Legalised Murder - Rethinking Life-sustaining Measures:

Imagine the scenario – you are a 35 year old woman, mother of two young daughters (7 & 12), who is severely injured in an accident with an extremely poor prognosis. That was me.

I suffered a severe head injury; I spent four months in a coma and spent 12 months in hospital leaving me with quadriplegia, partial blindness and use of only one hand but with an enormous will to live. Luckily I had not signed an Advanced Health Directive (known as a Living Will) when I was 25, which I would have done not knowing the wonderful life I could lead. These Advanced Health Directives, I call Legalised Murder.

I’m glad I had my accident 12 years ago when euthanasia was illegal. Sure before my accident I would have said ‘put me down’ if I was ever injured badly but I’m so happy I survived and right now I wouldn’t have changed a thing in my life. It frightens me with these Advance Health Directives, or the ‘Living Will’ as it is popularly known, being legally binding. ‘Living Will’ is such a misnomer – it should be renamed ‘Dying Will’. I know I can’t prevent such an option but I would like it to be clear and understood that a decision made when one is 25 years old is quite different to the one you would make when you’re 65 years old or older. I feel that as a 25 year old you lack the maturity and appreciation of life. Car insurance companies are of the same opinion.

All life is precious. It is against the law to commit suicide or murder. Speaking on behalf of all the disabled, given a choice, we don’t want to be devalued and have an ‘upright’ decide our quality of life. I know of one particular person who has quite severe physical disabilities and is unable to communicate in the traditional sense. His biggest fear is to be placed into hospital, not be understood and have someone decide that his life is futile. What is being done to safeguard these people? There is a push in Queensland to have this law passed.

What criterion is to be used when a life is considered futile? I know from reading my hospital records I was not given a lot of hope to survive. I was artificially ventilated and artificially fed through a nasal gastric tube and given every opportunity to survive against all odds. Where has the Hippocratic Oath gone? I have grave concern for future accidents and births if future legislation does not continue to safeguard the rights of people with disability to live.

In reading through an Issues Paper reviewing the legislation governing withholding and withdrawing life-sustaining measures, I found it disappointing that not one person on the reference group was disabled or had anything to do a person with a disablity or a disability service. I find that rather surprising when you look at the percentage of people with disablity throughout the population of Queensland, the reference group is hardly a good cross-section of the general public of Queensland. It appears the reference group was mostly made up of academics.

People with disability deserve to have their voices heard. I refer to the recent movie Million Dollar Baby where the lead role was made out to be a hero when he put an injured young woman out of her ‘misery’ because he thought her life wouldn’t be worth living. Sadly this is how many people see life with a disability.

I question what is meant by Personal Matter when the issues mentioned are about where one lives, what education one has, what one eats and how they dress? Does that mean someone who was educated to Year 10, vegetarian, living on the wrong side of the tracks and unfashionably dressed is a candidate for euthanasia? They are human beings for goodness sake. I have been told I am unfashionable but I wear clothing that I can manage and I am also very conscious of my diet as my health is of utmost importance to me.

I was considered in a Persistent Vegetative State (from hospital records) and yet I was quite aware of things around me, I just was unable to react. I did notice when people around me were caring. Just because one is in not reacting in the traditional sense, doesn’t signify the ‘will to die’. The Glasgow Coma Scale (GCS) used by the hospitals in Australia is very limiting. On admission to hospital my GCS was 4 and 2.5 months later it came to a 6.

The Glasgow Coma Scale is scored between 3 and 15, 3 being the worst and 15 being the best. It is composed of 3 parameters: Best Eye Response, Best Verbal Response and Best Motor Response, as given below;

Best Eye Response (4)
1. No eye opening
2. Eye opening to pain
3. Eye opening to verbal command
4. Eyes open spontaneously

Best Verbal Response (5)
1. No verbal response
2. Incomprehensible sounds
3. Inappropriate words
4. Confused
5. Orientated

Best Motor Responses (6)
1. No motor response
2. Extension to pain
3 Flexion to pain
4. Withdrawal from pain
5. Localising pain
6. Obeys commands

Note that the phase Glasgow Coma Scale of 11 is essentially meaningless and it is important to break the figure down into its components, such as E3V3M5 = GCS 11

A Coma Score of 13 or higher correlates with mild brain injury, 9 to 12 is a moderate injury and 8 or less is a severe brain injury.’

Teasdale G., Jennett B., LANCET (ii) 81-83 1974.

