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Bioethics Medicine

An update on Andrea Clarke

In the comments of my post regarding Andrea Clarke, the woman whom a Texas hospital is trying to pull the plug on because its bioethics committee has declared her care “futile” despite the fact that she is not comatose and is able to communicate her wishes comes an update posted yesterday to the Democratic Underground discussion boards:

I don’t really know how to begin this post. Everything is so different now, than it was before. It’s like everyone moved the pieces on the chessboard, while I was out of the room.

First the good news: Andrea’s white blood cell count is down, for the fourth day in a row. This signals the level of infection that she has in the repaired valve of her heart.

More good news: Andrea was on two “pressor” medications. These are drugs that increase the blood pressure, so that the organs will receive enough blood. They are very, very hard on the body, though. Andrea has now been taken off of these medications, not because it is a part of withdrawing treatment, but because she no longer needs them.

Okay, I tricked you! There’s all good news, no bad news! (I’m sorry; I’m just so happy!) The futility process has been halted. Andrea has a new doctor and the medical futility process has stopped right there, with him! He has lowered (halved) her pain medication, which she doesn’t seem to need as much of now (none of us in our family ever thought she needed as much as they were giving her, but the futility morons pour on the pain meds right before unplugging a patient that is cognizant–we have learned that this is part of the “process”).

This new doctor told us to make no mistake about it, our sister is in “serious” condition, but that doesn’t mean, he said, that she can’t get much better!

You know, my sister, who was one of the first patients ever to be operated on using the then brand new technology of the heart-lung machine, made history when she was five years old. And, having been declared “futile,” and having had her family and the rest of this country fight that death sentence…..well, she might make history again, showing that this law gives doctors too much power over people’s lives, if she continues to recover.

Knowing Andrea as I do; knowing her iron will to live, I’m putting my bets on her.

It just goes to show that we have to be very careful about how we go about declaring patients’ care “futile.” Clarke is without doubt in bad shape according to this update, but there is also little doubt that she is showing significant signs of improvement. Whether this turns out to be just blip on a downward course remains to be seen, but it would appear that there are far more reasons for optimism than the hospital has let on. It also makes it me more suspicious than ever that this was more about money than sparing Andrea Clarke further suffering. Clarke is not out of the woods yet, and apparently the hospital is planning another meeting of its ethics committee.

Sometimes in such cases it’s helpful to bring in fresh blood, so to speak, to look at the case again objectively. Lacking all the baggage that comes from caring for such a patient for a long time, a different physician may see things that can be done and may not see the case as futile. It’s human nature and all too easy for a physician who has cared for months for a patient who doesn’t appear to be getting any better to fall into the trap of losing hope and asking himself why he’s continuing to “torture” a patient who doesn’t appear to be getting better. It’s all too easy to lose objectivity when you have to face the same patient day in and day out over several months on a ventilator suffering multiple setbacks.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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