ACLS – Life Sustaining, Life Saving, or Just Another Protocol

I’ve been working my way through the story and comments that have been left and are continuing to be left on Rogue Medic’s post regarding the Living Will scenario. It got me thinking though, if Mr. Read is attempting to invoke his father’s living will that requires two doctors to agree that he will never recover, was he thinking that our application of ACLS was a “life sustaining” measure?

I guess it would really begin with how one defines “life.” If the respiration of oxygen and the circulation of nutrients is the only criteria, then lots of things are alive. Plants and single-celled organisms are considered living things based on those criteria, but are we defining human life based on what makes us human? If we added in self awareness to the criteria, then we have drawn a distinction between what is human life, and what is just life.

Was Mr. Read breathing at the time of initial exam?

No, or EMS would never have been called.

Did Mr. Read have a self-sustaining heart beat at the time of initial exam?

No.

Was Mr. Read aware of his surroundings?

I would say no.

So, using the criteria for human life we have just established we have determined that Mr. Read was not among the living. Meaning, he is dead, and living wills don’t apply to people that are already dead.

It does bend an interesting discussion into the use of devices in ACLS like AUTOPulse and LUCAS. If we can artificially create heart beats through compression devices, and we can artificially create respiration using ventilators, do we now have a living human that was once dead? Are they “life sustaining” devices or merely improve the chances of regaining that which was already lost?

I don’t believe that compression devices are life sustaining. Once again, we have to fall back to the idea that we are starting with a dead human being. We can’t sustain something that wasn’t there when we started or we didn’t restart, but we can sustain abuse upon a corpse ad nauseum.

  • Depending on the presenting rhythm, the Living Will had little bearing in this case. If it were VF/VT or a near-physiologic PEA, I’m of the opinion the Living Will matters. Sorta the Princess Bride, “he’s only mostly dead”. Alas, I’m certain it was a terminal or post-terminal rhythm. I think this whole charade could have been avoided if the crew took some time to explain what was going on to the family.

    • True that a little tact goes a long way. I may not have even thought of this stuff if this had never made the news.

  • Depending on the presenting rhythm, the Living Will had little bearing in this case. If it were VF/VT or a near-physiologic PEA, I’m of the opinion the Living Will matters. Sorta the Princess Bride, “he’s only mostly dead”. Alas, I’m certain it was a terminal or post-terminal rhythm. I think this whole charade could have been avoided if the crew took some time to explain what was going on to the family.

    • True that a little tact goes a long way. I may not have even thought of this stuff if this had never made the news.