Andrea Clark Is Not the Only One, Meet Yenlang T. Vo
I represent Andrea Clark and the family. I came to represent the
family because I signed up on the registry of health care providers
and referral groups that have volunteered their readiness to consider
assisting families in the situation where the present attending
physician and hospital ethics committee decides to withdrawing
life-sustaining treatment.
As soon as I signed up, I got TWO cases. One involves Andrea Clark.
Andrea's case has been getting media attention. Ms. Yenlang Vo's case
has not. I would like for you to know about Ms. Vo's case.
Ms. Vo is in her 60's. She is a patient at St. David's North
Austin Medical Center here in Austin, Texas. She has been diagnosed
with persistent vegetative state--but that is disputed by the family.
Ms. Vo's daugher, Loann Trihn, is an emergency room doctor and she
disputes the diagnosis. Such a diagnosis is very subjective and
involves clinical assessments. Dr. Trihn and her father have both
witnessed her mother being responsive.
The attending physician wishes to withdraw dialysis, That is not
acceptable to the family--and it against the express wishes of the
patient expressed before she became unable to communicate. Ms. Vo
needs a new shunt surgically implanted for her dialysis. She is
receiving it by a different means at the present. The physician,
apparently, does not believe that her state of life justifies the
surgery.
Withdrawal of dialysis with no further attempt at creating a surgical
access port not only condemns Ms. Vo to a rapid and untimely death,
but prevents any initiation of dialysis on an outpatient basis should
her sepsis be successfully treated and maximum medical improvement be
obtained. The family have all observed signs that the mother retains
certain cognitive abilities which may well improve with continued
treatment. Removing dialysis is a preemptive and premature act which
deprives her of a more natural path toward a peaceful end of life and
is contrary to her expressed wishes to fight with all her strength
until her time has come. Dialysis is no longer an extreme procedure
and is performed for many patients on a routine outpatient basis and
can in some case be self administered. To deny such a service in a
critically ill patient without family consent and access to judicial
due process is ethically, morally and very possibly legally wrong. The
care for this lady should continue according to the highest current
medical standard.
A physician I retained to look at this opines regarding the surgical
implantation of the shunt as follows:
Whether to perform surgery is always based on the risks of surgery
versus its benefits in individual cases. When the risk of not
performing surgery exceeds the risk of the surgical procedure, then
surgery is indicated. In this case, as pointed out in the
Continuation of Affadavit, the risk of death without the shunt
surgery appears to be 100%, whereas the risk from surgery, while
perhaps high, is unlikely to be 100%, based on the information
provided. Therefore, using the risk-benefit analysis, this patient
can only benefit from surgery. The fact that she is cognitively
impaired should not be used as a reason to deny her surgery.
The Texas Futile Care Statute gives only the recourse of discharge
from the facility within ten days after the letter from the ethics
decision is given to the family. The facility has found only one
facility that will take her--one in Illinois.
The family lives in Travis County and Illinois is too far--though it
may end up to be the only choice. I am continuing to work on attempts
to slow the process down to find more appropriate placement here in
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