Family fights to keep comatose man alive (Ethics comm. votes not to)

[rainbow4321]

http://www.baytownsun.com/story.lasso?wcd=19802

Raymond Holder’s family is convinced the 51-year-old Baytown man will wake up from the coma he’s been in for four months. But doctors treating Holder at Memorial Hermann Hospital are recommending he be removed from life support by denying him food and medication under a heavy dose of morphine to lessen the pain of dying.

The Crosby family is fighting to keep Holder alive and forced the hospital ethics committee to review their case. The verdict came back late Friday afternoon. The doctors had not budged and believe Holder will never regain consciousness, and if he did, he would not be the same man.

By law, Memorial Hermann has to assist Holder’s family in finding another caretaker and make every effort to care for him until he is moved. However, if Holder is still under Memorial Hermann’s care after 10 days, they have the right to discontinue his life support.

After moving Holder from Memorial Hermann, the cost of long term, possibly indefinite, care for a comatose patient is extremely expensive. Medicaid will reimburse the cost up to $150 a day. But the average price for a comatose patient to live in a nursing home is often higher than Medicaid pays, said Rosemary Patterson, spokeswoman for Texas Department of Aging and Disability Services.

[Erika]

1. This is extremely interesting

It begs two questions

1. Who makes the decision as to whether the man is indeed beyond recovery

2. Who pays for the cost.

If the family wishes to keep the man alive against the advice of the doctors, who should pay for it?

[Maat]

2. I don't think that they should have the right to disconnect.

I've always been under the impression that it was the family's decision (whoever in the family who had the legal capacity to make it).

I hope they successfully move him. I'd be glad, as a taxpayer to help fund the cost. These things resolve themselves one way or another soon enough naturally.

Another case I feel sad about is the Schiavo case. If it was a TRUE right-to-die case, as it would be if my husband made the decision for me, it would be one thing. But no one will ever convince me that Terri's husband isn't just eagerly awaiting the life insurance payoff. If he wasn't, he could have just divorced her, and allowed her parents to become her guardian; they seem to get such joy by being around her. And I have seen pictures of her reacting what appears to be very happily to them.

And, one of my friends surprised everyone and came out of a coma after nearly a year - when doctors thought the situation was hopeless.

[Erika]

3. Terri's husband could have profited from divorcing her

He chose not to so he could carry out her wishes. Her parent's scaresly visited her, documented, until the right wing "Right to Life" group decided to exploit Terri as a poster child for their political purposes.

I have seen the pics showing the area which used to be her brain now shown as a black area. It has atrophied to the point of almost non-existence. Only a dot of the brain is left. The Court documents and judges confirm that her husband did everything possible to rehabilitate her. That is why the courts have kept him as the legal guardian.

This issues still begs the question as to who makes the decision in these cases and who pays for them. Regardless of your good intent, the costs of this type of care would break the average working class family within a few months. It is clear that the Medicaid (tax-payer funds) would in no way meet the costs of the care.

[OldLeftieLawyer]

5. Just for the record ..........

Mrs. Schiavo has no life insurance. That's another myth promulgated by the right-to-no-choicers who want to pre-empt her husband's legal right to take the steps he deems best for his wife.

She's on Medicaid now, all the funds having been spent on her care, and that means she has no assets - including any and all life insurance policies.

Those pictures aren't of her reacting - they're of a fundamentally brain-dead human being doing nothing. And, by the way, those tapes were made by her parents in violation of a court order forbidding them from doing such a thing - Mrs. Schiavo's personal privacy was violated, which is shameful.

Her brain is mush. I hope she'll be on her journey, which was only interrupted by man-made intervention, in defiance of God's will for her, shortly.

[LostinVA]

8. And, she is NOT in a coma

her cerebral cortex has literally liquefied. She is in a permanent vegetative state.

[mordarlar]

12. By some accountings the money is far less but not gone.

[OldLeftieLawyer]

15. Those so-called "accountings" are wrong

She would not be on Medicaid if she had any assets. Anyone who tries to assert otherwise is not telling the truth.

[Quakerfriend]

20. For all of you who have commented on Ms. Shiavos case

I know some of her family members personally, and I must tell you that her husband does not have her interests at heart AT ALL, and never has. He has only taken steps to pull the plug, once the $$ that he might have gotten was used up.

Some members of her family have done work with severly brain injured children/adults from all corners of the world. They would like try to help her with this therapy. He has barred them (legally) from the opportunity to do this.

[OldLeftieLawyer]

27. Sure

Sure.

Right.

Uh-huh.

[mordarlar]

11. Terry was injured under very suspicious circumstances....

A scan done right after her brain injury showed she had multiple injuries from several dates. There were also issues about the condition of her neck. Michael has lied repeatedly about his actions that night. He says he turned her over onto her back and than says he returned her to her face. In another telling he says he held her in his arms. He claims he called her brother but he in fact called her father. It was her father that called 9/11. When her brother arrived, by his fathers call, Terry was lying on her face with her hands by her neck.

