Great question, and good for you for addressing it now while you're young and healthy. The majority of my critical care patients are elderly with multiple comorbidities, however when I practiced at the local trauma center, roughly half of my patients were very young. Your organism doesn't care about age, and you're not immune to sudden catastrophic injuries or illnesses that can take you down quickly. My neuro ICU typically has at least 3 or 4 people under the age of 40, who suffered intracranial hemorrhage, acute respiratory failure/ARDS from pneumonia, or pregnancy-related complications, etc. Point is, it's important to address this at every age if you care about your quality of life when you're no longer able to make those decisions in real time.

There is no magic number of days, but you should think about how that state of being comports with how you want to live your life. In most cases, it's pretty clear whether someone will never return to their previous state of health, when certain forms of acute injury strikes. Massive debilitating stroke, intracranial hemorrhage, things like those can and will change your life forever, and it's pretty clear early on (within minutes of starting a CT scan, in some cases) that the quality of life ship has sailed. Then there are cases where the treatment and recovery is lengthy with a fairly broad set of possible outcomes.

I've seen thousands of patients on life support and with little hope of recovery, and the absence of a living will, or an ignorant, conflicted family member charged with making these decisions, can make goals of care and disposition a living nightmare for the patient.

If you don't want to live in a state of incapacitation, and your life is being artificially prolonged, make it clear in that living will that as soon as it's reasonably certain that no meaningful recovery--to the standard you establish (walking, talking, interacting with people, for example)--you want those artificial means of life support discontinued and your goal of care to be comfort while your family says goodbye.

Or, you can opt for a tracheostomy, PEG tube feeding, and years of decubitus ulcers, strokes, and other insufferable forms of misery in a long-term care facility. Not the course I or anyone who's worked with this population first-hand would likely recommend. Absent a living will or competent POA acting on your behalf, that is very often the outcome, and it's tragic.

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The devil made me do it the first time, second time I done it on my own - W

To address the insurance point. Are you asking if you have a massive disabiliting stroke but we're the provider of insurance, you'd want to be kept in a persistent vegetative state so your spouse and kids can keep their insurance

I really wonder if that insurance would continue to apply to them if you can't work, earn money, pay premiums

There is nothing as undignified as those requiring palliative care receiving ridiculous hail Mary treatments to extend their life by days

If I were in a vegetative state with no meaningful chance of recovery. Pull the plug

Definitely not that- just curious if 0 days vs. say 30 days gives the family a difference in being able to adjust without putting them at further risk. Especially if say it was a car accident and another family member was severely injured as well and using that health insurance.


ETA ‘MERICA!!! Only place we get to have these considerations

Everything Spher said.

I’d put a 1 in the box to let family say goodbye and then move on. The doctors know if you’re coming back. There are no miracles.

I’d add to that if you are of age to be an organ donor please make sure its known the you wish to donate. A head injury or massive stroke will kill the brain, but the rest of the organs are still viable.

Good on you for taking care of these issues.

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"When the power of love overcomes the love of power the world will know peace." Jimi Hendrix