HOSPITAL TO WITHHOLD LIFE SUPPORT! QUESTIONS ABOUT PROTESTING!

[Th1onein]

I need a lawyer's help here, I think. But maybe some of you can help me.

My sister, who has been in the hospital these past three months, and is not expected to live, gave her family, myself included, very clear instructions that she wants any and all procedures necessary taken to preserve her life. Her prognosis is "abominable," so the doctors say. Today, they called a meeting of her family members, including her brother, myself, and my other sister, and her son. They want us to agree to disconnect my sister from the respirator. They offered a "compromise" of withholding antibiotics and increasing pain medication to a point where she would die of either an infection, or the heart disease that she was hospitalized for, in the first place (pain medication makes her condition worsen).

We want her left on life support, not because this is an easy decision for us, but because it is what she made very clear to us, while she could be clear. We, in turn, made this very clear to the docs.

Now, they are going to have a committee meeting, including the "ethics" people and if they decide to discontinue her care, they will give us ten days to get her into another facility or they will "pull her plug." Needless to say, no other facility will take a patient under these circumstances.

Now, she has insurance, and her insurance is paying for her care. Money is not the problem. The problem is that the doctors feel that her prognosis is dismal and that she is in too much pain to have any quality of life. We have visited with her, and she does not seem to be in pain, although she does display her usual "bitchiness" when we wake her up. She's always been this way; nothing has changed except, now, she can't communicate with us.

We, my sister, brother, and my sick sister's son, are planning to go out in front of St. Luke's Episcopal Hospital in the Houston Medical Center, and carry signs that say things like, "St. Luke's Please don't kill my mom," and "St. Luke's Please don't kill my sister." We want the public to know what is going on at this hospital.

My question is this: Do we need a permit to do this? I've contacted the City of Houston and they say they don't know. What are the constitutional grounds for picketing without a permit? (Of course, we know not to picket on hospital property, because that is trespassing, and we've contacted the hospital general counsel and he is sending us the "meets and bounds" for the property.)

[nadinbrzezinski]

1. From an ethics perspective I can almost see

the answer from the Ethics committee... her request was that all be done to keep her alive... but the question of quality of life intrudes and the possibility of recovery.

If her prognosis is that bad, there is no expectation that she will survive, that is what the ethics committee will probably point out.

By the way, it is never easy, and in times such as this one I would also recommend you talk to your priest, rabbi, what have you. They should be good in providing some guidance too

[Th1onein]

3. I am making no choice. My request is for legal help regarding a permit!

WE HAVE NO CHOICE TO MAKE. The choice was HERS and she has already made it. We are simply following her wishes. Period.

My question is not about my choices. My question is about the ability to protest without a permit.

I am not talking to a priest, rabbi, or anyone else. I'm not "religious."

[nadinbrzezinski]

6. self delete

[radwriter0555]

24. Why worry about a permit? You're not assembling. You have the right

to be on public property and protesting peacefully.

And even if you got a ticket, what's the big deal? It's not anywhere near as serious as what's going on with your mom.

Get out there and do what you have to do.

And look harder for a facility that will take her... why wouldn't they if they can make money from it? There ARE facilities for long term, terminal care.

I'd focus your energies on long term care... it's out there.

[SPKrazy]

2. As A Member Of An Ethics Committee I Have A Question

Is the family able to attend the meeting to give their view?

Does your sister have a living will?

Is she competent to sign such a document now? (does she have mental capacity? Or is she non-responsive? on edit: after re-reading your post, I see she is on a respirator. Is she conscious or comatose?

I don't know the answers to the protest questions. But you might want to get a lawyer to represent yours and your sister's interests in this situation. Hospitals tend to be shy when lawyers show up at meetings like an ethics committee meeting.

Good Luck

[Th1onein]

5. Answers to your questions.

Yes, we were able to attend. We told them, in no uncertain terms, that we were going to follow our sister's instructions.

My sister has no living will. I obtained a protective medical decisions document, which she was going to sign (this is a document that says that she wants to be kept alive no matter what the prognosis), but before she could sign it, she had an intracerebral bleed, which made her unable to sign anything. She is paralyzed, except for one hand, which she uses to squeeze ours when we ask her questions. She does NOT WANT TO DIE and has made this very clear.

We are getting an attorney, but we want to protest and let the community know what this hospital is doing.

