Family decided to turn off – and what to do doctors

The UK Supreme court was allowed to disconnect patients in a vegetative state from life-support systems on the initiative of relatives and doctors. Previously this required a decision of the special court, the process often took up to several years, the BBC reports. Do I need to artificially extend the life of a man who for a long time in a vegetative state, and how ethically to make a decision about ending someone else’s life.

Photo: Pixabay

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Judgment passed based on the history of the disease 52 year-old patient. The man was a banker, led an active lifestyle, fond of sports. In the summer of 2017, he suffered a stroke and fell into a vegetative state – he never regained consciousness, and eating and drinking could only use the life support system. The doctors came to the conclusion that even if a man wakes up, the rest of his life he would suffer from severe physical pain and cognitive impairment. After that, relatives and doctors came to the conclusion that it’s better to be disconnected from the feeding system and ventilation.

The representative of the National health system has appealed to London’s High court with a request to rule that in such cases, disconnect the patient from life support without a court decision on the initiative of relatives and doctors. The patient died in December last year, but proceedings against him continued after his death to establish a legal precedent. In the end, the High court of London issued a decree, which was confirmed by the Supreme court.

The regulation simplifies the abolition of vital assistance to the patient who cannot Express their will, – feeding, hydration (supports water balance) and ventilation.

Simplified an existing procedure

Egor Larin, doctor of the palliative care expert Fund “Live now”

Egor Larin

In many countries it is believed that artificial (intravenous or enteral) feeding patients in terminal stages of the disease, including in a vegetative state, is unethical, as it prolongs the agony and prevents the natural care of human life. It is written in the various international guidelines on palliative care and guidelines for nutritional support.

According to some data, patients in a vegetative state, terminal condition, and patients who have lost the ability to eat independently, such as people with als do not experience hunger, that is, if they stop feeding, they die from the underlying disease, not from starvation.

The question is who and how decides on the cessation of feeding. In several European countries, e.g. Germany, if the decision-making handed over to someone from relatives or a third party, then in theory he could stop inepdmercedes therapy such as artificial respiration, nutrition, intravenous infusion.

In Russia legally, the patient (or his legal representative) can refuse a ventilator, artificial nutrition and any other medical intervention, but in fact it is not achievable in the hospital, I personally did not encounter such cases in their practice.

Also, if physically the person is not able to sign the refusal of medical intervention, but it is capable and can voleizyavleniya, a relative has no right to do it for him.

In Russia it is impossible to transfer the right to consent or refuse medical intervention. This is possible only if the other person is legally recognized as a legitimate representative, and this, in turn, the patient must be found incompetent. In the case of children under 16 years of age legal representative of a child are the parents, a priori, and in this sense the situation of failure is easier.

But all doctors are afraid of accusations of lack of medical care, and we see that in fact the right of withdrawal does not work. Many doctors believe that the ambulance says about consent to health care.

Therefore, if the patient is unconscious, it cannot Express the will and has no legal representative, then the decision is taken by panel of three doctors.

When the patient is already on a ventilator or artificial nutrition and he comes to his senses, in the West, if he can Express his will in the rejection inepdmercedes provision, doctors are required to follow his will. In Russia about this practice to date, I have not heard, although the subject starts being discussed, and it was good.

Medicine in the first place should serve the best interests of the patient.

In the UK, in my opinion, they’re just simplified an existing procedure, removing it from one link. It is necessary to examine the law together with lawyers, perhaps we can learn something useful for yourself.

It’s not even euthanasia, and the murder of a defenseless man

A physician anesthesiologist-resuscitator of the priest IBAS, instead (Senchukov)

The Priest IBAS, Instead (Senchukov)

The decision of the High court of London about the possibility of termination perform life-sustaining measures for patients in a vegetative state simply by the mutual consent of doctors and relatives is shocking.

The patient clearly did not ask him to kill, that is not euthanasia. It is clear that this is not a suicide. This is not brain death, because in a vegetative state electrical activity is preserved. Moreover, the concept itself, a vegetative state is heterogeneous – it includes as apallic syndrome (“waking coma” – saved the change of periods of sleep and wakefulness) and akinetic mutism (patient follows eyes), amential state (deep fading of consciousness) and some others.

That is, this is pure murder of a helpless man by those who should be its defenders – relatives and doctors. And it is difficult to say whether mercy.

If we can guess (only guess!), that person is in a coma normal (at least terrestrial) feels nothing (the consciousness of the oppressed), the “vegetative” patients some sensitivity I have. And depriving them of food or liquid, not to mention the breathing, it may increase their suffering.

Perhaps here we have a purely financial interest – not to spend money for treatment hopeless patient, to inheritance, etc. But, most likely, does humanism shows their true devilish grin.

But what if the person wakes up, his quality of life will be very low, does not matter – you can’t kill people even of supposedly humanitarian reasons. Humanism considers man the measure of all, so natural conclusion, the notion of “quality of life”. If we define life as a Gift of God, humanism suggests that this Gift may be improper, i.e. God becomes such a “bungler” and the humanist – altenator – OTC-correcting God’s mistakes.

Until recently, murder (even out of mercy) is still frowned upon. Now and the screen removed. To kill you need and do not care about the suffering.

You need to consider each specific situation and the opinion of all parties

Chief freelance specialist in palliative care, Ministry of health of Russia, the Chairman of the Association of professional participants of the hospice care Diana Nevzorova

Diana Nevzorova

In a country where infancy, palliative care in the form in which it is now universally accepted that any such decisions are taken only after long discussions with different points of view and consideration of various clinical cases. So I’m sure the solution is definitely an informed.

And we have yet to come through the improvement of palliative care and the entire healthcare system based on such concepts as the desirability of a medical intervention, the expression of the will of the patient and, of course, the quality of life of the patient.

In General it is a difficult ethical question. On the one hand, the patient has the right to refuse any medical intervention. It is enshrined in law: “the right to liberty and security of person” enshrined in article 22 of the Constitution, “the right to refuse medical intervention” – in article 20 of the Federal law № 323 “On the fundamentals of health protection in the Russian Federation”.

If the patient is not able to personally Express their will, his interests are protected by the guardians or close relatives. On the other hand, lack of medical care is a criminal offense and doctors are obliged to provide all possible assistance.

Another question – how promising this aid.

In any case, it is always necessary to consider each specific situation and the opinion of all parties – relatives, and doctors.

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