Should Removal of Mechanical Life Support Machine at the Request of a Patient be Considered Killing or Letting the Patient Die?

All physicians, nurses and other health care workers have felt unease at some time about "pulling the plug." Is such termination of life supporting euthanasia or simply allowing nature to take its course? In "Why Does Removing Machines Count as Passive Euthanasia?" (Hastings Center Report, Vol. 27, No. 3, pp. 28-37, May-June 1997), Patrick D. Hopkins argues that the removal of a machine which substitutes for a failed vital organ is equivalent to removing that life-sustaining organ. The resulting death is caused not by some natural course of the illness but by the fact that the organ function (the machine itself, which substituted for that organ) was removed. And who removed it? The health care worker at the request of the patient or surrogate. This then represents active euthanasia. Yet if removal of life-support is an accepted ethical and legal process in terminally ill patients, why not accept assisted suicide of a terminally ill patient who happens not to have a single failing organ that has been replaced by a machine? In Hopkins' words: "[M]uch of the ethical discourse on euthanasia smacks of moral timidity. So I conclude this paper with a call for responsibility--not a call to take new responsibility, but a call to acknowledge that we are already responsible. Our moral practices already allow us to kill patients in hopeless and painful situations, as well they should. It is a good kind of killing. But now we need to set aside our prejudices against the artificial and set aside our myths of the natural death and extend the option of good killing to those trapped by nature."

Where do you come out: is the distinction between "letting die" and "killing"--accepted by many physicians, ethicists, and courts, including the U.S. Supreme Court--correct, or is it merely an attempt to avoid acknowledging an uncomfortable reality, that "pulling the plug" has more in common with cutting out a vital organ than with letting nature take its course?

Here is the question:

Does the death following physician removal of a life-support machine at the request of the patient represent killing the patient or letting the patient die from their underlying illness?

If you have an answer (or another question), click HERE and e-mail me a response.
Date: Sun, Jun 13, 2004 7:51 PM From: ECarrico03@aol.com To: DoktorMo@aol.com

Let common sense prevail......death is not the worse that can happen.......I see elderly nursing home patients come thru the ER and intubated.....they have been nonresponsive, contracted, stage 4 decubiti for years. There is no dignity being on life support at that stage of life. Evelyn

Date: Wed, Apr 14, 2004 5:04 PM From: lslab3@email.uophx.edu To: DoktorMo@aol.com

I personally feel that if death is a given sentence, the person will die with or with out life support over time. If the diagnoses is terminal and there is no hope for a normal productive life then removing life support should not be an issue because it allows the person to die with dignity. LINDA SLABAUGH

Date: Fri, Dec 5, 2003 10:21 PM From: dardzin@rochester.rr.com To: DoktorMo@aol.com

Hello DoktorMo, The Doctor is the pro and their job is to Save Lives Only..........They know that by pulling the plug that person will be killed...........Even if the person says to do it and let them die, the Doctors job is to Save That Human Life and they can not be the plug puller...........The bucks got to stop here with the Doctor, and if they can't protect that human life with all the gusto they have no matter what, they should get out of the business................Very interesting website......SteveD

Date: Sun, Nov 9, 2003 10:28 AM From: zpool@creighton.edu To: DoktorMo@aol.com

Hi Doktor Mo, I have just thrashed this out in a pharmacy ethics class. And the professor made it clear that when you deal with euthanasia issues it's better to leave your personal beliefs out of the scenario. But many of the students found that is hard to do and the message board turned very heated!

I personally believe that there is no distinction. I feel that ending a life is killing even with the best of intents (as being sanctioned by patient and patient's family). But as a pharmacy student and having learned the ideas of autonomy and the living will and informed consent (with all the alternatives, risks, and consequences) I feel that as a professional one has to but aside spritual/moral/and personal bias against a procedure and respect a competent person's voluntary decision. Of course there are cases where there is no living will, the person is no longer competent and then 'pulling the plug' seems very hard.

