Brad and Dr. Robinson

Brad is a seventeen-year-old male with advanced cystic fibrosis (CF). Due to the present condition of his lungs, Brad has been given about three months to live. Brad comes into the ER with his girlfriend Jenny. Brad is unable to breathe. Dr. Robinson ascertains Brad’s age, after Jenny unwillingly gives it up, and intubates him. After Brad is intubated, his mother is located and called. When Brad’s mother Janice arrives, she informs Dr. Robinson that Brad has been living with Jenny in an apartment recently. Janice and Brad have recently been in a fight because of Brad’s decision to run away and live with Jenny (and not her). Dr. Robinson pulls Brad’s mother aside and tells her that there is a good chance that Brad will not wake up. His brain was without oxygen for an extended period of time and there is a good chance that he will not recover. Also, the amount of time on the ventilator did nothing to improve Brad’s condition and nothing can be done further to improve it. Dr. Robinson asks Brad’s mother about a DNR order and about her son’s wishes at the end of his life. Because of Brad’s adamancy about not being intubated when he originally arrived in the ER, Dr. Robinson is concerned about going against Brad’s wishes. Jenny also returns to the hospital with a non-statutory advanced directive stating that Brad did not wish for any heroic measures and under no circumstances did he want to be put on a ventilator unless it would improve his condition. Janice says she is not ready to lose him and says to intubate him again if necessary. Dr. Robinson looks at the advanced directive that Jenny brought in. Although this is a non-statutory advanced directive, and thus has no legal authority, Brad is extremely clear with his words. Brad wrote that he has watched numerous friends with CF die both on ventilators and on by choking to death on their own saliva and he never wanted to be in that situation. He never wanted to be on a ventilator and he wanted to spend the last days of his life with Jenny. He also wrote that his mother could not understand his feelings because she was blinded by her love for him and her fear of losing her only son. Dr. Robinson is concerned about doing what is best for Brad. Brad has a 2% chance of waking up to even a semiconscious state according to the neurologist’s assessment. He will continue to deteriorate on the ventilator and he will require ANH and a central line infusing his body with medication to control his pain. Taking into consideration the wishes of Janice, Brad’s legal guardian, and the advanced directive Brad wrote prior to his hospitalization, how should Dr. Robinson proceed?

--Written by Kate Sulkowski