Medicine is Hard! (Neurosurgeon’s Thoughts)

[@mvhill59]

He had the right to make his own decision, may he rest in peace.

[@NickanM]

His body, his life, deemed competent = His choice.

[@peggyfox600]

He had every right to be disconnected from the respirator.

[@ahwell9984]

I can understand his family's desperation for him to live, seeing value in his life whatever its limits, and I hope I'd be able (in the young man's situation) to do some kind of compromise ("I'll wait 6 months and see if I feel differently" or something), to help my family through it all. But I think the right ethical question was asked: "Who is in a BETTER position than the patient to determine whether this patient will live or die given that he is a competent adult?" The answer, which I think was also correct, was "No one. Only he can decide." Heartbreaking situation. May they all be at peace.

[@graniabenge2814]

He absolutely had the right to make his own decision if competent to do so.

[@LindaKing-lf8nk]

I was an intensive care nurse for 30 years. A pain therapy nurse for 10 I worked in a trauma unit and a mixed unit where we did everything we had to meet with 2:50 these terrible decisions all the time.I would have seen if a palliative counselor could have talked to him about maybe just waiting a week or so to see if his feelings would change. However, it is his body. It is his life and there are fates worse than death

[@forgivenatcalvary]

Sometimes a person can change their point of view, so if possible, I would say wait and see instead of making a terminal decision soon after injury. My daughter was 26 when she had a C1 Spinal Cord Injury in 2020 leaving her quadriplegic on a vent. She adjusted amazingly well and I’m so grateful she didn’t act on her initial impulses to perish. She’s the strongest person I know and a joyful blessing to me. ❤ She has limitations but her life is precious.

[@pjk1714]

His body, his choice. My father went into a comma and no one could find his living will. We had that conversation years ago so I knew what he wanted, yet his sister was adamant to keep him alive. Their brother spoke to me, caught in the middle being a man of the cloth telling me the hospital would require me to make the choice. The next day my father woke briefly, signed the form and drifted back to sleep. He passed on his terms and took that weight off my shoulders.🕊️

[@annk9817]

I can understand both sides of the situation, but ultimately I'm glad he was able to have his wishes respected.

[@shannonstilwell8225]

As tragic as it is, I’m glad that he had his mental facilities to make his own decisions. My mother and father were in a horrible accident in 2021. My father, although hurt, did recover. My mother on the other hand, was put on life support and we were told that she was brain dead and would never be able to function. It was so hard for us. She hadn’t left any kind of indication whether she would want to stay alive on machines or not, but we ultimately made the decision that we didn’t believe that she would want to as they said that she wouldn’t even be able to pet her dogs. Her dogs were her joy in life. Was so hard to make this decision for someone else though.

[@tinahauser8864]

This is why everyone needs advanced directives as soon as they turn 18.

[@andreakane3993]

What a heart breaking story. The patient was deemed competent, therefore able to make his own decisions.

[@teresaforsyth6185]

Yes, I would do as the patient did. He made his decision. Thank you and Ethic Committee for him to pass

[@lindabarnes9935]

He don't want to suffer anymore. Since he know There's no chance of him back to normal life .rest in peace young man😢

[@rke0502]

Very sad I think I would've at 21 made the same decision.

[@Mont.Alhlaly]

Same

[@CruzCruz-nw7fi]

It’s just sad , that young man showed a lot of courage,

[@danielosmon]

You and your colleagues are such strong people. I feel all of you took the proper steps and made the right decision. Thanks for sharing

[@Cheynayful]

Back when I was a resident, I also had a patient with acute quadraplegia after trauma, but he was age 46. Like your patient, he also requested to be extubated. Thankfully, his family was supportive, despite being devastated by the diagnosis, so while we still had to get ethics and psych involved, there was no real conflict. I think some might have a bigger issue with the patient in your scenario due to his young age, based on the argument that the pre-frontal cortex is still maturing at his age, and thus, he might be more impulsive than would be appropriate for making such an absolute decision. However, my personal believe is if a young person is deemed old enough to theoretically be drafted and shipped off to a war, they are old enough to have agency over their own bodies.

[@peterking1134]

His body; his decision! I don’t understand why this is being questioned

[@luisalphahernandezomega1704]

*SO MUCH MENTALITY, SO LITTLE BODY USE, I UNDERSTAND, REST IN PEACE.* *DUDE, I WAS WRECKED BY A CAR WHEN I WAS 4 YEARS OLD IN THE YEAR 1994, I HAVE BEEN MADE HANDICAP OF MY RIGHT BODY HEMISPHERE AND ESPECIALLY MY RIGHT HAND TO THIS DAY EVER SINCE.... WE ALL COME TO A TIME ASKING: WHERE WAS GOD...??? I UNDERSTAND THE BIG SERIOUS LIFE DECISION, MAY THE PERSON REST IN PEACE.*

[@JD-HatCreekCattleCo]

I am right now in a similar situation, with a spouse. It is their choice, even if we disagree.

