Doctors from the Reims University Hospital have summoned Vincent Lambert’s family to offer him an end-of-life protocol. In order to convince the parents of its merits, they will unveil a recent ENT assessment showing that their son’s condition is not improving.
“Following the judgment rendered by the ECHR (1) on June 5, 2015, I chose to initiate a new procedure with a view to a decision to stop treatment”. This is an extract from the letter received last week by members of the family of Vincent Lambert, who are torn over the fate of this patient in a vegetative state for seven years.
A Family Council is therefore organized this Wednesday at the Reims University Hospital. Vincent Lambert’s parents will first be received, then his wife. The first are for the maintenance of treatment, the second defends the end of treatment. During these meetings with the doctors, three questions will be raised.
Frequent swallowing disorders
First, the ethical point of view of this situation. Keeping Vincent Lambert alive does it amount to engaging in unreasonable obstinacy under the terms of the Leonetti Law on the end of life?
Another question, if the final decision is up to the patient’s doctor, after consultation with the medical team, the point of view of the family is also important. This is the whole difficulty of this file, because Vincent Lambert had not notified his advance directives in writing. He had only, according to his wife, indicated that in such circumstances, he would like to die with dignity. Finally, at the heart of the debates, everyone will focus on the patient’s current state of health, with a recent medical examination as a new document in the file.
A few days ago, a source close to the case revealed to Why actor that the clinical picture of Vincent Lambert has worsened. The medical team led by Dr Daniela Simon will present at this collegial meeting a new ENT assessment (carried out by indirect laryngoscopy) which confirms that Vincent Lambert has more and more difficulty swallowing. The false routes caused by these swallowing disorders have become frequent. However, this problem is far from trivial, according to Dr Yves Rébufat, president of the National Union of Hospital Anesthetists-Resuscitators (SNPHAR).
The risk of aspiration pneumonia
“This is something quite common in patients who are either head trauma or cerebro-injured. They often have problems with the mobility of the laryngeal crossroads. In fact, these people can no longer swallow their saliva. This flows directly into the trachea instead of going into the esophagus, ”describes this doctor.
“Repeatedly, these false routes increase the risk of developing aspiration pneumonia. The saliva then falls directly into the bronchi and lungs. This promotes bacterial overgrowth which can cause lung infection. This worsening of the respiratory picture sometimes leads to the death of the subject, ”he adds.
Evidence of severe neurological damage
In order to avoid this situation, most of these patients are tracheotomized for life. “This is a surgically made opening in the upper trachea below the larynx. It ensures permanent airway permeability, ”explains Dr Rébufat.
This technique of securing the upper airways would not be offered to Vincent Lambert. Like any vegetative patient who does not have a brainstem lesion, his ventilatory and cardiac functions are indeed “spontaneous”.
To conclude, Dr. Rébufat nevertheless argues that “regular false routes testify to severe neurological damage”.
A suspicion validated by the latest medical expertise carried out on Vincent Lambert by three of the best French neurologists (Prof. Marie-Germaine Bousser, Jacques Luauté and Lionel Naccache). In their conclusions, these experts had reported a deterioration in the patient’s state of consciousness. They also confirmed the irreversibility of his brain damage.
(1) European Court of Human Rights
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