The Medical Ethicist: Always on Call

July 12, 2013

What happens when a patient lies unconscious in a hospital bed, kept breathing by a life support machine, and even though he is expected to recover, his family directs the hospital to pull the plug?

Call in the medical ethicist.

Ashwaq Masoodi's fascinating and harrowing article in TheAtlantic.com last week offers a window into the challenges faced by those who have the unique responsibility of handling ethical dilemmas in hospitals.

prager-profile

At the outset of Masoodi's story, Dr. Kenneth Prager, a pulmonologist and medical ethicist who has worked at NewYork-Presbyterian Hospital/Columbia University Medical Center since the 1960s, receives a call from a doctor at another hospital who tells him there's a family who wants to take a 36-year-old loved one off life support because he will need multiple amputations. The family believes that because the patient worked as a bricklayer, his life would be worthless without his hands. Masoodi writes:

Prager, director of Clinical Ethics and Chair of the Medical Ethics Committee, was uncomfortable with their decision. He has been involved with the medical ethics committee at the New York Presbyterian hospital since its inception in 1992 and is called for ethics consultations around 150 to 200 times per year. Brown's case was one of the few unusually complex cases he encountered.

"If there is any doubt about what the patient would want, it would seem appropriate to err on the side of life. Wrongful death is a greater injustice than wrongful life," said Prager.

As the story continues, the complex world of medical ethics unfolds:

Prager thought even though it was an accepted practice to rely on families for making decisions of an incapacitated patient's care, he did not think it was right to let Brown die. He told Williams that as long as Brown's brain was not severely damaged, he could live.

He said had he been on the ethics committee, he would have stressed that this was an unprecedented type of case and no one knew of Brown's wishes. "He (Brown) could have never have envisaged this. I don't know how the relatives could possibly know what he would have wanted," said Prager.

Read the rest of the article to find out what happens to Brown. It's a gripping read, and the story will have you wondering—at the end—whether you should, as the title states, "Make Your Wishes Known."

[The Atlantic]

Tags

Ethics, Life support, Medical ethics