Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

 

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question was

 

My Brother is Brain Dead in the ICU and the Doctor Wants to Withdraw Treatment. Why Do I Need to Change my Approach Towards the ICU Team?

 

You can check out last week’s question by clicking on the link here.

 

In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Camille, as part of my 1:1 consulting and advocacy service!  Camille’s brother is considered brain dead in the ICU. She is asking if the ICU team can legally withdraw treatment against his brother’s living will?

 

My Brother is Brain Dead in the ICU. Can the ICU Team Legally Withdraw Treatment Against my Brother’s Living Will?

 

“You can also check out previous 1:1 consulting and advocacy sessions with me and Camille here.”

 

Part 1

 

Part 2

 

Aubrey: Hello?

 

Patrik: Hello?

 

Camille: Hello? Hi, can I speak to Aubrey?

 

Aubrey: Hello? Hello. Can I help you? Oh, just a moment, please.

 

Patrik: So that’s the right number you think? Okay, good, good. We’ll just wait then.

 

Patrik: And she called you a moment ago? Is that what you said?

 

Camille: She’s in a room, she’ll be right out. Can I put you on hold for a moment?

 

Camille: Yes. Okay. Thank you. Is everything okay?

 

Aubrey: With what, honey? Is everything okay with?

 

Patrik: Did you hear Camille that she asked you if everything is okay? Did you hear that?

 

Camille: Yeah.

 

Patrik: Right.

 

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Camille: She didn’t reply me.

 

Patrik: Right. No, she did ask, she did ask back, that’s why I’m wondering, did you hear that too? She asked you, right, yeah, but then she asked you back.

 

Patrik: I answered that everything was okay.

 

Camille: I’ll transfer you, okay?

 

Aubrey: CCU, this is Aubrey.

 

Camille: Hi Aubrey, this is Camille.

 

Aubrey: Yes ma’am, I know. Give just one second. Are you there?

 

Camille: I’m here.

 

Aubrey: Okay. I have the doctor, Dr. Brown needs to speak with you real quick, okay? However, he is too busy now, can I talk just talk to you?  Is that okay with you?

 

Camille: Oh, that’s fine. It’s a bit hard to hear you.

 

Aubrey: Okay. Can you hear me better?

 

Camille: Much better yeah, and just to let you know also, I have my brother in law, who is an intensive care nurse on the phone too.

 

Patrik: Hi.

 

Aubrey: Hey, how are you?

 

Patrik: I’m very well thank you. How are you?

 

Aubrey: I’m good. Hey listen, we need to just talk to you about your brother and about DNR status and what the plan for the future is. So, in North Dakota, there’s a new law that actually allows a physician to make a patient a DNR based on imminent death, and that’s what it’s called is imminent death. In that statute, if the physician believes this imminent death is, you know in the future, that they can make a patient DNR. The requirement for that is that the DNR doesn’t go against what the patient would have wanted when they were able to speak and we have a living will that says that’s exactly what he would want. It also requires that we notify the legal next of kin, make a good faith effort in doing that, and that’s what we’re doing right now is to let you know that that DNR order is going to be put into place.

 

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Patrik: Can I just talk, sorry, before you go on because this is a life or death situation. Can you send the law to us? Can you reference?

 

Aubrey: You can look it up, it’s in the text.

 

Patrik: It will be up to you, really. It’s not for us to look up, it’s for you, this is a life or death situation, it’s for you to provide that to us.

 

Aubrey: You, you need to calm down because I’m telling you what’s going to happen.

 

Patrik: And I’m going to tell you what’s going to happen to. I’m going to tell him that you would need to provide that law.

 

Aubrey: Okay, well when you come up here, I can, I’m more than happy to provide that law.

 

Patrik: You can email it.

 

Aubrey: No, I’m not going to email it. If you come up, I’ll provide it.

 

Patrik: Why not?

 

Aubrey: Let me continue, let me, let me continue talking to Camille because that’s who I need to chat with. So, that DNR order is going to be in place.

 

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Camille: Yeah.

 

Aubrey: We have also, based on your brother’s living will, he wanted none of this done. It’s clear in his living will.

 

Camille: It’s not.

 

Aubrey: He wanted, he want, no, I will read it to you, ma’am. Let me go ahead and read it to you, just let me finish. If there is no reasonable likelihood of recovery from his condition, his desire is that.

 

Camille:  Why are you talking over me?

 

Aubrey: Well, because you’re not letting me finish.

 

Camille: You don’t have permission to talk over me. You cannot do what I asked you not to do.