[@ahwell9984]

I hope you will both find peace.

[@JD-HatCreekCattleCo]

@@ahwell9984 thank you, we are at peace, it’s not the death that scares me, it’s the surviving afterwords. 🙏❤️

[@gaylesharp9652]

He had the right to his decision. His family just didn’t want to lose him ( which is understandable), but he felt like he would have no quality of life.

[@shazgannie9982]

It is very difficult, but he has the right to make his own decision. RIP.

[@LAURIEOHIOLPN]

Being he was competent & the extreme dependence on medical care & equipment, just to stay alive. Yes, he had the right to choose. Prayers to his family , in hope of coming to terms, what he really wanted. May he RIP 🙏 ❤

[@cynthiaa2644]

I've always made it clear to my family that it's about quality of life, not quantity, for me.

[@sylviamacdonald9256]

It’s always an individual’s decision regardless of the family’s situation

[@roberty.9569]

No one should be forced to live a life they don't want to live.

[@cruelladevil1001]

He should be allowed to make his own decisions.

[@Suekyle]

Very painful decision yes but I think the patient , if deemed competent, must be allowed to make the decision.

[@carolstettheimer9906]

I’m an ALS widow, so I definitely have both thoughts and feelings.

[@anngoodman9323]

So sad. And really really difficult for all. There is a movie called Me Before You with Emilia Clarke. 2017 I think. The main character never changed his mind about dying.

[@TRUTHisTRUTH70]

Self-deterimination should always be updeld if the patient is mentally competent.

[@amymccrary1049]

Let him make his own decision.

[@stamatiamcgrath7992]

As hard as it sounds I agree with his decision. So hard for everyone involved. Parents don’t want their kids to go l, as a pretext myself I understand but his quality of like was so horrible I agree with his decision.

[@claudettecicora1192]

I believe it happened exactly the way it was supposed to. However I can Only imagine how difficuit was for you and his family.❤❤❤

[@willj1598]

I think legally the answer is clear. I think ethically the right for him to make that choice is clear. I think ethically it would be reasonable for a provider to decline to participate. Emotionally their is no right answer. I'm glad he was able to make the choice, versus so many that suffer injuries that render them unable to decide anything.

[@yoyo-dj5bv]

It must have been an incredibly difficult time for the parents to see their child go. But I think it’s a good decision to respect his wish. it sets everyone free, eventually.

[@JulieR73]

I agree with his choice

[@brianlawson363]

I am with the young man. Twenty one years and a future of constant care and others taking care of bodily functions and hygiene. No, he preserved HIS dignity. "The time you won your town the race, we cheered you through the market place." "To rose lipped maidens and light foot lads." IYKYK.

[@AlmostMileHighInUtah]

Completely agree with the patient's decision. Hopefully he donated his orange to save other lives.

[@ANGELAVITULLI]

The young man was deamed competent by a certified psychologist to make his own decisions he may have factored in that this present state of life wouldn't improve from a moral perspective he did have the right to refuse further treatments.

[@Wisconsincatmom]

His body, his choice

[@Saint_Ann]

As a family member, I would try to encoueage him to give it a little time before making the decision. After that, he is an adult and it is game on.

[@SUGAR_HOUSE_WYE]

Wow. Yeah tough call all the way around (in my opinion). Remember the Hippocratic Oath? “First, do no harm”. I would argue that at some point earlier in the rendering of care, the decision should have been made (think ‘Do not resuscitate’ order)…not hooking him up to life support (if he had a DNR) would have avoided the conflict by honoring his wishes before leaving him with severely diminished quality of life. But fortune tellers we are not.

[@ashleyjones7714]

I have to agree with his choice. He's the one who is feeling what his body is going through, despite his family's feelings. He chose peace so please respect his decision and let him have peace. I'm sure he's in Heaven now with no pain. ❤ Both my parents passed away when I was young from cancer, and I saw what they both had to go through, as far as pain and treatments. In their final days, they chose peace. I was ready for them to be with God because I was there the entire time with treatments and doctor's visits, body scans and the need to hang onto hope that things would get better. It was agonizing, even for me to watch as a daughter. I'll never forget in my mother's final days when she literally told me to tell the hospice nurse to give her whatever she could for pain. They get ready to go home. ❤

[@TheSUPERHAPPY1]

Should have had the choice of MAID as well

[@MimiM-us7vn]

The issue I have is with the overly dependence on the one single psychologist. Fact: Not all psychologists agree. Fact: Not all diagnoses by medical doctors are alike and thus second opinions are encouraged. Sad that there wasn’t a second opinion by a different psychologist. Medical decisions are hard. Correct. But second and third opinions should be right to all patients and families. Hard decisions should not be the excuse to make a final decisions based solely on one person’s psychological diagnosis.

