Ethics roundtable debate: should a sedated dying patient be wakened to say goodbye to family?

Brian WoodcockThe ability of modern medicine to maintain the human body by artificial means has progressed dramatically. Even in the face of complete failure of respiratory, cardiac, and renal systems, artificial organ replacements can maintain life to a point beyond that where any feasible recovery is possible. With artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation, it can be extremely difficult to die in a medical center with access to these advanced modalities of life support. Problems can arise when the patient reaches a point where technology is maintaining 'life' but there is no way for life to continue without the technology. Withdrawal of this support can raise more difficult questions than during institution of support. The case we are presenting concerns the dilemma of whether a patient would want to awaken before life support is withdrawn and he/she is allowed to die. And in this circumstance, who should make that decision?A 57-year-old patient suffered intraoperative complications and failed to wean from cardiopulmonary bypass during a coronary artery bypass graft operation. Inotropic drugs and intra-aortic balloon counterpulsation failed to restore an adequate circulation. The patient was transferred to the intensive care unit (ICU) on multiple life support systems, including mechanical ventilation, and left and right ventricular assist devices.Cardiac transplantation is not possible for this patient for logistical reasons. The biventricular assist devices cannot be continued indefinitely. Placement of a permanent implantable left ventricular assist device is not feasible. The alternative is likely to be withdrawal of support, which will result in rapid death.In the ICU the patient is heavily sedated with propofol, but otherwise presumably neurologically intact. Would you want to wake the patient up first so he could be informed what is happening? Would you give him a chance to say goodbyes to family? Should the