 

Aubrey: Well, actually, legally we can.

 

Patrik: Where is the evidence for that, that you can do that legally?

 

Aubrey: Let me finish, because.

 

Patrik: You haven’t answered my question. Where is the evidence for that?

 

Aubrey: Okay.

 

Dr. Pippen: We have a copy of it. You can read it.

 

Aubrey: Yeah. So let me finish.

 

Patrik: Email it. Email it.

 

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Aubrey: So, you have three options and you have until Wednesday at five o’clock to decide what you want to do, and at that time we’re going to follow what he has in his living will. Okay, if you want to listen to what your options are, I’m happy to go over those with you.

 

Camille: Now you listen to me, I already gave you my option, my option is no.

 

Aubrey: Okay, but that’s not what, that’s not what he wanted. You’re going to have to listen to me for a change. You’re going to have to, well, you’re going to have to listen to me for a change.

 

Camille: I have a legal document that says.

 

Aubrey: You do have a legal document, in your legal document he filled out and said he did not want any of this done. So we’re going to follow, we’re going to follow what he wants, and yes ma’am, we are. We are. So, what your options are is you can either find a physician on your own by Wednesday at five o’clock, if you don’t want to listen to me, that’s fine, but I’m giving you all your options, and at five o’clock on Wednesday we’re going to remove the ventilator.

 

Camille: Oh wonderful.

 

Aubrey: Okay, so you, you have the option to try to find, if you’ll listen to me, if you will listen to me, you have the option to try to find a judge who will put in place a legal injunction against us from removing him from the ventilator. You have to do that at five o’clock on Wednesday. If we don’t receive something from a judge saying we cannot remove him from the ventilator, then we will remove him from the ventilator, right after five o’clock on Wednesday. That’s option number one. Option number two is that you find a physician on your own that’s willing to accept him as a legal brain dead person and is willing to transfer him to another facility, but that has to also be done by five o’clock on Wednesday.  And then your third option is if you decide that you would like to take away the ventilator today, we can do it today.

 

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Camille: I told you that we wanted to take him home.

 

Aubrey: Okay, well. I have talked to Dr. Brown. He is on board. Dr. Pippen is on board. All the physicians are on board because he is legally brain dead.

 

Camille: No he isn’t.

 

Aubrey: He already made his wishes known before he got in this state. Yes ma’am, he did. I can read it to you, I have it right in front of me.

 

Camille: Listen, even the attorney, he can’t even read and he completed that to him, at all.

 

Aubrey: Well, I will tell you that it’s notarized by a notary that says he’s known to me and I believe him to be of sound mind and has voluntarily signed this document in my presence. So you have an actual notary.

 

Camille: Do you want to see the signature? Look at the signature, highly sedated, had written and held by the attorney because he couldn’t sign it.

 

Aubrey: Okay, well this is a legal document. It meets North Dakota living will statue, advanced directive statue. We’ve had the attorneys go through that and it meets every requirement that North Dakota has for this, even though it’s not an actual North Dakota form.

 

Camille: Why didn’t you guys talk to me about attorneys? Why didn’t you talk to me about attorneys?

 

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Aubrey: Well we, yeah, the attorneys are for the hospital and before we do anything we have to, you know, get everything through them to make sure that we’re doing what legally we should. So, those are your three options. Wednesday at five is the time that we need to see something. Otherwise, we’re going to follow his directive that says he does not want to be prolonged and he wants it withheld or withdrawn and be permitted to die naturally. And that’s what his words are in this document. He is telling us through this document that he doesn’t want to be like this and you as his power of attorney, it says actually that the power of attorney has to make care decisions consistent with my living will declaration.

 

Camille: Listen, I have it in front of me.

 

Aubrey: And you are not doing what he wrote that he wanted done. Okay well, the living will, his wishes and what he wants takes precedence over what you want, this is about him.

 

Camille: No, no, no, no.

 

Aubrey: Yes it is.

 

Patrik: Can I just ask you, sorry, can I just ask you, so the brain dead that has been verified by two independent parties?

 

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Aubrey: Well it’s been verified by a nucleolar brain scan. He has absolutely a nucleolar brain scan.

 

Patrik: Okay, and what’s your policy around, and what’s your policy around how does brain death need to be determined in your hospital? What’s your policy around that?

 

Aubrey: It’s the policy by North Dakota law and the nucleolar brain scan with no flow is an indication of legal brain death. So it’s the North Dakota law.

