Ventilation or dignified death for patients with high tetraplegia

British Medical Journal, 1985 · DOI: · Published: December 7, 1985

Spinal Cord Injury Pulmonology Bioethics

Simple Explanation

This study reviews the cases of 37 patients with high tetraplegia who were artificially ventilated to understand their views and those of their families. The study aimed to determine if these patients should be ventilated or allowed to die, considering the burden of care and limited resources. Researchers interviewed patients and their relatives separately to understand their perspectives on ventilation and quality of life.

Study Duration

1968 to 1984

Participants

37 patients with high tetraplegia

Evidence Level

Not specified

Key Findings

1
Most patients who were still alive wanted to be ventilated again if needed, highlighting a will to live despite their condition.
2
Relatives who were glad about the ventilation felt that any life was better than none and family ties were strengthened.
3
Young mothers sometimes regretted the decision to ventilate due to the impact on their own lives and the deprivation experienced by their children.

Research Summary

The study reviewed the case histories of 37 patients with high tetraplegia who were artificially ventilated between 1968 and 1984. Most patients who were still alive expressed a desire to be ventilated again if needed, and many relatives were glad the decision to ventilate had been made. The study highlights the ethical dilemmas surrounding ventilation for patients with high tetraplegia, especially considering the impact on families and resource allocation.

Practical Implications

Patient-Centered Decision Making

Emphasizes the importance of including the patient's and family's perspectives in ventilation decisions, but acknowledges the difficulties due to the complexity of tetraplegia.

Resource Allocation

Highlights the need for discussion on how to allocate scarce resources, balancing the benefits of ventilation for tetraplegic patients with the needs of others.

Comprehensive Support

Stresses the importance of providing total emotional, educational, and physical support to ventilated patients and their families.

Study Limitations

1
The study's outcome could not be predicted based on pre-injury factors, except that patients over 59 fared badly.
2
The study acknowledges that the physician may not fully appreciate the reality of tetraplegia, making it difficult to apply ethical principles appropriately.
3
The study mentions the limited ability to determine different qualities of life when allocating resources.

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