An ICU Ethics Consultation: A Second Look

• Published in: Neurocritical care Vol. 11; no. 2; pp. 296 - 298
• Main Authors: Vertrees, Stephanie M., Bernat, James L.
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01.10.2009; Springer Nature B.V
• Subjects: Aphasia - etiology; Brain death; Cerebral Infarction - diagnosis; Critical Care Medicine; Emergency medical care; Ethical Matters; Ethics, Medical; Fatal Outcome; Hospitals - standards; Humans; Intensive; Intensive Care Units - standards; Internal Medicine; Intracranial Hypertension - diagnostic imaging; Male; Medical imaging; Medical Staff, Hospital - standards; Medicine; Medicine & Public Health; Middle Aged; Neurology; Radiography; Subarachnoid Hemorrhage - diagnostic imaging; Terminal Care - standards; Ventilators; Brain Death; Ethic Consultation; Cisatracurium; Neuromuscular Blockade; Ethic Consultant
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-009-9212-1

[...]they concurred that the medical treatment alone could cause or contribute to his immediate death. The ethics consultants agreed and advocated continued ventilator treatment until the pentobarbital no longer produced significant respiratory depression. Because the patient’s neurological examination showed no evidence of brain function, the ethics consultants initially suspected that he might be brain dead. In this case, we believe that the patient’s profound brain damage caused by his markedly elevated ICP resulted in permanent damage to his medullary breathing centers. [...]apnea could be confidently attributed to his brain damage irrespective of a potential contribution by respiratory suppressant medications. According to this argument, if our patient’s family understood and agreed, it was reasonable for the ICU team to respect their wishes and withdraw life-sustaining treatment.