Life support: Information, ethics & decision-making

Ahmed Raza

Written by Amanda Menard, LPN, a practical nurse since 2005 with experience in ICU, cardiac care, and case management. She is pursuing her MSN for Family Nurse Practitioner and is a former Military Medic with the Louisiana National Guard.

Life and health depend upon the efficient function of the different organs of the body. If vital organs such as the heart, lungs, or kidneys fail, death is imminent. Life support refers to techniques and procedures to artificially replace the function of vital organs. The objective is to buy time for patients so that they can be treated for the underlying cause or are able to recover on their own. Let’s take an example of a person who suffers from acute lung injury and cannot breathe. His lungs can recover if given the proper time and treatment, but the problem is if he can’t breathe he will not survive long enough to recover. This is where life support comes in. A mechanical ventilator, a typical example of life support, can assist or replace a person’s breathing temporarily. The need to provide life support could be urgent and short-term, which forms the basis of CPR and BLS, or prolonged. Chief forms of life support are

• Mechanical ventilation — assists or replaces a person’s breathing through the use of a machine called a ventilator.
• Cardiopulmonary resuscitation — provides blood and oxygen to body tissues, especially the brain, when a person’s heart and/or breathing stop. It involves various basic maneuvers, as well as the use of defibrillators, drugs, and pacemakers at advanced levels.
• Artificial nutrition and hydration — is essential for life when someone cannot eat or drink. It is administered through a tube that is inserted into the stomach, intestine, or a vein.
• Dialysis — substitutes for lost kidney function.

As common as life support has become, a debate over ethical issues related to it has become just as common. To understand this debate, we need to look at the pros and cons of life support.

Ethics and pros & cons of life support

The biggest pro of life support is that it sustains life for a longer period of time, allowing for hope and solutions. Some patients pull through and make a full recovery and others don't, but people involved in these situations typically feel that they have a chance. People against life support point to situations where it is clear that there are no chances of recovery and life support only prolongs the dying process. While people who are in support of life support say that it is morally wrong to let someone die, those against it argue that it is morally wrong to keep someone alive without their consent, possibly prolonging their suffering. There are other considerations as well, such as what constitutes a judicious use of medical resources.

When life support techniques were initially introduced, they were seen as lifesaving and most people had no issues. However, today there are a number of landmark cases and situations that have people split over ethical issues, with each side feeling passionate about their moral stance. Ethical panels have been put together and a number of situations arise that cause the debate to continue. As the ethics debate progresses, it is important to stay abreast of the issues and facts about life support.

• Life support options for people with serious illness — Frontline, PBS: PBS.org offers information for people who are considering life support for a loved one with serious illness. The article touches on ventilators, DNR orders, family conflicts, and more.
• What is a pacemaker? — NHLBI, NIH: This article gives in-depth information on pacemakers.
• Death, treatment decisions and the permanent vegetative state: evidence from families and experts: This comprehensive essay provides information on arguments for and against life support, and the ethical issues involved in "pulling the plug".
• Pulling the plug: ICU 'culture' Key to life or death decision — Vitals: This news article discusses how the medical culture of an ICU can affect physicians’ decisions on life support.
• Ethical issues near the end of life: This article features information on life support and raises questions about the many ethical issues surrounding it.

For healthcare providers, please also take our advanced cardiac life support overview quiz which reviews all the advanced topics.