A 32 year old lady is the victim of a car accident. She is brought to the ER almost immediately by EMS. Enroute to the ER, the EMS staff resuscitated the lady with fluids and 2 defibrillating shocks according to the ACLS protocol because the patient is in Ventricular fibrillation.

She is stabilized in the ER and placed on a ventilator. On the 3rd day, weaning is attempted but fails due to apnea. This means that there is no spontaneity in the patient's breathing.

A neurologist who is on consult feels that the patient has no brainstem reflexes.

A urine drug screen shows no drugs.

An EEG is performed and shows no cerebral activity.

What should you do

1. Advise the family that the patient is brain dead and should be extubated
2. Advise the family that the patient is brain dead and see if they want to donate her organs
3. Advise the Local organ harvesting team about the patient and advise the relatives of the patient that she is brain dead and further efforts will be futile so you must facilitate stopping life support.
4. Continue treatment aggressively because this is a young patient and has a better chance of improving
5. Provide supportive care until the patient's relatives realize that the patient is not going to survive by herself and then tell them that you concur.

The answer is 3.

Stopping ventilator against family's wishes

This is allowed only under certain circumstances.

1. When the patient is brain dead.

2. When the patient is terminally ill and another physician concurs. Although in practical life, one would involve "Risk management" departments of the hospital in this scenario.

3. When the potential benefit from the intervention is less than the burden and acts only as a disruption to the peaceful passing away of the patient. Ethics committee of the hospital should be involved to make the decision.