Obviously the Terri Schiavo case is a combinatiion of these factors. Here is a case where there is nothing in writing and the patient is no longer able to make that decision. But there's a supposed decision she made earlier orally in casual conversation with her husband that she would not like to be artificially kept alive. Well, her husband wanted to cut life support but her family didn't. And he got a court order to cut life support and the governor stepped in to stop it. This kind of case obviously tears people apart on the issue. Do you respect/trust the husband's desire to fulfill his wife's supposed choice that can't be verified or do you side with the family? Obviously the governor sided with the family. Does government stepping in represent a needed interevention to protect life or was this an example of government rearing its ugly head in a realm where it didn't belong? Another good topic of discussion.

Date: Fri, Oct 10, 2003 1:33 PM From: heajones@cox.net To: DoktorMo@aol.com

It's a question of what does it mean to have an advance directive or a living will. If it is in the patiens wishes that they not be kept alive without certain qualities of life then this should be respected. If it is not respected, that is another ethical issue. "pulling the plug" is in not anyway killing the patient when that have expressed the wishes to not be kept alive in such a case. It is simply respecting the wishes of the patient.

Date: Thu, Sep 25, 2003 6:51 PM From: ksrncnn@earthlink.net To: DoktorMo@aol.com

I feel it represents letting the patient die, or letting him go. If they are terminal and there is no hope, we should let them go with dignity. Especially if it is there wishes not to be kept alive. Why is it, that we do not want to see our animals suffer and have them put down and ease their suffering, but we will not do the same for our own? I am sure that each of us would not want to be kept alive, with no quality of life.

Kathy Sims

Date: Wed, Jun 4, 2003 2:43 PM From: Meganterryhansen@aol.com To: DoktorMo@aol.com

Taking a patient off a life support machine at his or her request is granting the patient his or her wish. As long as the patient is competent to make a sound decision I believe his or her request must be granted so that patient autonomy is allowed.

megan hansen, salem state college, massachusetts

Date: Mon, Jun 2, 2003 6:52 PM From: Pstokeslpn@aol.com To: DoktorMo@aol.com

I think if you consider a patient that is unfortunately with a terminal illness and has obviously come to terms with this, it is the responsibility of the medical staff to indeed carry out the patients wishes. That is why we address such topics with our patients. "In the event of'" is hopeful reviewed with the patient and includes accurate information. This is necessary for the patient to make an informed decision. With all of these issues considered, why would anyone second guess the patients decision.

Patti S

Date: Tue, Apr 8, 2003 6:13 PM From: Seni4u@aol.com To: DoktorMo@aol.com

First of all let me tell you how great I think you website is! I am attending the RN program and was given the address by one of our instructors from Coastal Georgia Community College as part of our studies.

As to the ethical question of 'Killing Vs Letting Die' : In my opinion, I would not consider helping a patient to die killing him/her. If the patient is of sound mind and requests to be taken off of life supporting machines then I would consider that my duty to do so. I also do not consider a machine as being the same as a vital organ and therefore I would see it as taking away a "life-sustaining organ." To me I would consider this patient request as important and binding as an "DNR" request made by a patient.

I know that there are a lot of other opinions out there and I am very much interested to find out more about this subject!

Sincerely, Ines Byers, Registered Nurse Student

Date: Sun, Apr 6, 2003 5:18 PM From: laplanko@tds.net To: DoktorMo@aol.com

I am a nursing student at CGCC. I try to keep an open mind to what others believe. I believe that this decision depends on the situation and what a person's beliefs are. My sister-in-law was on life support when she had staph infection in her blood stream and it severely damaged her heart. My brother had to make a very hard decision. Physicians were saying that she was not going to recover and he needed to decide whether or not to take his wife off of life support. My brother decided not to take her off and a few months later she had open heart surgery and a few years later she is just as healthy as a person could hope to be. Knowing what we know now, if my brother had made the decision to take her off he would have been responsible for her death. This decision is a hard one and I believe as a nurse my job is to support the family in the decision they need to make, and educate them on all the possible outcomes. It is important that they are making the decision with the best interest of the patient in mind and not there own wishes and desires, this is probably the hardest part.