[SPKrazy]

10. You Might Try To Get The Local News Involved

Write a press release, fax it to every news organization, do a press conference, hire a lawyer.

All these are ways to battle this kind of decision.

In all honesty, you may have to really ask yourself what chance does she really have at life?

Can she live off a respirator? How much has the intracerebral bleed affected her? Cerebral tissue is what makes us in a sense, human. (Although I believe in more than that, but just "hardware" speaking)

The other thing that will inevitably come up, is funding for a step down unit where she could be out of an ICU (I assume that's where she is) bed and on a long term unit, even in a nursing home there are sometimes ventilator wings. At any rate she is very vulnerable to infections, furter Cerebral/vascular accidents, etc. since she is not breathing on her own, sedentary, and suffering he insult of her previous CVA.

I'm very sorry to hear about your sister, and I appreciate her desire to live. (on edit: whatever spirit of life there is in the universe, may that spirit bless you and your family as you go through this difficult time.)

I'm sorry to sound like such a downer.

[Horse with no Name]

18. She doesn't legally have to have documents to continue treatment

It is implied.
Only her wishes to discontinue treatment are legally necessary.

[SPKrazy]

20. I Don't Think She Wants To Discontinue Treatment

And state laws vary, I'm not familiar with Texas law, but from what I've heard, they are able in Texas to cut off life support even with evidence that the person didn't want it turned off.

(Some case recently about this, not long after the Schiavo fiasco)

[Horse with no Name]

23. The boy was Sun Hudson eom

[Warpy]

19. Appointing the court as guardian is a great idea

because the court will then appoint people to evaluate the reliability of things like patient responsiveness, something families are not always in the best position to do, themselves, if we remember the Schiavo case correctly.

In any case, if the patient herself is found to be responsive by an independent legal entity and capable of refusing terminal status, the hospital won't have much of a choice in the matter. They'll have to keep her on life support.

[Warpy]

4. First, don't picket the hospital

I know what your sister's wishes were, but there comes a time when prolonging life turns into prolonging death. When she wanted everything done, didn't she also want to be comfortable? Perhaps the compromise of leaving her on the ventilator while increasing her pain medication is the best one you can make for her sake.

The docs know they can keep gigging her insurance forever, and so does the hospital. Their motivation isn't money, clearly. They just know that your sister's body will no longer support her life and they want her to exit peacefully and with dignity.

I can tell you that it's very stressful on hospital staff when they have to care for someone on life support who is not adequately medicated because the family has balked at terminal care, meaning adequate comfort medication. Ventilators HURT, as anyone who has ever been on one can tell you.

This is heartbreaking for you because you know what she wanted, to stay on earth as long as she possibly could. However, death is inevitable and the time comes to all of us when we have to let go.

Please consider allowing them to increase her comfort meds, and please try to listen to the docs about the complications that ventilators themselves can cause after a long period of time. Ask yourself if your sister would want to live forever like that.

Picketing the hospital won't do her or you any good.

[Th1onein]

7. All of us are terminal. I will follow my sister's wishes.

What you are telling me is that when I ask her, "Do you want to die," and she answers me with an AWFUL face that clearly says NO, I should just "let go" and let the doctors, who are in SUCH pain and stress, unplug her anyway?

This is not about the POOR doctors and their feelings and their stress. This is about my sister and what my sister wants.

[bread_and_roses]

9. self-delete

my question was not pertinent to your original query.

[Warpy]

14. Where did I say "unplug?"

Before you launch into an attack, please read the whole post.

[Igel]

8. Texas has a 'futile care' law.

It's sometimes heartless.

Wikipedia has a succinct summary and relevant links: http://en.wikipedia.org/wiki/Texas_Futile_Care_Law The link to the actual chunk of statute works, and the statute is a bear to wade through: http://www.capitol.state.tx.us/statutes/docs/HS/content/htm/hs.002.00.000166.00.htm Perhaps a lawyer can do the wading for you.

It would have helped if a written advance directive had been left, or if there had been sufficient witnesses to certify that what you say really are the patient's wishes. But, in the end, it's up to the doctors to decide: if the care won't work, in their humble opinion, they have the right to stop what they're doing. For them to put in the time and expend resources in what amounts to making the family feel better is a bad allocation of resources.

