Navigating Tough Decisions: A Family's Dilemma on Life Support Options

Can surgery be performed? Follow-up question?

Dear Doctors of the e-Hospital in Taiwan,
Hello! I previously wrote to inquire about my father, who has been intubated for over a month.
The doctors have stated that he is 100% dependent on the ventilator for survival and will never be able to be weaned off it.
They have been urging us to consider a tracheostomy.
My father is nearly 90 years old, and we cannot bear to make that decision.
Additionally, he has been suffering from dementia for almost 10 years.
We have consulted with doctors, and they have informed us that as long as there are any signs of life, they cannot remove the tube.
This situation is truly the greatest torment for my father, my elderly mother, and us, his children.
I sincerely ask the doctors to help us find a solution! We feel we have no way out!
Sincerely, Miss Wu

Ms. Wu, 30~39 year old female. Ask Date: 2014/01/07

Dr. Liao Yaopan reply Family Medicine

Hello, would you like to understand the situation regarding "tracheostomy"? Based on the aforementioned circumstances, the chances of successfully extubating in the short term are low.
I personally recommend that a tracheostomy is a better option for an assisted airway.
The use of a ventilator requires a clear airway, and the current endotracheal tube is inserted through the mouth into the trachea for about twenty centimeters.
This tube needs to be changed regularly, and the safety of changing the tube must also be considered.
Oral hygiene care is more limited in this situation.
A tracheostomy involves creating an opening in the trachea to place a tracheostomy tube, which makes care and regular tube changes more convenient.
However, one must accept the very low risk associated with the surgery.
I suggest that family members communicate and understand more with the attending physician.
Thank you for your letter, and Changhua Hospital cares about you.

Reply Date: 2014/01/07

More Info

Navigating the complex and emotionally charged decisions surrounding life support options for a loved one, especially a parent, can be one of the most challenging experiences a family faces. In your situation, where your father has been on a ventilator for over a month and is unlikely to recover, it is understandable that you feel a profound sense of anguish and uncertainty. The emotional toll this situation takes on you, your mother, and your siblings cannot be overstated.

Firstly, it is essential to acknowledge the difficult position you are in. The decision to continue or withdraw life support is not merely a medical one; it is deeply intertwined with ethical, emotional, and familial considerations. In many cases, families are faced with the heart-wrenching reality of balancing the desire to prolong life with the quality of that life. In your father's case, the medical team has indicated that he is entirely dependent on the ventilator and that he has been living with dementia for nearly a decade. This raises significant questions about his quality of life and what he would want if he could express his wishes.

One of the first steps you might consider is to have an open and honest conversation with your family about your father's wishes. If he had previously expressed any preferences regarding life support or end-of-life care, those wishes should guide your decision-making process. If he had not made his wishes known, it may be helpful to discuss what you believe he would want based on his values and beliefs. This can be a difficult conversation, but it is crucial for ensuring that everyone is on the same page and that your father's dignity is respected.

Additionally, consulting with a palliative care team can provide valuable support. Palliative care focuses on improving the quality of life for patients with serious illnesses and can help families navigate complex decisions about end-of-life care. They can provide guidance on what to expect as your father's condition progresses and help facilitate discussions about the goals of care. They can also assist in managing any discomfort your father may experience, ensuring that he is as comfortable as possible during this time.

It is also important to consider the emotional impact on your family. The stress of making such decisions can lead to feelings of guilt, anxiety, and even conflict among family members. Seeking support from a counselor or therapist who specializes in grief and loss can be beneficial. They can help you process your emotions and provide coping strategies for dealing with the impending loss of your father.

In terms of the medical aspect, the recommendation for a tracheostomy (氣切) is often made to facilitate long-term ventilation and improve comfort for patients who are expected to remain on a ventilator for an extended period. However, this decision should be weighed carefully against your father's overall prognosis and quality of life. If the medical team believes that your father will not regain consciousness or meaningful interaction, it may be worth discussing the potential benefits and burdens of such a procedure.

Ultimately, the decision to continue or withdraw life support is profoundly personal and should be made with compassion, respect for your father's wishes, and consideration of the emotional well-being of your family. It is a journey that no one should have to face alone, and seeking support from healthcare professionals, counselors, and trusted friends can help you navigate this difficult time.

In conclusion, while there may not be a clear-cut answer to your dilemma, taking the time to gather information, consult with professionals, and engage in open dialogue with your family can help you arrive at a decision that honors your father's life and legacy while also considering the emotional needs of your family. Remember, you are not alone in this journey, and there are resources available to support you through this challenging time.

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