Tracheostomy Consent: Fill & Download for Free

This happened to a patient I knew. Mr B had lived in our ICU for 5 months. After many attempts he couldn’t breath without a ventilator and could not live outside of the ICU. He was asking to be extubated and allowed to die. His family wanted to keep on trying in-spite of his suffering and wishes. The family along with his pulmonologist, Dr S decided to give him surgery to insert a tracheostomy tube in his neck. However, Mr. B refused the surgery. So Dr. S had him sedated with Propofol for 3 days and with the family’s consent the surgery was scheduled and completed. Thankfully I wasn’t one of the nurses assigned to Mr. B and a participant in denying him his right to decline further medical treatment. Mr. B did not survive to leave the ICU. I however was burned out and left. We had another long term resident who I later found out died after 14 months in our ICU. This was not a not term acute care facility such as Kindred, but an ICU at a hospital with over 500 beds. A lot has changed in 18 years and hopefully this is no longer happening.

Yes, and it recently happened in the USA, but to have sexual intercourse with a woman who is brain-dead is rape, because she cannot give consent to the sexual intercourse. Therefore any man who has sex with a brain-dead woman is a rapist.It has happened that women have gone into a vegetative or brain-dead state when they were already pregnant, and carried the baby to term. The baby is often delivered by Caesarean section but in fact a woman does not need to be conscious to deliver vaginally, provided she does not have an endotracheal tube in place or a tracheostomy. A woman in a vegetative state still pushes involuntarily in second stage, and in any case most of the expulsive power in second stage comes from the uterus itself, not from pushing. However an endotracheal tube or tracheostomy makes it impossible to push because it prevents closing of the glottis. The woman in the recent case in the USA delivered vaginally.

A2AThey don’t always view those interventions as life saving. Just life-prolonging.In cases where these interventions don’t provide any meaningful improvement in quality of life, there’s no value in those interventions. For example, my sister has severe disabilities and no ability to do anything for herself. She frequently develops respiratory failure. During several hospitalizations, doctors have pushed my parents to consent to a tracheostomy, where they put a hole in your airway to provide an artificial airway; as an extension of that, she would also have to be permanently on a ventilator. While they do make ventilators that can be taken in public, it would essentially remove any ability for her to easily go into public, it would likely result in her needing to have some level of sedation at all times so that she doesn’t remove the device maintaining her airway, and it would severely impair the quality of life for not only her, but everyone else in our family as well. Nothing about it would prevent her from being hospitalized. It wouldn’t make her less likely to develop pneumonia. There’s no value at all in doing it other than technically speaking, it could potentially extend her life because she wouldn’t be as likely to develop respiratory failure. Does it mean she’d die sooner? Potentially. However, I’d rather her have a higher quality of life for a shorter period of time than be forced to spend her existence tethered to her bed or the house moderately sedated or restrained. That’s not a life worth living.The focus in these situations is what the patient’s goals of care are. Sometimes people think that what matters most is having more days, and they’ll try to do literally anything and everything to avoid death, no matter the consequences. People who have experience in healthcare see the consequences of those choices and understand the meaning of futile measures, and so they don’t choose them.