[@ucxx_CoD]

In my opinion, either the doctor in charge or his family or preferably both should've tried to negotiate a more logic-based decision instead of just letting this young man run along with what he wanted. While I do believe grown adults should have the right to do whatever they want so long as it doesn't impact anyone else's life in a negative way, I do think for situations as dire as this that they should've tried to negotiate a more logical and thought-through decision.

[@My.Funny.Bunny.]

It was HIS body, no one else’s. HIS experience in this universe and this life, no one else’s. So it was HIS decision to live or die.

[@annsmith9877]

If he had the intellect to make a decision his life was viable and precious. Why are people so narrow minded when it comes to "quality of life"

[@sherireuther3047]

At 21 I made some impulsive decisions that I wish would have never happened. There is something called neuroplasticity. I have never heard of total reversal of quadraplegia however his life may have been better over time. My condolences to his family for their loss. These are absolutely heartbreaking decisions.

[@gracelovesme-r3j]

At a young age, and still traumatised by the accident, I would want him to wait until the initial shock of his situation had begun to subside, and he was in a calmer and less agitated state of mind. Given a few months of good counselling and support, he may have found value and meaning in life despite his limitations!

[@traceysmith311]

As hard as it would be to lose a family member in that situation I think since he was deemed mentally competent the only right choice is to respect his wishes. He is the one that has to live in that body and if he doesn't wish to do so, forcing him to do so would be cruel and something I wouldn't want to do to someone I loved.

[@donnasr1799]

I think we sometimes want people to live for ourselves. We can't come to grip with life without them. Each person has the right to decide when to end their life and die with dignity.

[@carolinb52]

Very tough decision.

[@LucitaBrown]

I don’t blame him. Pull the plug. What young man would rather live as a quadriplegic than die? This guy was lucky that he was deemed competent to make his own decision or he might still be living a miserable life today - for his family members.

[@GreggBB]

His life, his choice!

[@Sappho123]

The suffering man is the only one to make his decision. It is self serving for the family to want him to live like that. They are adding more suffering to the injured man.

[@nonyabidness5708]

Um... he is 21 but had an accident 30 years ago?

[@susanferretti5781]

I think he should've waited. There are always advances in medicine. Perhaps if a paralyzed volunteer could have talked to him it could've helped. However, if the long run the patient's choice is his choice. It is his body, his right, and his choice. We have to abide by it.

[@blueq4324]

Can the family request for a second pysych evaluation?

[@user-qz9st4dq5w]

As long as he is deemed Ox4, the PT has the right to self-determination n make all of their medical decisions. I see both sides. Ultimately, it's the PT decision.

[@peggymartin7681]

Torn…

[@gregorymalchuk272]

I think the real takeaway from this scenario is that we need to fast-track the revolutionary gene-therapy based spinal cord regeneration regimes thet are currently in animal trials.

[@mac-ju5ot]

Dunno... We kuve not far from Christopher Reeves was throw iff the horse one town over....a oit of people at the stabkes were discussing this oneday....i honestly dont know how id feel.im.looking at gamna knufe surgery after a ac.vm ablation...

[@baxtercol]