While there will most likely be little money left when Terry passes (it has all gone to attorneys) one has to wonder why he wants to stay in control. He says it is because he loves her and wants to fulfill her wishes. Thing is to get the money for her,he told the courts that he intended to care for her for the rest of her life. When asked how long he thought that might be he answered 50 yrs or so. He also said it was unfair to remove her from a feeding tube early on. After the award though his opinion changed. He only said it was her wishes within the past few yrs.

Some Drs.say she can improve and some say she cannot. Her cerebral cortex is fairly destroyed. Yet in film she appears to form letters in words she is asked to say. These good moments are not consistent sadly.

The courts have refused at Michaels request any tests be done to see if she is capable of eating. She does not drool with means she is capable of swallowing oral secretions. Yet they will not see if she can eat on her own before removing the tube.

I have spoken to others about this and they claim it is unfair to her to have her suffering by keeping her alive. They said she is incapable of feeling pain of starvation. Seems to me if you cannot feel or suffer starvation there is no suffering to let her stay on and try for some improvement. There has been nearly no therapy in years again by Michaels request. Why not let her family try therapy for a period of time and see if there is improvement? If there is not then take the action they are threatening now.

[Maat]

24. I so agree.

Just let the parents enjoy what time they can with her. I know that I would want to if my daughter was in that situation. My heart breaks for them.

My dad has been suffering from dementia due to his alcoholism for at least 7 years now. Now, he is at the point where he has no concept of another human being and he doesn't recognize us. It was good to have him for a bit after he went in and out of a coma. I would never want to starve him to death; we are just going to let nature take its course. And it will.

[bushisanidiot]

18. "Naturally"

"I hope they successfully move him. I'd be glad, as a taxpayer to help fund the cost. These things resolve themselves one way or another soon enough naturally."

If it were up to nature, this guy would be dead already. But once again, humans try to play God and stop the inevitable.

[tblue37]

21. My 55-year-old brother

was in a vegetative coma following a hip-replacement operation 1 1/2 years ago.

After two weeks we were told that he was getting worse, not better, that the prognosis was pretty much hopeless, and that eventually we would have to make the hard decision to discontinue life support. A month later, he was conscious and in rehab, and four months after that he was living at home by himself again. He still has a few very minor deficits--mainly that he has trouble concentrating sometimes, and he reads more slowly than he used to, but if you had not known him before the stroke that caused his coma, you would not know that he had any deficits at all.

With comas, the first few days are important, and the first 6 months are very important, in terms of prognosis. But after what happened with my brother, I no longer believe that even excellent doctors have all the answers about who will or won't recover from a vegetative coma.

Four months seems to be rushing it.

BTW, when we in the family first saw signs of his coming conscious for brief periods, the doctors said we were imagining it, it was wish fulfillment, there was no evidence of it, blah, blah, blah. Even when the nurses and the physical therapist began to report some responsiveness, the doctors said the responses were random and meaningless reflexes.

Sometimes doctors might have a subconscious interest in one view of things, in the same way that the patient's family might have a strong interest in viewing the case in the opposite way.

I'm just saying.

[Maat]

23. I so completely agree.

And I'm so happy for your brother - and your family.

[moobu2]

4. It looks like he has no real functioning cerebral activity

First of all, in the article you are getting a one sided story from the family. In fact when the spokes person was asked to comment she say's they "could not divulge specifics about Holder’s case by law". They cant give their side of this or go into the specifics of his medical condition so you're left with the story being told by a family member who may not understand his state. She may be (unintentionally) misrepresenting his condition and it could be much worse than we are led to believe.

Family members of lived ones in these case sometimes just can not accept the reality the person is gone. They might take a blinking eye or a reflexive groan as an indication the person is aware some how but it's pretty clear, once it has gotten to this point, that this man is operating on brain stem reflexes. So, he will never wake up because he doesn't have the necessary living brain tissue.

Then there's the whole issue concerning feeding tubes and the thinking that that is somehow "food" in the traditional sense. I mean, it isn't meat and potatoes is it? no. It's more like a mixture of nutrients, vitamins and calories about the consistency of baby formula that is injected, usually, through a tube surgically inserted into the stomach wall. At that point it becomes a substance to keep your organs functioning basically. it isn't food at all.

people often regard feeding tube life support differently than say respirators because of the emotional and social attachment we give food.

You could write a book on all the issues explaining them but when there are disagreements like this. It usually comes down to someone in the family unable to understand the condition of the person and also maybe emotionally unable to accept that they are gone.

In the end, once your higher brain dies, you are dead whether they keep your body functioning or not.

If the family insists on keeping this mans body alive like this and he hasn't ever expressed his wishes, in writing or orally, one way or another, then they should pay for it somehow.

[OldLeftieLawyer]

6. A remarkably good and cogent statement

You zeroed in on the salient aspects of this matter - that there's no indication that what's being published is the definitive statement of the case, and that people sometimes cannot accept the finality of death.

