When Life Support Is Questioned Early in the Care of Patients with Cervical-Level Quadriplegia

Abstract

Some patients with cervical spinal cord injuries ask to die. It is\ngenerally held that a competent, informed adult has the right to forgo medical\ntreatment, even life-sustaining therapy. Furthermore, respect for patients'\nautonomy is not only a fundamental ethical principle, but is also sanctioned\nby law. In particular, there are a number of published accounts of patients\nwith high-level cervical injuries who have been granted permission by the\ncourts to discontinue life support. In all these cases, the patients were\nbeyond the acute phase of their injury when they made their decisions. In this\narticle, we focus instead on cases in which the question of terminating life\nsupport is raised by the patient, a staff member, or a family member soon\nafter a complete cervical spinal cord injury, while the patient is still in\nthe intensive care unit. This situation presents a number of special problems. \nPatients frequently have a diminished capacity to make important decisions\nduring the first several months after an injury, and they are often not\nadequately exposed to the types of information needed. Furthermore,\nprofessionals working in this segment of the care continuum may have biases\nthat increase the possibility of a too-hasty decision. When such problems are\nnot appreciated or are addressed capriciously, the result may be the premature\ndeath of a person who could have lived a happy and productive life.