 

Patrik: So you don’t have a specific hospital law or sometimes in some hospitals, brain death needs to be verified by an outside party. That’s not the case in this situation, is that what you’re saying?

 

Aubrey: No, no. We follow the North Dakota law.

 

Patrik: Okay. Camille, I think we might have to leave it here for now and we might have to talk.

 

Camille: Okay. All right. Thank you very much.

 

Aubrey: You’re welcome. And like I said, if we don’t hear from you by five o’clock on Wednesday, we’re going to follow his directive, okay?

 

Camille: Okay. Okay.

 

Aubrey: Okay, if you have any questions, be sure and call.

 

Patrik: Camille? Are you there?

 

Patrik: Hi Camille. Can you hear me? Can you hear me? Hello?

 

Camille: Hello.

 

Patrik: Can you hear me?

 

Camille: Yes, okay.

 

Patrik: Okay.

 

Camille: Yes okay.

 

Patrik: So number of things. They are definitely bullies, there is no doubt about that. Who was this lady who spoke? Was she a nurse? Was she a doctor? Who was she?

 

Camille: A nurse. We have general nurses here.

 

Patrik: Oh my goodness. I’m ashamed of my profession. I’m ashamed of my profession. I really am, because that’s not… I just feel horrified the way she spoke to you. But irrespective of that. So I don’t know-

 

Camille: You can hear the doctor in the background too.

 

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Patrik: Yeah, I know, I know. I heard that. I heard that. So, but irrespective of that, Camille, there’s a number of things there. So number one, we need to find out what the North Dakota law really says. Right. And we can look that up. Google will tell us.

 

Camille: Can you check that for me?

 

Patrik: Pardon? Pardon?

 

Camille: I think the answer is if you can check that out for me.

 

Patrik: No, no, I will, I will. The next thing that I’m going to do… I’ll tell you what I’m going to do as the next step. I will email Professor Pope. I will email him. He’s usually pretty good in responding, even on a weekend. He’s usually pretty good. He always responds to my emails because I have situations like that all the time. And whilst he’s not prepared to take on cases, he will always point me towards somebody who might be.

 

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Camille: So you noticed the doctor didn’t talk?

 

Patrik: Yeah, yeah, I noticed that. I’m ashamed of my… I’m ashamed of my nursing profession when I hear that this is a nurse talking to you, the way she spoke to you. I mean I’m just horrified. But that would be true.

 

Camille: Well, I need a deal because I need to get a judgment.

 

Patrik: Yeah. Yeah.

 

Camille: Or find a physician-

 

Patrik: Yes, yes. And also that’s why I asked. It hasn’t been transparent to me how they tested for brain dead. That hasn’t been transparent to me. Most hospitals have a need to do two independent brain death tests, right? It doesn’t sound to me like that has happened. Right? So one thing that I would do if I was you when you go to the hospital, I would ask for the policy and for the law, I would. Because you know that there are probably loopholes in that. There are probably things in there that they haven’t followed on. Right?

 

Patrik: And because you want to buy time at the moment, you need to buy time, you will need to ask for a policy and you will need to ask for the law and you will need to ask for a deadline. You need to say to them, “Tomorrow by three o’clock I want this policy.” But I will email that to you, what you exactly need.

 

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Camille: Okay. Okay. Okay.

 

Patrik: Okay. So-

 

Camille: So she said the policy was also online.

 

Patrik: If it’s North Dakota law it would be online. But most hospitals also have a hospital policy. All right? So-

 

Camille: But you see how all the doctors were there? You were all there, not just one.

 

Patrik: Yeah, yeah. And they let… Right, right. And she was doing all the dirty work for them?

 

Camille: Yes.

 

Patrik: Right. I’m horrified by this. But anyway the-

 

Camille: That’s why I have to go through everything. Every single thing.

 

Patrik: So, and-

 

Camille: I need a lawyer. I need someone-

 

Patrik: Yeah, you will. Now, you will need a lawyer. You will need a lawyer, especially with an injunction, right? You will need a lawyer. One way out of this dilemma could be that you could potentially send him to another state. Right? And-

 

Camille: I tried that but he says there is no hospital in this country-

 

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Patrik: Well, yeah, but you see with one of our client’s loved one, she was able to be transferred to another state. All you need in another state is a hospital that admits him, and you need a state that doesn’t define brain dead as dead. Right? And as I said, I know that New Mexico is one of those States. Right? When are you going back into the hospital now? Are you still planning to go back there tonight or…

 

The 1:1 consulting session will continue in next week’s episode.

 

Kind Regards