Are Doctors Pulling the Plug on Brain Injuries Too Soon?

Are Doctors Pulling the Plug on Brain Injuries Too Soon

A new study shows that doctors should exercise extreme caution when deciding to end life support for individuals who have suffered severe brain injuries. Researchers warn that withdrawing life support on patients who are not ready may result in unnecessary deaths. Because brain injury outcomes vary widely, doctors may be causing the unnecessary death of patients who might otherwise recover and regain consciousness.

The Canadian Study

In six level-one trauma centers in Ontario, Alberta and Quebec, Canada, scientists studied 720 individuals older than 16 who suffered traumatic brain injuries. They found that the overall death rate of patients was about one-third, yet the rate fluctuated widely between 11 and 44 percent.

The average number of deaths, 70 percent, occurred because doctors removed life-sustaining equipment. About 46 percent of these deaths occurred within the first three days after ending life support, while 64 percent occurred within the first three days of the patient’s admission into the intensive care unit. Researchers believe the difference in decision outcomes comes from a lack of standard protocols for doctors to follow. Many of those patients could have lived if doctors had evaluated patients more carefully.

Three days may not be enough time for a doctor to make an accurate assessment of the patient’s condition, nor may it be enough time to find out if the patients support the doctors’ decisions. While no one can expect a doctor to make correct decisions all the time, the great variance in opinions among doctors suggests many may be erring in judgment.

Locked In Syndrome Leaves Patients Unable to Communicate

Life and death decisions are always painful. In the case of traumatic brain injury, patients may not want life support removed but have no way to communicate that information. The case of Richard Rudd demonstrates this point dramatically.

Rudd lay comatose in a British intensive care unit after a motorcycle accident. Having seen a friend become paralyzed in the past, he told his parents he would never want to live that way. When his parents talked to doctors about ending life support, they thought they were doing the best to follow their son’s wishes.

When doctors began discussing the decision in Rudd’s presence, he began to blink furiously. Doctors worked to communicate with Rudd and found he was indeed speaking with his eyes. Rudd repeatedly demonstrated his wish to stay on life support. Rudd was not in a vegetative state, but suffering from “locked in” syndrome, in which patients are fully aware but unable to communicate. Today, Rudd has recovered some facial function and neck movement, but requires a ventilator to keep him breathing. Outcomes like this underscore the need for doctors to use great care in deciding to end life support.

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