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No. An insured person on full life support is probably about as profitable as it gets.
Court blocks hospital from disconnecting Jahi McMath from life support
- Thread starter William Haskins
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No. An insured person on full life support is probably about as profitable as it gets.
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I'm right there with the mother. I would be in denial if it were my son lying there too. A former co-worker of mine had surgery, got a staph infection, went into a coma, then no brain activity. Two weeks later, she woke up. No idea why. That's enough for me to say don't you dare touch that button. With the advances in medicine, it could be decades or it could be tomorrow that scientists invent something that helps with this issue. I would grasp that possibility and hold on to it for as long as possible.
Sounds like this idiot attorney is laying the groundwork for a malpractice suit (as well as validating Billy Shakespeare's advice).
Parents aren't supposed to bury their children. Children are supposed to bury their parents and 15 years ago my mother passed away on New Year's Eve, which is the reason I don't party anymore on this night.
It was hard watching my mother die, but it would have been crueler to keep her alive when it was time for her to go. Science and medicine are wonderful and have come up with new technologies and methods and machines to keep hearts pumping, lungs breathing, blood flowing and life--or at least a reasonable simulation of life--to continue long past the body's natural expiration date.
I understand why the family is going to these extraordinary lengths for Jahi. In a similar situation I might do the same for my daughter or son.
But at some point the light has to flicker on and the realization comes that I would be doing this for me, not for them and that's the wrong reason.
Letting a loved one go is hard. Feeling that hurt and that emptiness that is never quite fully filled in again is harder, but death is inevitable, it always wins and it never loses. Death is undefeated.
Even IF Jahi were to waken from her coma, what of it? She will be dependent upon machines and 24-hour care for the rest of her life.
This little girl is brain-dead. There is no procedure, no process, no medicine and no cure that will resurrect her brain. For all intents and purposes Jahi McMath is dead with only her outward shell remaining alive.
At what point does the quality of life supersede simply being alive as a faded shadow of who and what you were?
The family of Jahi McMath should let her go and get on with the grieving process they are understandingly delaying.
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That is true. There was a split in the family.
However, both the State of Florida and the Federal government got involved and passed legislation specifically targeted toward her particular case.
From Wiki:
Congress passed similar targeted legislation and GWB returned to Washington from vacation to sign it. Ultimately the courts' decision prevailed, but there it was a huge political divide at the time, with small government conservatives insisting that the state intervene, and big government liberals stating that the government had no business interjecting itself.
http://en.wikipedia.org/wiki/Government_involvement_in_the_Terri_Schiavo_case
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To be honest, that statement was made somewhat tongue-in-cheek. Though nowadays, I do believe that profit vs. cost rates as a higher factor than medical ethics or humanity when many hospital/insurance decisions are made. This is the world we've created.
As a writer, I look at things from multiple views. For example, I can look at it from the hospital administrator's view: the hospital is going to have to pay a large sum of money due to a lawsuit. Add to that, that they will likely also have to eat the very expensive cost of keeping this child alive. For who knows how long. Or their insurance will, which will affect their bottom line also.
A cynical view, yes. But also a possible one.
Anyway, my main point was to show that many people have been declared "brain dead" and then come out of it. Yet I see many here saying "pull the plug already."
I side with the mother and choose not to call her deluded or claim she's prolonging the agony or that she's doing something wrong.
The fact is people HAVE been declared brain dead and awoken before. So of course she's going to hope her child will too.
I have read and empathize with many poster's stories of having to let a loved one go. But letting go of a loved one who has come to the natural end of their life is vastly different from pulling the plug on a 13 year old child who was fine until a moment ago.
And like I said, doctors aren't infallible, nor does medical science hold the answer to every question or scenario imaginable.
If others have also been declared unrecoverable and yet still recovered - against all the advice and assurances from the doctors - how could I not give my child that chance also?
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I Googled and could not find a case where brain death had been diagnosed and the person recovered.
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I posted four links in my original post, though my search was cursory and not research level depth.
"Should have" and "are able to" are not always the same thing. I mean very much in what "should have happened." IMHO it is not a stretch to see how a parent could entrench vs the very system that said everything was fine -- and now it's not.
All I know is demanding a parent make a decision of this type in the same hospital and with the same staff is asking too much of a person. It is not an environment helpful to the decisions that have to made. And that's without laying an ounce of blame on the hospital/staff (which is a different issue).
That's my .02.
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As some of you know, this sort of thing -- pediatric intensive/critical care -- is what I've done for 35 years. I've been in this situation, or similar ones, many times. I have a couple of comments about this case. Bear in mind that we probably don't have all the relevant information.