I think we have had a classic example presented to us with the Terry Schiavo case in Florida. How that poor defenceless woman was murdered was horrendous – you would be arrested if that was being done to a dog. I think there are more safeguards for animals than humans. Can anyone appreciate the agony involved with dying of dehydration, starvation or suffocation, while people watched on?

At the time of my accident I was separated from my husband and he had taken work in South Africa. My defacto partner took my accident on board and thankfully at no time was I wanted dead no matter how futile my situation or future seemed. Don’t discount the ‘human spirit’.

Scenario A to consider – Trevor is a 40 year old man who is married with two young children. He is a high school physical education teacher and also competes in marathons. Trevor has been training for the 2010 Commonwealth Games. He and his wife have discussed each of their wishes should either be involved in an accident which would require invasive medical treatment to recover. They pledged to each other that they would ensure that the other would never have to incur what they perceived to be unacceptable indignity of being on life-sustaining measures if there was only a limited prospect of making a full recovery.
Trevor’s family is involved in a car accident. Most of the family escapes serious injury but Trevor sustains severe head injuries and is placed on life-support. Trevor’s wife Amanda is advised of his condition – he has suffered significant brain damage, cannot currently breathe on his own and he will need to be on life-support until his condition stabilisers and staff can more accurately assess his prognosis. At this stage, however, the prospect of Trevor ever being able to live independently again is extremely remote. This sounds very familiar.

The public is of the opinion that you are ‘better off dead than disabled’, I know these case studies are hypothetical (or at least, I hope they are) but he is a fit young man who has many reasons to live. Perhaps his wife was counting the cost financially, I’m sure he would think differently if it were her, or is that how the medical world is thinking and they are looking for a legal way out. I can’t do the things I used to; my life has changed not ended. Through perseverance, love and encouragement I have become as independent who has been admitted to hospital for a minor procedure. An adverse event occurs regarding her anaesthetic and Anne suffers severe and irreversible brain damage. Although she is not clinically dead, there is only minimal core brain activity. Her breathing is laboured and it is likely she will have to be put on a respirator (and certainly other life-sustaining measures) to survive.

Anne’s family is told that she has no prospect of recovery and that life-sustaining measures should not be provided to her. Anne’s family do not agree with this approach and insist that life-sustaining measures to be given as needed.

I agree with the family. Who does this doctor think he or she is? Saying it would have to go to court, when treatment could be being done, makes it really difficult to understand the rationale behind it. Again I think it is all to do with money not humanity. as possible, graciously rely on the help of others and contribute to society.

Scenario B to consider – Anne is a 40 year old woman

What I’m also curious about is many of the situations are an emergency so I wonder the wisdom in waiting for a person of authority to be found to render a decision. With all the advances in medicine makes me wonder about all these cost-cutting decisions being made about life and death situations.

Please allow doctors to be doctors and work by the Hippocratic Oath which they undertook on graduation. This includes the ambulance people. Don’t allow them to become Legalised Murderers. Allow them to shine.
This situation could happen to any one of you, at anytime

Questions:

1. Scenario A: Trevor is a 40 year old man who is married with two young children. He is a high school physical education teacher and also competes in marathons. Trevor has been training for the 2010 Commonwealth Games. He and his wife have discussed each of their wishes should either be involved in an accident which would require invasive medical treatment to recover. They pledged to each other that they would ensure that the other would never have to incur what they perceived to be unacceptable indignity of being on life-sustaining measures if there was only a limited prospect of making a full recovery.
Trevor’s family is involved in a car accident. Most of the family escapes serious injury but Trevor sustains severe head injuries and is placed on life-support. Trevor’s wife Amanda is advised of his condition – he has suffered significant brain damage, cannot currently breathe on his own and he will need to be on life-support until his condition stabilisers and staff can more accurately assess his prognosis. At this stage, however, the prospect of Trevor ever being able to live independently again is extremely remote.

Q1. Should his life support be turned off?

2. Scenario B: Anne is a 40 year old woman who has been admitted to hospital for a minor procedure. An adverse event occurs regarding her anaesthetic and Anne suffers severe and irreversible brain damage. Although she is not clinically dead, there is only minimal core brain activity. Her breathing is laboured and it is likely she will have to be put on a respirator (and certainly other life-sustaining measures) to survive.

Anne’s family is told that she has no prospect of recovery and that life-sustaining measures should not be provided to her. Anne’s family do not agree with this approach and insist that life-sustaining measures to be given as needed.

Q2. You are the doctor speaking privately to her family what would you say?

Q3.Should our doctors/medical services be responsible for our medical future – if so, how?

Q4. Should we be responsible for our own medical future? - if so how?

Q5. Is our medical system governed by money? Where are the humanitarian goals gone?

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