Ventilators and living wills: What’s a Christian to do during the pandemic?

Victor J. Cardenas isn’t one to tell patients whether they should place a “no ventilator” clause in a living will. As a Christian doctor and pulmonologist in Galveston, Texas, he says that’s up to the individual.

Still, Cardenas encourages patients to think carefully through the issue, especially in light of the COVID-19 pandemic that has placed ventilators at the forefront of the national discussion. In May, The Washington Post reported on a trend of older adults placing “no ventilator” or “no intubation” orders in their living wills. 

The use of a ventilator, Cardenas said, isn’t a “one-size-fits all” issue that can be handled easily with a form. 

“I always think if someone is thinking about putting some limits on their medical care or whatever, that they [should] have a very open discussion with their primary care physician [and] have a very open discussion with their family so that everybody can kind of be on the same page,” Cardenas, who practices at UTMB in Galveston, told the TEXAN. “When that happens, it’s a lot easier and it reduces a lot of stress on the family.” 

Cardenas understands why patients are sometimes hesitant to permit use of a ventilator. 

“When you’re on a mechanical ventilator, you have a tube down your throat [and] we almost always have to sedate them fairly heavily because it’s uncomfortable,” he said. “… A machine is pushing air into your body and [they] often have to be tied down because we don’t want people to suddenly pull something out when groggy.”

Patients who are on ventilators for days or weeks can develop bed sores and experience loss of vitality.

“There’s a point where medically we have our limitations. … We say that as physicians, not as the Almighty, but as physicians.”

On the other hand, ventilators can help spare lives, too, even if the average time on one for coronavirus patients is about 10-12 days.

“Mechanical ventilators can be life saving,” he said.

Health—and not necessarily the patient’s age—is the biggest factor in a ventilator’s success, Cardenas said.

“If you’re 82, and you’re healthy, and have been exercising and you’re in really good shape, you might be fine,” he said. “But if you’re 10 years younger [and] you have diabetes and heart failure, you’re much less likely to survive than the fit 82-year-old.” 

The success of ventilators on coronavirus patients is hampered by the lack of therapies.

“The body just has to go through the process of [fighting] the infection,” Cardenas said, adding about drugs, “We’re still trying to figure out what works and what doesn’t.”

One option for supporters of living wills, he said, is to add a time limit to the ventilator clause. That way, it gives the doctors and the family the opportunity to use a ventilator if it might help.

Cardenas always prefers to talk directly to the patient if possible. 

“Sometimes they’ll say, ‘Well, I just don’t want to be kept alive for weeks and weeks on the ventilator,’” Cardenas said, using a hypothetical scenario. He said he’ll sometimes reply, “We might be able to get you through this” with only a few days on the ventilator.

Thor Madsen, an ethics professor at Midwestern Baptist Theological Seminary, urged caution in placing a “no ventilator” clause in a living will.

“No written document can anticipate every contingency that may arise in medical decision making,” Madsen told the TEXAN. “In reality, medical treatment plans have to be made on a day-by-day and case-by-case basis, using informal methods of judgment that legalese would never capture. Therefore, living wills are not good alternatives to the input of a trusted, informed, and biblically-wise decision maker.”

Cardenas said faith can impact one’s decision.

“From a Christian standpoint, we believe that there’s more to life than just this life,” he said. “… I think that helps in terms of trying to decide beforehand what you want for you and your family.”