Who Has the Right To Pull the Plug?

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Laila El Baradei
December 2, 2022

Governments make decisions and those decisions are expressed in policies, laws and regulations. Now, when there is a terminally ill patient with a minimal chance of recovery, who has the right to pull the plug? The decision is quite ethically charged, complicated and ultimately, there may not be one right answer. Moreover, regulations differ from one country to another.

Deciding to pull the plug may be the hardest decision a family ever has to make. In some situations, despite the failing health situation of their loved one, family members find it very hard to deliberately put an end to his/her life. In other instances, it may be the contrary. There have been cases reported in the United States in which families have sued the hospital to force them to remove life support, with the argument that they want to put an end to the suffering of their loved one and that he/she would never have wanted to live in a vegetative condition relying on machines.

After examining what was written about the subject, some gawking facts were revealed. Some say that it differs, even within a same hospital in the United States, how and when the decision is made. It seems that concrete scientific evidence does not always exist to say when we should pull the plug. Mostly it comes down to a decision based on consultation between a hospital committee and family members. The problem is a person may be alive, with functioning brain cells, but with no hope for getting well, and with little hope of being capable of surviving without life support. Your brain may still be working but you are in a coma!

In some countries, like Egypt, the situation is somewhat blurry. Hospitals and the medical staff do all that they can to try to maintain the lives of their terminally ill patients in the Intensive Care Unit (ICU). However, at specific points in time, they may go back to the sick person’s family to consult about the next steps. For example, although they may not ask before they use a ventilator, they may go back and seek approval before starting dialysis in the case of kidney failure. Not doing dialysis for a terminally ill patient means death. So why is there a choice in some aspects of treatment, and no choice in other aspects?

In Switzerland, the government allows for mercy killing—Euthanasia. This means that individuals suffering from incurable and possibly painful diseases have a say in whether or not they wish to receive assistance from healthcare facilities that will help them end their lives painlessly. We have all watched sad movies where the protagonist decides for himself/herself to go through mercy killing and travels to Switzerland to have it implemented. It turns out that this happens not only in Switzerland but also in Belgium, Holland, Luxembourg and in Oregon, and Washington states in the United States.

There are multiple complicated dimensions related to the ‘pulling the plug’ decision:

• For the family members, aside from the grief, sadness, anxiety and guilt, there are also the financial costs. If you do not have medical insurance, having a person admitted and treated at the ICU in a private hospital, for example in Egypt, is very expensive. Cases of family members remaining in a coma and hospitalized for more than a year are frequent. Eventually, the sick person passes away and the responsible family members find themselves in debt.
• For hospitals, it is a lot of work around the clock to try to maintain the life of an ICU in-patient. If it is the government’s money being used in a public hospital there is always the question of whether there should be priorities/triage, and whether in allocating scarce resources, preference should be given to those who have a higher chance of survival.
• There is also an ethical dimension. Many clergymen call for the continued provision of treatment to the sick regardless of the chance of their survival and regardless of the cost, even if the family of the ill person goes bankrupt.
• The Medical Opinion: Is there a consensus on what death means? There are very lengthy discussions about what death means and how it can be defined. However, with today’s advancements in science and technology, the consensus seems to be that it is the death of the brain cells that makes up the most definitive criterion for “death”.

Conclusion

Perhaps we need to decide early on, while we are still fit, and while our brain cells are still functioning, whether we would want to continue living—God forbid—in a vegetative condition relying on ventilators and other equipment. Perhaps we should inform our close ones what our preferences are. We have to know that public policies are not the same worldwide and it is not always up to us to decide, even with our brains still intact. And if we want to be well cared for, hold on to life dearly and want healthcare providers not to give up on us easily, in all cases, we need medical insurance to cover us during those tough last days. 

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Author: Laila El Baradei, Ph.D. is a Professor of Public Administration at the American University in Cairo, Egypt. She is a regular contributor to PA Times Online. Email: [email protected] Twitter: @Egyptianwoman

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