Ethics and family in braindead patients
The first ethical principal that physicians must apply to their practice is the Hippocratic oath: above all, do no harm.
The second is that patients should get to choose their own treatment. However, what is the most ethical solution when the patient is not in a position to speak for themselves and the family member choosing treatment for them is not prepared to face a hard decision.
This is situation that Dr. James Mills encounters regularly as a neurosurgeon and member of the ethics committee at Bayhealth Medical Center, a hospital in Dover, Delaware.
“In medicine and in general,” Dr. Mills said, “we don’t think it’s good to do harm to a person or body. In the short term, you are doing more good by keeping the body alive when you are harvesting organs, but in long term cases it is more harmful to keep a body alive for no purpose.”
Dr. Mills recalled one specific occasion when a colleague had a patient that was clearly braindead – that is, there was no function or blood flow to the brain – and the family of the patient asked the surgeon to wait 14 days before declaring him braindead.
The surgeon initially agreed but the case had to be brought before the hospital’s ethics committee to discuss whether this was a violation of their ethical responsibilities as doctors. The committee came to the discussion that an outside specialist should be brought in to discuss the meaning of “braindeath” with the family so that they could be better prepared to make an ethical decision for their family member.
“Most ethical dilemmas in medicine can be solved by coming to a better understanding of medicine for the situation,” said Dr. Mills.
Late on the evening of November 7th, 2009 Dr. Mills was on call as a resident at Ruby Memorial Hospital in Morgantown, West Virginia. It was on that night that he saw a patient who would change his career forever.
The patient was a young man who had been involved in a violent altercation in a convenience store parking lot that had started of an argument about the Philadelphia Phillies. It didn’t take long for Dr. Mills to determine that Ryan Diviney was effectively brain dead.
“It was the result of a completely random minor act of violence,” said Dr. Mills. “The family was not in a position to accept the situation.”
Ultimately, Diviney was not determined to be completely braindead from a medical standpoint. Rather, he was in a “persistent vegetative state,” a condition where the brain is receiving enough oxygen and blood flow to stay alive but has no function.
The family was advised by an outside neurosurgeon who had no contact with the patient that they should fight to keep their son alive on life support, in opposition to the advice they received from the hospital staff at Ruby Memorial. It has been ten years since this incident and Diviney’s family continues to hope for a miracle recovery.
“This case has influenced me throughout my career to fight really hard to restore brain function and keep my patients alive but to also accept that it isn’t always possible,” Dr. Mills said. “But now, I also fight hard to educate the family members to the best of my abilities, even if it hard for them to accept the reality of the situation at first.