On the other hand, there are stipulations in the law that are relevant. 10 day written notice. Notification of opportunity to transfer. Why? Because you're more than welcome to fish around for other opinions; the current crop of MDs are not gods, they merely may implement their decision, and if the patient moves on to be under the care of yet additional doctors, those doctors may implement *their* decision.

Picketing is unlikely to be useful. Much harsher, far more tear-jerking cases in which the hospital could be plausibly accused of penny-pinching and acting in a selfish manner all proved pointless.

Move her. Surely there's some hospital someplace that's willing to accept the money.

[SmokingJacket]

11. I was once arrested for parading without a permit.

Not in Texas; another state. A city will arrest you if they think you're "disrupting" commerce, or whatever. But if you feel strongly about it, and it seems clear that you do, you should go ahead and do it, and accept the risk of arrest.

Best of luck to you. :hug:

[radio4progressives]

12. Did she leave those instructions in her living will?

did she leave those instructions to her care providers?

[Th1onein]

13. SHE IS COGNIZANT. She does not want to die!

They don't care about that, though.

[Caoimhe]

16. if she is awake and aware

get her to sign her living will! That will end the debate in terms of her wishes. I think you definitely need to move her to another place if her wish is to stay alive by all means necessary.

It really boils down to what SHE wants, not what you want, the doctors want or the insurance companies want.

[SPKrazy]

22. Her Mental Condition Sounds Like She May Be Incapacitated

due to her intracranial cerebral bleed.

She would have to have capacity to understand, and communicate that she did in fact understand what she was signing. And guess who can say whether a person has capacity? Only a doctor. A court can decide on competence.

Perhaps she can find a doctor who is willing to take her case and transfer her out of the situation where they are obviously not wanting to continue her at the level of care she is at.

[ismnotwasm]

15. Strange situations.

I want to put this as kindly as possible.
Your sister made her choices very clear, and you and your family are to be commended for honoring her choice.
I find it odd that the city can't give you information on whether or not you need a permit. Someone must know-- I can google the info for my city. If not-- just go for it, the police will come and let you know what you need. (they won't arrest you)

Also, as far as I know (unless laws differ in Texas) they cannot "pull the plug" without permission. So I don't understand that part at all. What we do in these situations, is "call a code" sometimes over and over and over, we do everything to save the person who wants "everything done" Ultimetetly, in terminal situations, despite everything, the person will die during these codes. We've coded 90 year olds. We've coded terminal cancer patients. (And I mean terminal) It's not our choice. I work on a unit-- while not ICU-- we deal with very, very ill people who are sometimes here for months. The fact that she still wakes up and is aware, is also puzzling. I don't understand the hospitals reasoning at all. We who work in hospitals and nursing homes across the nation see these situations every day.
I don't know the hopital, but it may be that they don't have the resources or beds to maintain a dying person who will need repeated codes. They may need the bed for someone who will live. I wish they had put it in a better manner to you. Another hosital may be a better choice.

We work with life and death issues every day in hospitals, and believe me, we want to see life.

[Horse with no Name]

17. It is the decision of the next of kin

Not the hospital, not the ethics committee, not the Doctors.
Don't let them bully you.
I wouldn't meet with the ethics committee without an attorney representing your family interests.
Force the hospital to take this to court.
They are trying to make you think you don't have options, but as long as she is funded, the hospital cannot make these decisions.
The ethics committee will try to tell you that it is their decision to make, however, with a family objecting, it is a legal matter and would be for the courts to decide.
My guess is that she has some type of insurance that has a capitation clause and they aren't making money on her anymore, so they want to jettison her.
It is, as always, about choice and the rights of the legal next of kin.
Think Terri Schiavo. It WAS Michael Schiavo's LEGAL right to decide to discontinue treatment. It is YOUR family's right to continue treatment.
Good luck and I am so sorry for your family's burden at this time.

[SPKrazy]

21. Some Good Points

And I see that I probably mis-stated or misread a previous post by you about this.

The attorney and the ethics committee is a good suggestion.

It is also possible to probably move her to a long term care facility that can take care of her ventilation and antibiotic needs without being in an acute care hospital. (Her condition sounds like it is past acute and is now moving into the chronic state. Whether or not there is rehab possibility remains to be seen. But a vent wing at a nursing facility, or a step down unit are possibilities.)

Also, they are in Texas, that land of "life lovers", except the ill, the infirm, those on death row, and practically everybody else except the unborn.:sarcasm: