Voiceless at the end of life

In a guest blog for the Scientific American, Dr Lahey uses a case study to describe the legal mine field that residents of the state of New Hampshire face when it comes to end of life decisions for patients who cannot speak for themselves.

The patient in this case was an ill-fated motorcyclist with serious injuries to the head and chest. The healthcare team informed the family that there was nothing more they could do to save the patient’s life and the family had reluctantly accepted that their loved one would not want to live this way, supported by machinery. “But there was a catch,” Dr Lahoy writes, ”the patient had no legal decision-maker. No one could speak for him, legally.”

He continues: “In most states, there is a clear hierarchy of legal representatives for patients who cannot speak for themselves. First the spouse, then the adult child, then the parents, or a sibling – and so on down the line.”

But in Dr Lahey’s state of New Hampshire and 12 further states in the US, this hierarchy is not in place and no statute stipulates this chain of command.

In the article he explains the impact on families in this situation: “That means unless the patient has an advanced directive document, or has appointed a durable power of attorney for healthcare, there is no default legal representative.”

This is where Dr Lahey comes in. In this situation, despite the family being designated as legal guardians for the patient by the courts, the judge did not grant them the power to withdraw life-sustaining therapy.

After reviewing the records, examining the patient, meeting with the healthcare team and then meeting with the family, Dr Lahoy took the stand in the court to represent the patient and family.

“In the end [the judge] ruled the family could withdraw life-sustaining therapy. Soon thereafter doctors slipped the breathing tube out of the patient’s mouth and gave him medicines to prevent air hunger and anxiety,” he writes.

This situation is not exclusive to an emergency room or intensive care setting. Palliative and end of life care is often confronted with the same legal and ethical dilemmas and this example adds weight to the argument for advanced care directives and living wills, allowing families time to concentrate on grieving for their loved one.

To read the full article on Scientific American.