Pulling the Plug

A recent court case caught my attention. At the sentencing, the mother of the perpetrator said that her son, who beat and shot the girl, wasn’t responsible for her death because the family “pulled the plug.” She claimed it was their fault their daughter died.

I was appalled by her words. Not only was it cruel for her to claim that Mary died because her family “pulled the plug on her” but it was scientifically incorrect. Mary was dead before “life support” was withdrawn. The actions of the criminal and his cohort caused her death.

As a health care professional, I have seen families anguish and suffer over “pulling the plug.” Part of it is the fault of the language we use. I would like to see everyone stop using terms like “withdrawing life support” and “pulling the plug” as the phrases are not accurate. Many families believe they are killing their loved ones when the machines and medications are stopped, but they aren’t because there is no brain activity prior to removing the ventilator.

It is customary to perform tests such as EEGs to check brainwaves and apnea tests to check for breathing before removing any machines. Some of these tests are required to be done more than once before considering removal of the ventilator and other interventions. “Life support” is a misnomer when there is no brain activity. All the machines are doing is circulating blood through the dead body.

It’s confusing because, why would we use a machine to keep a body’s circulation and oxygenation going? Because first we need to verify that the person is truly deceased.

A victim of a gun shot or a head injury or an automobile accident comes into the Emergency Department. At that point, the patient’s status is unclear. They have been resuscitated and tests such as CT scans and MRIs are done to assess the injury. It isn’t until later that a clearer picture becomes apparent and the patient is failing or has never responded. No matter how hard the medical team works, the patient will never recover. The brain damage is too severe. At this point, the machines are keeping the circulation and oxygen going through the body so the heart and other organs are still functional. But the brain is dead. The family may be approached at this time regarding organ donation. The medical team gives the family time to absorb the inevitable. The family starts to grieve and make some decisions.

It’s not the family who killed the patient. It’s the gunshot wound, the head injury, the massive destruction of the car accident, or the criminal behavior of others that killed the patient. Families should not feel guilty about the decision to remove the ventilator and discontinue the high powered IV drugs that are oxygenating the body and maintaining the blood pressure and circulation.

It would save a lot of people, who are already grieving, the added guilt feelings and additional anguish if we changed the terminology to what it actually is–organ support.