Perhaps my comment is unique to this thread in that I have cerebral palsy and I am also a bioethicist. Another one of my uncommon realities that I and others call a miraculous gift colors my perspective: I am 64 years old, a twin (my sister is with God) with a 6-month and 1 week gestation, born in 1960. I am functional, self-determining and living independently against all odds, with spastic quadriplegia and several other chronic challenging and sometimes depressing (but emphatically not life ending) comorbidities. I am unashamedly and unequivocally a joyful thankful woman of faith. God is the Arbiter of life and death. So I have laid bare my bias of which I am extraordinarily aware. With that set of personal and professional credentials, I offer these thoughts and questions: A bioethicist is morally and professionally obligated to take into account each and every perceivable, discoverable and considerable facet of each individual case. Time to do so thoroughly should never be truncated, even in the name of and under the guise of autonomy. As a bioethicist, I am never supposed to impose my personal opinions or beliefs and I must never attempt to sway any involved party and absolutely never compel or make any outcome decisions. I must make objective, plausible, actionable and socially accountable recommendations. I cannot and must not do any part of my work single-handedly. If this had been my case, I would have made the young man aware of all of the technology and supports available to people with physical disabilities while being realistic about the many challenges ahead. I would have called in peers and experts, especially those who had come through the initial suffocating and real despair. For instance, I would have done everything in my power to put him in touch with people like Joni Erickson Tada. I would have been his window to the world where life with a disability can be a life well lived, albeit somewhat more difficult than normalcy, whatever that means. Perhaps most piviotal and most painful and difficult would have been my duty to minimize family influence and pressure. I would have gently but firmly asked his family not to make an already extremely traumatic situation more emotionally charged. I am also a social worker and if it were permitted me, I would have taken hours and done whatever was within my power to have myself and others listen. I wonder if the young man knew about people like Stephen Hawking who carried his ventilator on his wheelchair. I would ask the same question I posed in my MS bioethics thesis: If Elizabeth Bouvia (a 26 year old mentally competent quadriplegic with cerebral palsy who became the first person in that situation -as differentiated from someone like Karen Quinlan or Terri Schiavo- in 1983 to be allowed to end her life as a legal to self-determination) may have made a different decision if, using a person-centered paradigm across all spheres: Medical, environmental educational, adjunct medical by which I mean personal care and access to the technological apparatus that make independent living realistically possible and financial including gainful employment were offered and implemented. I humbly yet forcefully suggest that the elephant in the room is not quadriplegia or other disability but abject fear of complete lack of control, agency and self-determination. Were I the ethicist involved, I would do everything possible to make sure that everyone involved begin the work that comes with such painful yet thoroughly necessary education and confrontation. Emotion has a central place that must be acknowledged and worked through but in a decision like this one, it cannot be allowed to dominate, much less to win the day. Medicine is difficult as both an art and a science. I respectfully submit that empathetic logic, - not a contradiction in terms- might go a long way if haste is not allowed to prevail. I know this is an extremely long comment and I make no apologies for it because 21st century technology has far outpaced our moral toolbox. I offer one final thought: death, using the usual definitions and realities that accompany it, is irreversible. Dialogue anyone?

[@1AlexanderCole]

I am often very upset with the doctors who somehow managed to perform an emergency thoracotomy, laparotomy, multiple bowel resections, diaphragm repair, aortic dissection repair, and minimize the damage of a self inflicted GSW through my abdomen and L2 vertebrae. Now I live in constant untreated pain because of the “opioid crisis”, soil myself, continuously want to die, but am too terrified of surviving another attempt to do it myself. Since 1996! I’m 52 now and applying for medical aid in dying.

[@yoyo-dj5bv]

🫂

[@ahwell9984]

I don't know what to say, but my heart goes out to you. I hope that you can get the assistance you want and need.❤

[@gregorymalchuk272]

You need to get some good MAOI antidepressants or ECT and get your mental health back.

[@1AlexanderCole]

@@gregorymalchuk272I’ve tried all the psych meds, all the treatments. Meds don’t fix life circumstances.

[@devdroid9606]

You don't say what kind of treatment he was receiving. If he says remove life support, that is very different from his family requiring that life support (and possibly more invasive treatment) be continued, against his will. Removing treatment is like not doing any medical treatment against his will, which is something that is always necessary in the case if someone who is considered competent to make thier own decision. So in this case it is not as if the doctors are taking his life away. They did not create the injury in the first place. The question of medical aid in dying is not applicable here, as there was no medical intervention that brougjt about the death.

[@sanjosemike3137]

In the times before modern medicine, a person with severe cervical fractures would never survive past the point of being without ventilation assistance. So this was not an "issue" prior to ventilation assistance. They would just expire. Now, there appears to be a choice involved. Some people do not believe in God because of these kinds of injuries. Their view is that after death, there is no consciousness of any kind and therefore any person who is CHEATED of life is ultimately cheated, period. Others, who (perhaps) have experienced NDEs believe they have experienced a form of afterlife. This is disparaged and rejected completely by atheists. But I think the atheist point of view is too restrictive. It is possible to suggest that a "transition" may occur that has nothing to do with God. We know that information in the Universe is "conserved" suggesting that quantum information is never lost. If other Universes exist in the "Multiverse" it is possible to suggest that a consciousness could be transmitted to another Universe in that form of information. That may sound ridiculous, but it could occur in a format that has nothing to do with God or Gods. We have no way of communicating with other Universes. But that does not mean that quantum information is equally restricted. Maybe that is the only way communication can occur. My point is that atheism does not always answer all of your questions. And that some things may occur in the Universe that have nothing to do with God. If a quadriplegic person believes he/she can make that "transition" at death, that should be their decision. And importantly, such a decision may have nothing to do with God or Gods. Sanjosemike (no longer in CA)

[@Godblessyou10100]

It’s Gods will and not his ❤❤🙏🏼🙏🏼🙏🏼❤️

[@susannovak8263]

Just my opinion - god put him in that position and it was the man’s choice to decide how to live or how not to live.