Date: Sun, Mar 30, 2003 12:50 PM From: AmAz0n848@aol.com To: DoktorMo@aol.com

Does the death following physician removal of a life-support machine at the request of the patient represent killing the patient or letting the patient die from their underlying illness?

The controversy surrounding the topic of passive euthanasia, the removal of the medical means keeping a patient alive, has been heatedly debated since as long ago as the 6th century B.C. The world’s most prominent philosophical schools of thought, including those of Pythagoras, Aristotle, and Hippocrates, have all presented rationales as to why or why not this form of death should be morally and legally permissible.

In Greek the term euthanasia means “a good death,” and many Greek physicians believed that passive euthanasia techniques similar to our modern concept of “pulling the plug” should be used to relieve pain and suffering. Other Greek physicians and followers of the Hippocratic school of thought, however, adopted the absolutist view in prohibiting any form euthanasia. They believed that a physician should at least do their patient no harm if he could not be healed, and on these grounds they condemned euthanasia of any form as murder. Pythagoreans also deemed such a form of passive euthanasia as murder because they believed that such an act would prematurely end the soul’s time in the body. In accordance with their theory of transmigration of souls, this would cause the soul to be placed in a lower life form in its next cyclical reincarnation. This would be an unacceptable punishment since the ultimate goal of the soul was to reach divine personal immortality through multiple reincarnations. Followers of Aristotle’s philosophical school of thought, on the other hand, would have viewed this scenario as letting the patient die from his or her underlying illness. This form of passive euthanasia, especially since it was at the request of the patient, would have been not only acceptable but commendable since Aristotle believed that death should be faced with courage rather than cowardice. He also believed that a citizen’s main purpose in life was to perform a duty that benefited the state as a whole. Therefore, if a citizen was terminally ill or unable to function efficiently, he or she would be viewed as an unnecessary strain on the state’s resources and would be allowed to die from the underlying illness.

By examining the ideologies of Pythagorean, Hippocratic, and Aristotelian schools of thought concerning passive euthanasia, it can be seen how controversial this topic has been for centuries. I personally believe that “pulling the plug” should be viewed as letting the patient die from his or her underlying illness, but I believe that individual responses to this topic vary greatly according to each person’s views on spirituality and their moral principles in regard to the respect for life ethic.

Date: Wed, Mar 26, 2003 1:54 AM From: shew@mailbox.sc.edu To: DoktorMo@aol.com

Does the death following physician removal of a life-support machine at the request of the patient represent killing the patient or letting the patient die from their underlying illness?

This distinction between killing someone and letting them die when they are on life support makes me think about the way ancient parents would allow for infanticide. Infanticide was usually done by leaving the baby out, exposing the infant to the elements, which amounts to "letting them die" - a passive death, rather than an active one where a parent would actually murder their infant. This was socially permissible at the time. The way infanticide was done can be easily likened to the death following physician removal of a life-support machine. In the case of ancient infanticide, the parents make the decision to allow the baby's death, which is like the case of removal of life support in that it is often the case that family members of the patient are making the decision. Furthermore, neither an infant nor a patient on life support can ask to be "allowed to die" or object to it at the time when the decision is actually made. Ancient reasons for infanticide and reasons for the removal of life support machines even follow similar logic - both are based in thoughts of economics and convenience, and both can be used to rid society of defective or damaged individuals.

Today, we think of infanticide as morally repugnant, but we allow for the removal of life support. However, these two concepts follow the same logic and share the same distinction of "killing" versus "letting the infant/patient die." This "killing" versus "letting die" rhetoric is contrived to ease the minds of the parties involved.

