Deciding on Life Support: A Family's Dilemma After Subarachnoid Hemorrhage

Family member suffered a subarachnoid hemorrhage after a car accident and lost consciousness?

Hello, doctor.
My grandfather suffered a subarachnoid hemorrhage due to a car accident.
After the incident, he received emergency care and was intubated, but he has not regained consciousness for over three weeks.
He has been transferred from the intensive care unit to a respiratory care unit for more than six months now, and he remains unresponsive and unable to breathe independently.
During this time, he has experienced several episodes of fever and hypotension, and the doctors have indicated that these could be critical conditions.
It is painful for us to see my grandfather suffer, but we did not discuss any advance directives regarding the withdrawal of life support while he still had consciousness.
Our family is unsure if we can make decisions on his behalf.
I would like to ask the doctor if, at this point (after more than six months), the family can request the hospital to consider extubation.
Additionally, another question is that three weeks after the accident, the hospital suggested that the family consider a tracheostomy, but the doctors could not determine if my grandfather would regain consciousness.
If we had chosen to withdraw life support at that time, would it have been possible to spare my grandfather from six months of suffering?

an, 20~29 year old female. Ask Date: 2022/09/13

Dr. Zhang Junwei reply Neurosurgery

Based on patient rights, patients can discuss requests for extubation with their physician at any time.

Reply Date: 2022/09/13

More Info

Deciding on life support for a loved one, especially after a traumatic event such as a subarachnoid hemorrhage, is an incredibly difficult and emotional process for families. In your grandfather's case, after being in a state of unresponsiveness for over six months, it is understandable that you and your family are grappling with the implications of continuing life support versus considering withdrawal of care.

First, it is important to recognize that the prognosis after a subarachnoid hemorrhage can vary significantly depending on the extent of the bleeding, the patient's overall health, and how quickly treatment was initiated. In many cases, patients may experience a prolonged period of unconsciousness or a minimally conscious state, and the likelihood of recovery can diminish over time. The fact that your grandfather has not regained consciousness after six months is concerning, and it may indicate a poor prognosis for recovery.

Regarding your question about whether the family can request to withdraw life support at this stage, the answer is generally yes. In most healthcare settings, family members can discuss the situation with the medical team and express their wishes regarding the continuation or withdrawal of life support. It is crucial to have a candid conversation with the attending physician about your grandfather's current condition, prognosis, and the potential outcomes of continuing versus withdrawing care. The medical team can provide guidance based on their clinical experience and the specifics of your grandfather's case.

If your family decides to pursue the option of withdrawing life support, it is essential to approach this decision with compassion and understanding. Many families find it helpful to involve palliative care specialists, who can provide support not only for the patient but also for the family during this challenging time. Palliative care focuses on improving the quality of life for patients with serious illnesses and can help facilitate discussions about goals of care, symptom management, and emotional support.

As for your second question regarding the possibility of having withdrawn life support earlier, it is difficult to speculate on what might have happened had different decisions been made. The medical team at that time may have believed that a tracheostomy was a reasonable option to provide a longer-term solution for breathing support, especially if there was any hope of recovery. However, the decision to proceed with such interventions should always consider the patient's quality of life and the family's wishes.

In situations like this, it is also important to reflect on the values and preferences of the patient. If your grandfather had previously expressed any wishes regarding life support or end-of-life care, those should be taken into account as you make decisions moving forward. If no such discussions occurred, it may be helpful to consider what you believe he would have wanted based on his values and beliefs.

Ultimately, the decision to continue or withdraw life support is deeply personal and should be made with careful consideration of the patient's condition, the family's values, and the guidance of the healthcare team. It is a process that requires open communication, emotional support, and a focus on what is best for your grandfather, both in terms of his physical condition and his dignity as a person.

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