In cases where the family is demonstrably irresponsible, it's not unusual for the hospital to go to court to get custody of the patient. Rare, but it happens. I wonder what the real story is, since the hospital is precluded from saying anything. It sounds fishy to me.

Interesting, too, the emotional component attached to feeding tubes. I've had people tell me that feeding tubes aren't "life support." I say, remove the tube and tell me how well life is supported without it.

If the family prevails, Medicaid will end up paying for his care, if they're without resources, or he's declared a pauper.

[Erika]

7. It's a religious interestingly point also

One belief is if God wished those to live who are now on feeding tubes, he would invent the tubes, as he did. Cross thinking is that man invented feeding tubes to overide God's will, in complete arrogance of God's will. Personally, I believe if diagnostic aids show that the brain is gone, God is not going to restore it. A case of Him either choosing not to nor giving us the science to do so.

[Disturbed]

9. Will the Tx. Gov. step in like...

Jeb did?

[aikido15]

10. I hope my family would...

Let me go if the doctors told them I would never be the same if I woke up. I know my family would, they know me and know I would rather die. I think most people would, don't know...:shrug:

[noonwitch]

13. Put it in writing so that they won't have to worry about it

My dad has a living will in which he states what he wants done for him and what he doesn't want done. You can state that you do not want to have a feeding tube, a respirator, whatever specific procedures you do not want medical personnel to use to prolong your live. If Terry Schiavo had done so, we wouldn't be having this debate about her situation.

I draw the line at removing feeding tubes, unless the person gave specific, written instructions to do so. We can't be starving people to death.

[OldLeftieLawyer]

14. It's not "starving a person to death" as we think of it

A feeding tube is not a meal. It's a delivery system of nutrients, going straight into a patient's stomach, without any enjoyment, taste, or any of the characteristics we associate with eating. There is no capacity in what used to a human brain to enjoy or even to need anything that "food" would offer. The things fed into that stomach are not food.

If you turn off the respirator, it's the exact same thing as removing a feeding tube, when you think about it rationally. Both systems are doing things the patient will never be able to do for himself.

Food's emotional, there's no question about it. But, removing a feeding tube is not "starving a person to death," but simply removing life support, just like a respirator.

[Bugaboo]

16. also...

the body goes into a natural state of anorexia as it approaches death. It's not as cruel as it sounds to withdraw a feeding tube. As OldLeftie said, feeding tubes aren't like a dinner. It's a medical intervention, like giving oxygen or pain meds.

[Bugaboo]

17. A reminder to everyone - get a living will!

You can get the paperwork from your local hospital. You will probably only need some witnesses, depending on the state. It makes a clear statement to your loved ones what you do and do not want done.

AND, although written is best, verbal will work too. Have that conversation with your loved ones and tell them what you do and do not want done. It's a tough conversation, but worth sparing them this kind of confusion and pain.

[rainbow4321]

19. It's part of our facility's admission paperwork...

We have to ask if they have a copy available for their chart or if they want someone to come by with information about getting one/filling one out.
But, like you said, people can fill one out anytime...don't wait to land in the hospital before you get one done, by then, you could be comatose or incoherent for whatever reason.
Most of the time I have to explain to people what it is. I worked at one hospital that had the Living Will questions mixed in with the "do you want the hospital chaplain to come by and see you" section.. some people freaked out over that..they would think we were "telling them" that they were about to up and die!

[ultraist]

22. Medicaid vs. Private insurance

Medicaid does not pay as much as private insurance. A doctor recently told me, the reason many of his friends will not accept medicaid is because it barely covers their costs and in some cases does not even cover the costs.

I wonder what this private hospital's recommendation would be if this man had private insurance? It certainly sounds like economic reasons are being factored in. The hospital doesn't want to foot the bill.

It's a well known fact that Medicaid patients often receive substandard care.

Health care is NOT of the same quality for poor people as it is for the wealthy.

[Blue Diadem]

29. I agree

At a nursing home I'm familiar with, they have a separate wing for the medicaid patients and will move a patient to the medicaid wing once their private insurance and money is used up. The rooms were on an equal level, however, due to the decrease in the number of staff working in that section the quality of care decreased tremendously.

[Corgigal]

25. doctors/hospitals kill 100,000

if not more, patients every year by errors. They can slow their little happy asses right down.

(raises hand to be on the jury)

[Erika]

26. Can you imagine the medical mistakes

if Bush succeeds in denying patients the right to sue?

Yes, in our country, the less than wealthy receive substandard care.

[Sgent]

28. Medicaid

Does pay (depending on the state) between 20-50% of what private insurance pays. In addition, Medicaid & Medicare DO NOT PAY by the day/procedure/item when people are inpatient. They pay a flat fee per admission (based on the admitting diagnosis) -- this is for the hospital bill, physicians are still reimbursed separately. The hospital has already lost a ton of money on this patient.

Without knowing the specific hospital in question, I can't answer; however, most hospitals have an ethics committee created from/by the medical staff. In general, the hospital administration may have a voice on the committee, but will not have a vote, which is reserved to those who admit patients or perform procedures in the hospital.