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Hi, it’s Patrik Hutzel, from intensivecarehotline.com with another quick tip for families in intensive care.

So Stephanie writes an email, and she says, when a critically ill patient is removed from the ventilator based on the ICUs perceived futility of treatment, but they did this without having ever allowing the critically ill person the opportunity to wake up from the induced coma. And once removed from the ventilator they continue to breathe, whilst they’re given continuous doses of drugs to “make them more comfortable” and then they finally stopped breathing. Is this euthanasia? And what is the most typical cause of death that is placed on the death certificate?

What a great question to ask Stephanie and it looks to me like you have done a lot of research already. And let me break this down for you. As you mentioned, futility of treatment is a term that from my perspective, is overused in ICU and it’s basically all about the perception of the intensive care team, that a treatment is futile and is of no benefit to a patient.

It doesn’t take into consideration a patient’s belief, it doesn’t take into consideration a patient’s advanced care directive potentially, doesn’t take into consideration a patient’s religious beliefs, spiritual beliefs, family’s religious or spiritual or cultural beliefs, it doesn’t take any of that into consideration.

Whenever there is futility of treatment in ICU being mentioned, it often comes down to emptying ICU beds and to let people die so the ICU bed is not occupied forever and the day and the next patient can be admitted. And the question then is, why doesn’t the ICU team give the patient enough time to wake up because, after I have worked in intensive care for over 20 years, the reality is, it can sometimes take many days, many weeks, sometimes even months until the patient wakes up after an induced coma.

The ICU team will never share that with you because it’s all about their agenda and their agenda only. And their agenda is to free up their ICU beds and avoid their worst-case scenario.

What is their worst-case scenario? The worst-case scenario is to look after a critically ill patient in intensive care with an uncertain outcome indefinitely. And quite frankly, many intensive care patients fit that criteria. And that’s why intensive care teams often say, “Oh, well, your loved one will never wake up”.

Well, how do they know? They don’t. Because I have seen things in 20 years of ICU where people do wake up, but even if they don’t wake up, who is to judge what quality of life needs to look like for a person.

Maybe a person who has an advanced care directive that says I want to live even if I’m in a vegetative state, that happens, it doesn’t happen often but it does happen. And it’s for no one to make a judgement about that. It is for the individual or for the family to make that judgment.

So then also, like you mentioned in your email, once they’re removed from the ventilator they continue to breathe while they are giving continuous doses of drugs to “make them more comfortable”. And then they finally stopped breathing because the drugs that they are given, which is often midazolam or versed, or morphine or fentanyl is basically hastening death and is killing people and that is euthanasia.

It takes out of the equation that people potentially, can live potentially in a vegetative state, when they are being removed from the ventilator if they are not given the sedative and the opiate drugs.

So that’s a whole different ethical debate that needs to happen there in terms of what is right or what is wrong. Again, it’s not for me to judge what quality of life looks like for a patient after an ICU stay. That is up to the individual, it’s up to the family and not up to anybody else.

So, because we are talking about euthanasia here and it is quite common practice in ICU, even though nobody wants to use the word euthanasia, the question is then, what is the most typical cause of death that is placed on the death certificate?

It really depends, if someone has had a severe sepsis prior to this, it really depends on what was leading up to it. Sometimes it’s documented cardiorespiratory arrest. Sometimes it’s documented cardiorespiratory arrest secondary to sepsis. Nobody will actually document euthanasia.

So, I hope that helps. Stephanie.

If you are in a situation like this, what you need to do, you need to contact us if your loved one is in a situation where the intensive care team talks about futility of treatment and ending life support and withdrawing treatment.

You need to contact us as a matter of emergency, we can help you put a stop to that. We are the experts on patient and family rights in intensive care. That’s what we’re specialized on.

So that’s my quick tip for today. Like this video, comment down below what you want to see or what questions that you have. Subscribe to my YouTube channel for updates for families in intensive care.

And if you have a loved one in intensive care, go to intensivecarehotline.com, call us on one of the numbers on the top of the website and I’ll talk to you in a few days.

Take care for now.