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When ventilation goes too far.

Ventilators keeping more than 8000 patients alive, in nursing homes: it doesn’t seem plausible. But it’s true.

In the US today approximately 8200 ventilators are being used in nursing homes, triggering a debate about whether these should be turned over to covid-19 patients, in the event of the country’s ventilator shortage continuing.

Although there is some discussion about whether the style of ventilator used long-term in these nursing homes would be appropriate, their use with adaptations for Covid-19 patients is still being considered.

In a Los Angeles Times piece Nursing Homes Have Thousands Of Ventilators That Hospitals Desperately Need https://www.latimes.com/california/story/2020-04-07/coronavirus-nursing-homes-have-ventilators-that-hospitals-desperately-need by Joanne Faryon, published on April 7, 2020, the discussion turned to examples of how this would work.  

These include switching off the ventilator of an elderly woman who’s been on one for, say, five years, who will never return to a normal life, to transfer that ventilator to a healthy patient suddenly struck down by Covid-19 who has a much better chance of returning to a normal life.

Joanne talked about two US states where elderly patients are kept on ventilators, indefinitely and permanently – California and New York.

“Most of the machines are in use, often by people who’ve suffered a brain injury or stroke. Some of those residents are in a vegetative state and have remained on a ventilator for years,” Joanne explains in the piece.

“The highest number of machines, about 2,300, is in California, where the state has created designated nursing home units for people on life support, officially called subacute units but known pejoratively by some doctors as “vent farms.” New York has the second most, 1,822, according to state officials,” she explains.

She points out that the existence of these ‘vent farms’ isn’t well known. But she has prepared a detailed exposition of them at inewsource.org’s http://impossiblechoice.org/deciding-when-a-life-is-no-longer-worth-living/

In that investigation she presents several videos of the situation, prepared by Brad Racino, which seem cruel to everyone involved – the patient and their family.

In the report she explains that even people who have already been ventilated and fed via tubes to the stomach for quite some time, can then be put onto kidney dialysis.

This is an unlikely scenario in Australian states, where medical staff ask the question “Is this treatment futile?” Although we have situations where those with brain injuries and strokes remain alive, we usually protect these lives and nurse the person but without what we deem the heroic and artificial interventions that Joanne has described.

So, although not impossible, we would be unlikely to get to a point where someone was being kept ventilated when tests show they wouldn’t return to consciousness if taken off the ventilator.

But even if that unlikely event did occur, medical teams would question the wisdom of adding the second layer of ‘futile’ treatment, the permanent feeding tube, and then following that up with a third layer, the kidney dialysis.

The Australian situation is explained well in the ELDAC tool kit. This is an extensive set of documents but a good place to start reading is at their Factsheet: Withholding and Withdrawing Life-Sustaining Medical Treatment. This can be found at: https://www.eldac.com.au/tabid/4988/Default.aspx

Among others, it makes the following points:

  • A decision to withhold or withdraw life-sustaining treatment is a common feature of medical practice when caring for people who are approaching the end of life.
  • A health professional may be liable under the criminal or civil law if they do not comply with a request to withhold or withdraw treatment.
  • A health professional generally has no duty to provide futile treatment, even if it is demanded by a person, their family or substitute decision-makers.

How do we discuss this issue with someone who might need to know? To find out more, go to Good Grief!’s discussion at:

To see one of Brad Racino’s videos from Joanne Faryon’s investigation, go to:

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