How do you decide to end life support when the individual is conscious?

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This may not be the appropriate place for the question but I need support. My friend of 48 years went in for a routine biopsy of her pancreas 4 weeks ago. Unfortunately the doctors discovered that her bile duct was blocked. Additionally she had internal bleeding in her stomach resulting in emergency surgery and removal of a portion of her stomach. A couple of days later a drainage was input for her bile. All seemed normal and recovery underway until another episode of internal bleeding. This time it was a blood vessel in her liver which was discovered after injection of dye to locate the bleeding. This causes the kidney to take a huge hit. Long story short, kidneys are not waking up, liver not functioning, mass in her pancreas is inoperative and at age 66 my dear friend cannot handle chemo or any surgery. She is on a ventilator, has a tracheotomy, receiving dialysis and continuous morphine drip to manage the pain. She is conscious and aware of condition but has not indicated she is ready to give up. In the past she has told family and friends she does want to be kept alive by machines. Do we ask her what she wants or take her off the ventilator to see if she can breathe on her own? The family thinks it's time because there's nothing that can be done at this time for her and she is basically on life support. Should we try to ask her?

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Yes. Definitely. If she is conscious and lucid it should be her decision. Is she aware of the dire prognosis of her conditions?

Instead of a direct question like "should we remove the ventilator?" I might approach it more like this. "I hate to see you depending on so many machines. Whenever you are ready to stop any of them, just let us know and we'll help with the process."

You must be so stressed out! My heart goes out to you.
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If your friend is conscious and of sound mind, then let alone family, her doctors have no choice other than to ask her. To give or withdraw treatment without the informed consent of your conscious, competent adult patient is out of the question. It is also, actually, her doctors' job to have the necessary conversations with her. I should leave them to it, and focus instead on offering emotional support whatever she decides.

I am sorry for your friend's suffering and hope she can be made comfortable.
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Thank you all for your responses. My friend does not have a directive but verbally gave the decisions for her care to her niece. And although responsive, she can only nod yes or no. On Monday the Dr, along with family & friends present, explained her condition. I'm able to make tears, we could see she was crying. The Dr comforted her and told her she didn't have to decide right then to come off the machines. So I'm thinking her niece & the Dr should maybe try again. She's quite sedated but can hear you. My prayers are that she goes peacefully in her sleep.
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Shouldn't she have a directive in place already? Such as a D N R? Perhaps while she is still conscious is the time to ask so it is legal and binding. But shouldn't a family member be responsible for this? I admire that you wish to take this on but perhaps since you already stated the family thinks this should take place maybe you should all discuss this and how you can proceed.

I'm sorry for you and wish you the very best. She is lucky to have a friend like you.
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Dear onlychild15,

I am so sorry to hear about your friend's situation. I know you love her a lot and do not want her to suffer. It is a very delicate situation. But I guess if it were me, I would want someone to ask me if I was conscious what I wanted. I would try to have more than one person in the room to make sure there is no misunderstanding.
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That poor girl. Thank you for being there for her. It's also comforting to know that she has a doctor with compassion.
My heart breaks for her.
She will be in my prayers.
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Country mouse is right. Understandably, all who care about her are concerned and want to help her make a good decision. If she has a religious leader, that person should be a part of this discussion with her. If not, perhaps the hospital has a chaplain that could talk with her.
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This sort of situation even can upset medical staff. Doctors take an oath to do no harm. In this day and age they now have to think to do no further harm. Whoever is making her decisions has to balance this woman's quality vs quantity of life. Taking in your valuable friendship makes it much harder to you. That is why each of us should sit down at a table during the good times and ask our loved ones what they would want done. I did this 15 years ago with my parents. I do not have this conflict. But for those who do not know, consider the further harm and suffering that sounds like futile care. It sounds like she will never be back to living at home.
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This last spring after 3 months in ICU, a very good friend of mine realized she would never get off the ventilator and she decided to turn it off. Hard on family but they heard her say she didn't want to live that way. The family gathered, said goodbye and the doctors turned it off. I don't know the procedure.

This is a good time for all of us to be sure we have our wishes written down so our families won't have these awful choices.
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DigitalBanker - I'm sorry to tell you that by putting her on life support in the first place the doctors were "playing God". Were it not for those machines, "God" would have taken her. You clearly do not understand that "God" is love and wants us to be happy.

OnlyChild - support your friend as she makes this difficult and scary decision. Visit with her. Read to her. Help her get information about her prognosis, palliative care, and hospice. Many people think they want doctors to "do everything" but then change their minds when faced with the stark reality of a long, painful death. So sorry for you.
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