Right Side of the Rainbow

By now, you’ve probably heard about Andrea Clark, a 54 year-old woman from whom St. Luke’s Hospital in Houston reportedly plans to withdraw life support Sunday.

I won’t comment on the specifics of Ms. Clark’s case. Among other things, the facts are unclear. We’ve heard only the family’s side of the story. Since the hospital is barred by statute from disclosing confidential information, we have not heard its side of the story. But I will make two general observations.

First, if bloggers and their readers want to use medical terminology, that’s fine. But as an RN, I wish they’d make an effort to understand it and use it with precision.

For example, it’s superfluous in this kind of case to insist that the patient isn’t brain dead. Of course the patient isn’t brain dead. No hospital refers the case of a brain dead patient to an ethics committee, and for good reason: if the patient is brain dead, the patient is dead. Brain death is the very definition of death.

Secondly, while it’s legitimate to point out when a hospital’s actions are inconsistent with the wishes of the patient or of the patient’s family, that fact doesn’t answer this question: “Is continued treatment medically futile?” The answer to that question requires medical judgment, not familial preference. In my experience, patients and their families often ask for things that are medically inappropriate. For instance, it’s not uncommon to hear a patient ask for antibiotics to treat a common cold. But a cold is caused by a virus and antibiotics only work against bacteria. Accordingly, a responsible physician will decline the patient’s request. (The promiscuous use of antibiotics has played a critical role in the emergence of drug-resistant “super bugs.”)

If you’d care to read the Texas Advance Directives Act (also known as the Texas Futile Care Law), the full text is here. This Act immunizes Texas hospitals from criminal and civil liability when, after following the required procedures, they withdraw treatment in cases deemed medically futile. The Act was passed unanimously by both houses of the Texas Legislature and signed into law by then-Governor George W. Bush.