Posted on 03/19/2005 7:19:45 PM PST by ambrose
March 8, 2005, 12:33AM
Hospitals can end life support Decision hinges on patient's ability to pay, prognosis
By LEIGH HOPPER
Copyright 2005 Houston Chronicle
A patient's inability to pay for medical care combined with a prognosis that renders further care futile are two reasons a hospital might suggest cutting off life support, the chief medical officer at St. Luke's Episcopal Hospital said Monday.
Dr. David Pate's comments came as the family of Spiro Nikolouzos fights to keep St. Luke's from turning off the ventilator and artificial feedings keeping the 68-year-old grandfather alive.
St. Luke's notified Jannette Nikolouzos in a March 1 letter that it would withdraw life-sustaining care of her husband of 34 years in 10 days, which would be Friday. Mario Caba-llero, the attorney representing the family, said he is seeking a two-week extension, at minimum, to give the man more time to improve and to give his family more time to find an alternative facility.
Caballero said he would discuss that issue with hospital attorneys today.
Pate said he could not address Nikolouzos' case specifically because he doesn't have permission from the family but could talk about the situation in general.
"If there is agreement on the part of all the physicians that the patient does have an irreversible, terminal illness," he said, "we're not going to drag this on forever ...
"When the hospital is really correct and the care is futile ... you're not going to find many hospitals or long-term acute care facilities (that) want to take that case," he said. "Any facility that's going to be receiving a patient in that condition ... is going to want to be paid for it, of course."
Patient showed emotion
Caballero said he believes the hospital wants to discontinue care because Nikolouzos' Medicare funding is running out.
Spiro Nikolouzos, a retired electrical engineer for an oil drilling company, has been an invalid since 2001, when he experienced bleeding related to a shunt in his brain. Jannette Nikolouzos, 58, had cared for her husband at their Friendswood home, feeding him via a tube in his stomach. Her husband couldn't speak, she said, but recognized family members and showed emotion.
On Feb. 10, the area around the tube started bleeding, and Nikolouzos rushed her husband to St. Luke's for emergency care. Early the next morning, she said, the hospital called and said he had "coded" and stopped breathing and had to be placed on a ventilator.
A neurologist told her, she said, that he is not brain-dead and the part of the brain that controls breathing is still functioning. Although his eyes were open and fixed when he first was placed on the ventilator, he has started blinking, she said.
A missed opportunity
Dr. Marcia Levetown, director of palliative care at The Methodist Hospital, said moving Nikolouzos to a nursing home or other type of facility may not be an option if his body is dependent on several types of technology, such as mechanical ventilation and kidney dialysis.
Levetown said when families and hospitals take their disagreements to court, it often means the hospital has missed an important opportunity in the family's emotional healing.
Often missing from aggressive medical care is empathy for family members and acknowledgment of grief, she said.
"The acknowledgment of 'You clearly love your husband very much. You've done the good fight' " makes a difference, she said. Levetown also tells families, "Whatever might be beneficial, you've made sure he's gotten that. We all wish he could get better ... How can we best honor this man ... as we accompany him in his next journey?"
Law allows removal
State law allows doctors to remove patients from life support if the hospital's ethics committee agrees, but it requires that the hospital give families 10 days to find another facility.
A similar case is still in the courts. Texas Children's Hospital wants to discontinue life support on 5-month-old Sun Hudson, who was diagnosed shortly after birth with a fatal form of dwarfism. His mother, Wanda Hudson, wants her son's care to continue at the hospital.
On Wednesday, a judge will consider whether Harris County Probate Court judge William McCulloch may remain on the Hudson case. Caballero, who represents Wanda Hudson, filed a motion that McCulloch remove himself from the case after making what Caballero said were biased statements.
leigh.hopper@chron.com
When you get down into the details, and with real faith and trust in God, these cases really aren't as complicated as people and the media would like to make them out to be. To demand that others care for my loved ones with their resources is wrong. When my loved ones are at that point, it will be MY cross to bear, and with God's help, I will pick it up and carry it. I will feed and bathe and turn them, and make sure that they have every medication that could help, most particularly pain medication. I will do all of these simple, ordinary nursing tasks that people have done for others since time immemorial. But, where there is no reasonable hope of recovery, I think the use of extraordinary life-extending measures is selfish and wrong. So, one gets second and third and if necessary, even more opinions. And, one prays and asks for guidance. It really isn't hard.
For the record, everyone in my family dies at home of one or more of the diseases of old age. They have what is necessary-- maybe a hospital bed, intravenous feeding, and professional help in nursing if necessary. All of this is reasonable and right. They are surrounded by loving family. And, they get the pain medication that they need, unless they refuse it. They trust in God, so they are not afraid, and they use the time at the end to say goodbye and to prepare for Him. Then, God decides when the time is right, and He takes them home. I want to go the same way.
I do want to point out that many, many people makes these decisions properly, and do the right thing, even though they do not believe in God. But, He knows them, His laws are written on their hearts, and they follow Christ without knowing it.
Creating more sources with whose funds? All the tax cutters on here should scream. Buy your own health insurance and cap out at X$.
We are speaking the same thing, albeit from opposite sides of the coin.
I do have health insurance my dear as do most people.
If there is a lack of care then we need to build more hospitals rather then resorting to primitive practices. It seems that you hold some lives to be of more value then others. That is a very slippery slope you are standing on. Careful you don't fall.
I don't have any health insurance. What are "primitive practices?"
All lives are equal. There comes a point of usefulness, and I am sorry to say it, but where should the resources go? Someone laid up forever in a hospital bed be they 6 or 60 or someone who needs a leg up when they are 25 or 30 with two kids in tow?
I'd go with the latter.
That is what you are proposing. At one time we did it for the sake of our survival as a whole. To do it when there is abundance is just sick.
If we lack resources then we should make more. You seem to think it is some sort of zero sum game. It is not. There is plenty and more can be made as needed.
Your denying someone treatment will not heroically provide treatment for others, it just will deny someone treatment. Lying to yourself about "hard choices" will not change it.
What you are proposing in Socialism. We should artificially keep alive the sick and the lame?
As much as I loved my grandmother, I wish she had dropped dead in her kitchen from her stroke, as had her sister, rather than endured the foolish "heroic messures" that only made her children feel more important.
What heroic measures were taken that your grandmother did not want, and why were they done? Were neither you nor your mother asked to consent?
What heroic measures were taken that your grandmother did not want, and why were they done? Were neither you nor your mother asked to consent?
My uncle took it upon himself to have grandma have brain surgery following her stroke. She thought my child was her child (they have the same name), she fell out of a chair and blacked her eye, etc.
My mother was too far away and I was in Pennsylvania (Grandma was in California.)
This is NOT just about Terri.
I'm sorry. These sorts of things are made much more difficult by the geographical separation of families, and by the inability of families to agree upon the proper course of action.
I propose that we just make more bandages rather then acting like drama queens and engaging in "hard choices" that are totally unnecessary.
We should artificially keep alive the sick and the lame?
As opposed to sticking them on a ice flow for the polar bears?
that only made her children feel more important.
And that is why you want to force "hard choices" on everybody else? To make yourself feel important?
Stop with the drama queen bit. It cuts no ice with me.
Hospitals are agents of the State and share the sovereign power.
Wow. 75 posts and no one has mentioned that the law referenced in the article was signed by Governor George W. Bush?
#74 did, but he went "bye bye".
Did he say something else, or was that all that was required for the zot?
He signed up today to make that comment. Most likely a troll.
That being said, it is a bit odd that we haven't heard anyone saying that Texas law on this matter promotes a culture of death.
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