Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

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

So currently, we are working with a client who has their 80-year-old dad in ICU with pneumonia, tracheostomy, and with an acquired brain injury after a stroke a couple of years ago. The intensive care team is now adamant that this man’s life is no longer worth living and that he should no longer have dialysis because he’s old and frail, and that he won’t have any “quality of life”, and I should say any perceived quality of life. I mean, what is quality of life anyway?

So given that he’s getting dialysis at the moment, he is obviously also in kidney failure. This man has documented an advanced care directive a couple of years ago where he says he wants everything to be done even when the situation doesn’t look good. His family obviously is advocating for him, and we are helping them in the advocacy process.

Interestingly enough yesterday, I was on a call with the client and with one of the intensive care doctors and I read the following law out to him, the California Health Care Directive Law. Before I read this out to you, the ICU doctor was adamant that he will not perform CPR (cardiopulmonary resuscitation) because he doesn’t think it’s in the “best interest” of our client’s father’s life, or quality of life.

Furthermore, the intensive care team has also asked the ethics committee to make a judgment about this man’s life. And the ethics committee said, “Well, we shouldn’t be providing CPR, we shouldn’t be providing any antibiotics, we shouldn’t be providing inotropes or vasopressors.”

And the other thing that’s become quite clear when working with a client is their religious beliefs that God takes life away and God gives life and not anybody else. So far, they have felt very disrespected by the intensive care team in terms of their cultural and religious beliefs.

Now, when the ICU doctor said yesterday that he will not perform CPR, sort of I said to him, “that means you’re telling us you are prepared to be breaching the law.”

Now, let me read this out to you the California Health Care Decision Law. There’s on the one hand there’s the right to die, and there’s also on the other hand, the right to live. And let me read out the section where it comes to the right to live.

“California Health Care Decisions Law prohibits an agent from permitting any affirmative or deliberate act or omission to end a principal’s life. The exception to that rule is that the agent may withhold or withdraw healthcare pursuant to the principal’s specific written instruction or as instructed to permit the natural process of dying.

The advanced healthcare directive may give the agent authority to direct the withholding or withdrawal of artificial nutrition, hydration, and all other forms of health care services. Case law also supports the right to give the authority to refuse medical treatment or request withdrawal. The rationale is to protect an individual’s fundamental right to control decisions relating to his or her own medical decisions, including the decision to medical treatment, withheld, or withdrawn.  It is imperative that clients who do not want to receive life sustaining treatment make that known by written instructions”.

Now let’s go to the other side of that coin where it says, “in the absence of an advanced healthcare directive”, which is not the case here, but I want to read it out.

Anyway, the state of California requires that a conservator be appointed by the court to make medical decisions on behalf of a conservative who has been declared to lack the capacity to give informed consent for medical treatment.

On the other hand, under the California case law, a conservator may not withhold artificial hydration and nutrition from a conscious, severely impaired conservatee who was not terminally ill, comatose or in a persistent vegetative state, and who had not left formal instructions for health care or appointed and helped an agent or surrogate for health care decisions. Absent clear and convincing evidence that the conservator’s decision is in accordance with the conservatee’s own wishes or his or her own best interest.

If there is an objection and the legal battle ensues, it will have to be shown to the court by in quote clear and convincing evidence that the conservatee would have wanted life sustaining treatment withdrawn or that it would be in the conservatee’s best interest. The clear and convincing evidence test requires a finding of high probability based upon evidence so clear as to leave no substantial doubt and sufficiently strong as to command the unhesitating ascent of every reasonable mind.

“California health care decision law prohibits an agent from permitting any affirmative or deliberate act or omission to end the principal’s life.”

So then when we read all of that out to the doctor yesterday, we said to him, well, so basically you are telling us you are breaching the law and he ended up being really cocky and said, “Well, if you want to go to a court and hit me with a lawsuit…”, he seemed to be above it all. And quite clearly, he told us, well, he’s prepared to breach the law.

That’s where we were at in 2023 where, some ICUs, not all ICUs, some ICUs, have doctors that try and play God and take lives in their hands or let them slip through their hands.

For this particular family, for our client, it is extremely important that they get an end-of-life situation on their terms, and they want to have a say if their loved one is going to die and how he dies, and that’s only reasonable as far as I’m concerned.

So, it is important for you to understand that you have the right not to have treatment, but you also have the right to have treatment, and that’s a good thing. If some families or some patients have different wishes than others, it is important that all sides are being listened to and all sides are being heard before rush decisions are often made, because ICUs need bed. They need to free up beds, they need to free up staff, so they can look after the next patients that are inevitably needing intensive care.

So, I hope that helps.

If you have a loved one in intensive care and you need help, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

Also have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team 24 hours a day in a membership area and via email and we answer all questions, intensive care related.

I also offer 1:1 consulting and advocacy over the phone, via Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I represent you in family meetings and we can also give you a life second opinion in real time, which is critical. You need a second opinion in real time. You need to do your own research and we can do all of that for you.

We also review medical records after intensive care if you have unanswered questions if you need closure or if you are simply suspecting medical negligence.

If you like my video, subscribe to my YouTube channel  for regular updates for families in intensive care. Give it a thumbs up. Give it a like. Click the notification bell. Share the video with your friends and families and comment below what you want to see next or what questions and insights you have from this video.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.

Related Articles:

Quick Tip for Families in ICU: Should I Let Go of my Dad with Cancer on a Ventilator & Tracheostomy? Quick Tip for Families in ICU: 3 Things You Need to Pay Attention to for COVID ARDS in ICU! Quick Tip for Families in ICU: How to Get Information in ICU Fast! Quick Tip for Families in ICU: What is Considered Progress While Ventilated with a Breathing Tube? Quick Tip for Families in Intensive Care: The ICU Team is Trying to Stonewall Questions about My Mom in ICU, Should I Make a Complaint?