressed capriciously, the result may be the premature death of a person who could have lived a happy and productive life.
Allowing to Die; Attitudes; Autonomy; Communication; Competence; Comprehension; Counseling; Critically Ill; Consent; Death; Decision Making; Disclosure; Family Members; Health; Health Personnel; Informed Consent; Injuries; Intensive Care Units; Law; Life; Paralysis; Patients; Prognosis; Quality of Life; Rehabilitation; Right to Die; Suicide; Treatment Refusal;
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