Date: Tue, Mar 4, 2003 9:12 AM From: achung@kumc.edu To: DoktorMo@aol.com

Should Removal of Mechanical Life Support Machine at the Request of a Patient be Considered Killing or Letting the Patient Die?

I am a Respiratory Therapy Student and during my clinical experiences at different hospitals, there have been situations when patients have been extubated and taken off of the ventilator to die. Everyone has there own opinions and feelings about this particular situation. I believe that this is "letting a patient die", as opposed to "killing a patient", especially if the family agrees or suggests this, and the patient's condition is worsening rather than improving. There has to be a time when it is realized that a patient is not getting any better after several days of support. The suffering of the patient nor the family should be extended when there is no hope. I believe that it is normal for everyone who participates in letting a patient die to feel bad, even though they may believe what they are doing is right. This is just the conscience and natural reaction of a normal human being.

Date: Mon, Mar 3, 2003 11:34 AM From: a_dogg@sbcglobal.net To: DoktorMo@aol.com

I am a student at KUMC, and a neonatal respiratory therapist by trade.I deal with the ethical issue of withdrawling support frequently, but from a slightly different perspective. My patients are generally preterm infants of less than or equal to 23 weeks gestation. We say that we can save them at that age but it is truly interfering with an inevitable course. My patients cannot really request to be removed from the ventilator, but they do continue to do poorly and by the fact that increasingly more drugs are used to stabalize them , they in their own way telling us the are not compatable with life.The parents in many cases want us to do everything , but what do you do when everything has been done? In their own selfish minds they are doing what is right to them ,but very wrong in my eyes. I do not consider this killing of the baby, it is truly giving them peace.

Date: Sun, Feb 23, 2003 6:51 PM From: greg.clark3@sympatico.ca To: DoktorMo@aol.com

I think there is a difference between life support and life assistance..and too many people think that vents, and medicine mean life support. If you needed a cast to mend a broken leg you would not hesitate but as soon as people see the machines it seems to create a different reaction. My Dad very recently passed away due to pneumonia and lung cancer. Before we found out about the cancer my mother battled with the fact that he never wanted to be on life support and wondered if she was going against his wishes. I believe life assistance is necessary in order to carry that person into a time they can once again support their own life. We did remove him from the machines shortly after we found about the cancer because he would never come back from the state he was in. People need to know more about their case, and research. My parents generation only seen medical issues in black or white. Either you are dying or you are not..and sometimes in these situations there are many areas of grey. Do I regret our decision. No. Do I wish I could have my Dad back?? With every heartbeat...but not to come back to suffer some more.

Date: Thu, Jan 23, 2003 4:03 AM From: kevin_teow99@cults-academy.aberdeen.sch.uk To: DoktorMo@aol.com

If people want to die than it should be their choice. If they can't make the choice then, they should try to be kept alive for they should live life to the fullest. Life is precious and should be worshipped.

Date: Thu, Jan 23, 2003 3:03 AM From: andrew_begg99@cults-academy.aberdeen.sch.uk To: DoktorMo@aol.com

let them pull the plug because they take up space.

Date: Sat, Nov 2, 2002 7:39 PM From: bhiltz@mnsi.net To: DoktorMo@aol.com

Someone said that no one seemed to have any regrets about terminating life-support of a loved one. My thought on that is that maybe if someone did regret such a thing they would not want to publicize it.

Date: Thu, Oct 31, 2002 3:05 PM From: winstonjen@yahoo.com To: DoktorMo@aol.com

In Australia, and in most developed countries, if you witness a murder and do nothing to stop it, you can get charged with murder. Basically, the reasoning is that if you don't do anything to save the person, then you are just as bad as the murderer. It should also apply to pulling the plug on a patient that needs the machine to live - UNLESS the doctor has the consent of the patient (or the family in the case of an incompetent patient). The 'letting die' distinction is a mere tool for doctors to avoid responsibility and ease their conscience.

