Responding to Requests for Ventilator Removal From Patients With Quadriplegia

West J Med, 1991 · DOI: · Published: May 1, 1991

Simple Explanation

Requests for ventilator removal by patients with quadriplegia have become more frequent. It can become difficult for health care professionals to discriminate between requests that reflect a reactive depression and those that represent the existential decision of a competent adult person. Responding to requests for ventilator removal by discussing the common occurrence of death wishes can be helpful and can reassure a despondent patient.

Study Duration

Not specified

Participants

30 patients with high quadriplegia using ventilators

Evidence Level

Not specified

Key Findings

1
There is a distinction between suicidal ideation and a thoughtful choice to discontinue life-sustaining treatment.
2
Competent patients with unremediable conditions requiring ventilator use have the legal right to be removed from ventilators.
3
Respecting patients' autonomy and right to refuse treatment can have therapeutic value.

Research Summary

Requests for ventilator removal by patients with quadriplegia who require ventilator use have become more frequent. The first consideration before formulating a response to such a request is determining whether the patient is expressing suicidal ideation or has made a thoughtful choice to discontinue life-sustaining treatment. There is therapeutic value in respecting patients' autonomy and right to refuse treatment as an initial response to requests for ventilator removal by patients with ventilator-dependent quadriplegia.

Practical Implications

Legal Counsel

Patients should obtain independent legal counsel to understand their rights.

Peer Support

Patients should meet with peers who have similar conditions and are living successfully with a ventilator.

Psychological Evaluation

Patients should participate in independent psychological evaluations to establish competency.

Study Limitations

1
The origins for these feelings may be unique to each person's attitudes, values, and previous life experiences
2
Health care professionals may have appropriate concerns that a patient's decision is a result of temporary reactive depression.
3
Patients with strongly expressed desires to withdraw mechanical ventilation may have a high probability of dying regardless of what action is taken by professionals.

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