Regarding the child's cause of death, I'd lay odds she had sudden bleeding from the tonsilar bed, a well-known complication after tonsillectomy if the clots fall off. After that I think she probably lost her airway, either from obstruction from blood clots or some other reason. She was a large girl undergoing the procedure because of sleep apnea. Such people often have difficult upper airways to access and control with a breathing tube in a hurry, and that was what she needed. The back of the throat is also a mess immediately after this kind of surgery and a rebleeding tonsil site can look like the Mississippi River back there. I know this from experience. It's a difficult situation to manage. I assume she went 4-5 minutes without an adequate airway, leading to brain damage and subsequent brain death. This is a common progression after anoxic brain injury from any cause.
So what is brain death? It means no function at the level of the brain stem or above. Function stops where the spinal cord joins the base of the brain. How do we know somebody is brain dead? There are a series of standard and relatively low-tech bedside tests to determine that. We first make sure the patient has a normal body temperature and has no sedating drugs in their system. There should be no purposeful response to any stimuli. The muscles are flaccid. Then we test for brain stem reflexes. One of these is response of the pupils to light -- there should be none. There needs to be absence of normal movement of the eyes to motion of the head (called doll's eyes) or no movement when we put cold water on the ear drum (called cold calorics); both of these measure the same reflex. There should be no blink reflex, called the corneal reflex, when a wisp of cotton is brushed on the eyeball. There should be no gag reflex when we stimulate the back of the throat with a wooden tongue depressor. Finally, the last test of brain stem function is the apnea test: we allow the blood carbon dioxide level to rise and look for any reflex to take a breath.
What happens after the bedside brain death determination varies a little from hospital to hospital. Many hospitals require 2 tests 24 hours apart; if both show no brainstem function, the patient is legally dead at the conclusion of the second test. As an alternative, we can do the bedside test followed by a simple scan to determine of there is any blood flowing to the brain; that gives us an immediate answer, and many hospitals require this for children. If the bedside examination shows no brainstem function and the flow study shows no blood flow to the brain, the patient is legally dead. I write the time of death on the death certificate as the time of the scan.
When I do these things I always want the family with me and watching what I do as I explain what is happening.
That all seems straightforward. As with this case, sometimes it's not. For one thing, not all cultural traditions recognize brain death as real if the heart is still beating. I've been in that situation. For another, sometimes there are reflexes at the spinal cord level that look as if the patient is alive. That's a difficult thing to watch.
The upshot is that I have continued support -- mechanical ventilation, often medicines to support heart and other organ function -- on a brain-dead patient for some time. Usually this is because the family wants some time to cope with things, or else there is a family member traveling to the hospital. I'm always OK with that, up to a point. A key principle here is that a family cannot force me to behave unethically, and continuing organ support of a dead person is disrespectful of the dead -- mutilating to the body. Many ethical traditions, including my own, refuse to do that.
The longest I have ever continued organ support on a dead person was 6 weeks. We had a huge court battle similar to this case, with the court ultimately allowing us to withdraw support. A family member then attempted to enter the hospital with a gun. It was ugly.
The bottom line is that, with the exception of the one case above, I have always been able to mediate the situation by listening to families, being frank about my own duties (both legal and ethical), and allowing them time to grieve. I have always regarded caring for dying people and participating in their death as an honor granted me by the family.
I think there is more going on in this case than we know. Why this case became so adversarial is probably a complicated issue, and these complexities do not translate well to the evening news.
Regarding the child's cause of death, I'd lay odds she had sudden bleeding from the tonsilar bed, a well-known complication after tonsillectomy if the clots fall off. After that I think she probably lost her airway, either from obstruction from blood clots or some other reason. She was a large girl undergoing the procedure because of sleep apnea. Such people often have difficult upper airways to access and control with a breathing tube in a hurry, and that was what she needed. The back of the throat is also a mess immediately after this kind of surgery and a rebleeding tonsil site can look like the Mississippi River back there. I know this from experience. It's a difficult situation to manage. I assume she went 4-5 minutes without an adequate airway, leading to brain damage and subsequent brain death. This is a common progression after anoxic brain injury from any cause.
So what is brain death? It means no function at the level of the brain stem or above. Function stops where the spinal cord joins the base of the brain. How do we know somebody is brain dead? There are a series of standard and relatively low-tech bedside tests to determine that. We first make sure the patient has a normal body temperature and has no sedating drugs in their system. There should be no purposeful response to any stimuli. The muscles are flaccid. Then we test for brain stem reflexes. One of these is response of the pupils to light -- there should be none. There needs to be absence of normal movement of the eyes to motion of the head (called doll's eyes) or no movement when we put cold water on the ear drum (called cold calorics); both of these measure the same reflex. There should be no blink reflex, called the corneal reflex, when a wisp of cotton is brushed on the eyeball. There should be no gag reflex when we stimulate the back of the throat with a wooden tongue depressor. Finally, the last test of brain stem function is the apnea test: we allow the blood carbon dioxide level to rise and look for any reflex to take a breath.