Sincerely, Winston

Date: Wed, Mar 6, 2002 5:27 PM From: bionicredneck776@msn.com To: DoktorMo@aol.com

It's a tough question to answer. It depends on the outcome.but my family never had the chance to talk it over. My grandpa was put on life support around midnight and about 5am my mother and 2 uncles decided to go home and get their blood pressure pills and other needed medicine. That left my aunt still at the hospital. we had only been home for maybe an hour or so when the phone rang. A cousin informed us my aunt had him unplugged . Needless to say my mother and her 2 brothers was very angry with her decision with out their consent. My answer is you only live once on earth live it to the fullest. And make sure all family members agree not just one make a decision. Thank you for your time.

Date: Wed, Feb 27, 2002 9:44 PM From: Kyra201970@cs.com To: DoktorMo@aol.com

Hello, I just read your articles on "letting them die." I agree with ALL of the comments and am surprised to note that they all agreed that letting them die is the best alternative. I let my father die 2 years ago not one time have I really wondered if I did the right thing. I know in my heart he would never of wanted to even be hooked up in the first place. One year ago this softball season (Im a coach) I lost a great friend and colleague do to complecations of a terrible car accident. He was on full ventilation and all hook ups. It was very scary to see him like that. For one he was not fully comatose he responded to much of what went on in the room. His family I don't beleive would have ever let him die. He did not give them the chance to go through all that hell, he died on his own. Taking the responsibility out of their hands made the decision obviously easier to deal with. Thank you for such a great site.

Franki Finch

Date: Sat, Mar 3, 2001 3:39 PM From: kpgiggles@hotmail.com To: DoktorMo@aol.com

I am a student at mizzou and we are studying moral and ethical discussion making in health care and how values of our own effects these. In regards to this question, I don't know if my answer is right or not, but I feel that if you are only "alive" by a machine, then how can you really be living. If you can not function on your own then you are not living. If a person is brain dead, they are not capable of breathing and living on their own. This is just to make a family feel as though their loved one is still there, just satisfying one of their own selffish needs. If they need machines to keep him/her alive, they do not need to be "living."

Date: Sun, Jan 21, 2001 7:27 PM From: BDahl201@aol.com To: DoktorMo@aol.com

I personally think there is no problem with pulling the plug on the life support machine. But there has to some kind of time limit with it. I say if they hae been on the life support for more then 3 years I think they should pull the plug.

Date: Tue, Nov 28, 2000 6:05 AM From: cleo815m@hotmail.com To: DoktorMo@aol.com

I believe that removing a life-support machine from a patients is letting the person die from thier underlying illness. I also believe that the doctor who removed the machine is shorting the patients life which does not need to be done. This is a very tough question that needs much more thinking but I came up with the answer that removing the machine is wrong.

Date: Mon, Oct 9, 2000 9:40 PM From: MARISSA-SPARKS@OUHSC.EDU To: DoktorMo@aol.com

I feel very strongly about this topic. I have worked in a critical care unit and watched patients lay for weeks on end on a ventilator. If the ventilator or the medication drips were to be removed the patient would more that likely not live much longer. I do think however that sometimes patients lose that sense of hope and would say that they want to die. I think that each case is individual, you might have a patient that is absolutely coherent, just depressed and perhaps their wishes should not be met until further evaluation of the true status of their health, but you also have those patients that have been in semi comatose and are unresponsive to pain, pupils do not respond... that should be taken off if it was their wishes at the beginning. In Oklahoma, where I live, once a patient is on a vent, they cant come off until that can breath on their own, unless they die. Even if they are a DNR, it is a sad case.

