Sometimes a stroke is so large that vital portions of the brain are damaged beyond repair. In these cases families are often asked to consider whether or not they have any documentation, or knowledge, regarding the patient's thoughts or wishes about being permanently dependent on medical support. Many families in this situation have knowledge about a patient's wishes based on discussions that happened prior to having the stroke that landed them in the hospital. For instance the patient might have spoken to a parent, or a sibling, about their wish to be "disconnected" or "unplugged" in a similar situation. Families considering withdrawal of medical support in these cases, should make their best effort to honor the patient's wishes.

Medical teams can be very helpful in providing information needed to make a decision. Don't get me wrong. This can be extremely difficult, but in many cases it is clear from the extent of brain damage that, independent of whether a person's heart and lungs could continue to work, it is unreasonable to expect that a meaningful recovery can occur because large or vitals parts of the brain are no longer alive (i.e., there is no reasonable chance of recovery of awareness, future independent living, ability to eat, walk or talk).

Should you ever be the decision-maker in one of these cases, try to remember whether your family member ever expressed any opinions about being permanently bed-bound, or about being dependent on a respirator or a feeding tube. Very often, the memories of these discussions have the answer of what to do in these most difficult moments.

Recommended reading:Does my loved one need palliative care?