Marissa D Sparks

Date: Wed, Jan 12, 2000 5:57 PM From: duck007@netzero.net To: DoktorMo@aol.com

My mother "died" in 1983. I was 24 at the time , and had the unique expierence of living with an alcholic all of my life (that person being my mom). She was not a violent, mean, or vindictive person, she was full of love and emotion, which I'm sure was inhanced by her alcohol consumption. In her 41st. year she was diagnosed with a nodual cancer on her neck. At that time she had been sober for almost a year,well that news ended that sobriety. Enough about the booze...After a cpl. of years of chemo and other treatments she had a stroke, not responding to any p.t. in the 2nd. wk. of her hospitalization her b.p. plumated,we (her kids) were called up to the hospitol and asked if they should "hook her up" the three of us said "no" almost in unison it was a tough decison but one that was alarmingly evident. She "stayed on" for 71/2 hrs. and died@1a.m. the following morning. I or my siblings have never regreted our decison. If we had hooked her up? A flat of cold flesh breathing only with the help of a machine, this I don't believe is what God would have intended, yet, I've been told I "murdered" my mom. To die with dignity, I beleive is an inalienable right that should be up to the individual or that persons most loved caretaker how anyone would promote suffering almost seems evil or sadistic. Thanks for letting me get that said.

Susan in MI.who loves her mom

Date: Wed, Oct 13, 1999 9:23 AM From: naitram2000@hotmail.com To: DoktorMo@aol.com

In the perspective of autonomy, terminating life support of a patient at his/her own will shouldn't be considered killing because this action is approved and consented by the suffering individual.

Date: Wed, Oct 6, 1999 7:59 PM From: AlmdJoy2@aol.com To: DoktorMo@aol.com

I am a senior at Notre Dame High school and just started learning about bioethics. We've been doing essays on what we would want our family to do if we were in a coma--basically drawing up an informal living will. I asked my parents what they would do and they immediatly responded with "We'd never let you die!" and I asked, "Well what if I was going to die anyway?" they said,"There is always hope, you should never give up on a family member." I guess the definition of stopping life support depends on your perspective. I (being the one in the coma) wouldn't want to be a "burden" to my family, economically or emotionally. However, if I was the one making the decisions and it was my mother or father in a coma or in a state of pvs, I don't think I could let them go. I'd be giving up, letting them die, in a sense killing them. I'd feel guilty, awful. I wouldn't actually be killing them because if their ailment was fatal the outcome won't change if they stay on life support, it'd merely delay the inevitable, but in my mind I'd be killing them.

Date: Sun, Sep 19, 1999 9:27 PM From: stk@clnk.com To: DoktorMo@aol.com

I believe that the removal of the a life-support machine at the request of the patient and/or family represents "letting the patient die". Due to the rapid advances in technology, people can survive for many years beyond "normal" means. If there were no way to maintain life by artificial means, most of these patients would already be dead. To maintain autonomy and human dignity, it is important that each patient be aloud the opportunity to die "naturally".

Shari King

Date: Mon, May 31, 1999 4:07 PM From: tracyj@midusa.net To: DoktorMo@aol.com

I believe it is allowing the person the freedom to choose. It is recog nizing that persons autonomy. In euthanasia, the doctor's intention is death, in this case, his intention is the respect of the patient's wishes. Thank you for allowing me to express my opinion.

Sincerely, Cameron Johnston

Date: Wed, Feb 17, 1999 5:09 PM From: RNCFNP99@aol.com To: DoktorMo@aol.com

In my opinion, we are dealing here with the principles of respect for autonomy. Upon the patient's request, he or she has the right to have the removal of the life-support machine only if the patient has been fully informed with the condition. According to the ANA code for nurses, clients have the moral right to determine what will be done with their own person, to be given accurate information necessary for making informed judgments, to be assisted with weighing the benefits and burdens of options in their treatments; to accept, refuse or terminate treatment without coercion. By pulling the plug, one has to question what benefits the patient will have versus the risks. In determining if we have actually killed the patient or just letting go from an underlying disease is a question between beneficence versus nonmaleficence. We also hacve to look at the sanctity of lofe issue versus quality of life issue. According to the ANA code for nurses, we have the moral obligation to alleviate the suffering and the provision of supportive care for the dying. This is a difficult issue to discuss and I know that I have yet to learn a lot to fully understand ethics. Please give me a feedback on my response. Thank you.

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