What happens after the bedside brain death determination varies a little from hospital to hospital. Many hospitals require 2 tests 24 hours apart; if both show no brainstem function, the patient is legally dead at the conclusion of the second test. As an alternative, we can do the bedside test followed by a simple scan to determine of there is any blood flowing to the brain; that gives us an immediate answer, and many hospitals require this for children. If the bedside examination shows no brainstem function and the flow study shows no blood flow to the brain, the patient is legally dead. I write the time of death on the death certificate as the time of the scan.
When I do these things I always want the family with me and watching what I do as I explain what is happening.
That all seems straightforward. As with this case, sometimes it's not. For one thing, not all cultural traditions recognize brain death as real if the heart is still beating. I've been in that situation. For another, sometimes there are reflexes at the spinal cord level that look as if the patient is alive. That's a difficult thing to watch.
The upshot is that I have continued support -- mechanical ventilation, often medicines to support heart and other organ function -- on a brain-dead patient for some time. Usually this is because the family wants some time to cope with things, or else there is a family member traveling to the hospital. I'm always OK with that, up to a point. A key principle here is that a family cannot force me to behave unethically, and continuing organ support of a dead person is disrespectful of the dead -- mutilating to the body. Many ethical traditions, including my own, refuse to do that.
The longest I have ever continued organ support on a dead person was 6 weeks. We had a huge court battle similar to this case, with the court ultimately allowing us to withdraw support. A family member then attempted to enter the hospital with a gun. It was ugly.
The bottom line is that, with the exception of the one case above, I have always been able to mediate the situation by listening to families, being frank about my own duties (both legal and ethical), and allowing them time to grieve. I have always regarded caring for dying people and participating in their death as an honor granted me by the family.
I think there is more going on in this case than we know. Why this case became so adversarial is probably a complicated issue, and these complexities do not translate well to the evening news.
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There are some directly antagonistic ethical issues in play here. Patients, and their families, are in charge of medical decision making. But they don't have the right to demand whatever they want. This can be as simple as requesting a test that is not medically indicated or as complicated as this case. Futile care is unethical, particularly if it causes pain to the patient. Of course in this case the patient is already dead, so one could argue that there is no harm in persisting. But there is ethical harm, I think.
I have been in the situation once or twice of requesting, on behalf of a family, transfer to another facility when we have reached an impasse regarding what is appropriate treatment. That is my obligation. But no facility I have ever dealt with would accept transfer of a dead person, which is what is being pursued here.
At any rate, nature has a way of deciding these things no matter what we do. This won't last long, in my experience.
I have been in the situation once or twice of requesting, on behalf of a family, transfer to another facility when we have reached an impasse regarding what is appropriate treatment. That is my obligation. But no facility I have ever dealt with would accept transfer of a dead person, which is what is being pursued here.
At any rate, nature has a way of deciding these things no matter what we do. This won't last long, in my experience.
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That was an excellent review for us. Thank you.
And since one side is (effectively, if not actually) prohibited from expressing itself, we aren't likely to ever know the full tale.
Incidentally, these cases can go both ways. Not only can it be a fight to keep a loved one on life support, but it can be one to enforce an DNR order, too.
I think I've mentioned before that on one of my father's frequent trips to the hospital, I ended up serving as an emergency witness for a family who was literally going door-to-door begging visitors to stand as witness for their father who was being moved to another facility. He was classified as DNR, but they were informed the order only applied to the hospital buildings or nursing care facilities. If he'd flatlined in transit, then "all attempts" would be made to resuscitate him, even though he wanted no such treatment, and the use of such techniques would have reduced his quality of life (there was a pain management issue, IIRC). They had to have a specific document for in transit care, and wouldn't allow him or his children to invoke the DNR without two signed witnesses.
The hospital's hands were pretty much tied in that case, too. They wanted to help this man out, but legally couldn't, and it was remarkably difficult for his (adult) children to locate another person willing to stand as witness for him.
I understand the idea of compassionate care, and even that of keeping someone on life support until their physical injuries have healed to the point that there's a chance their natural ventilation can support their body, but there's something intrinsically wrong with a system that makes it so difficult to carry out a patient's wishes no matter what route they decide to take.
I think I've mentioned before that on one of my father's frequent trips to the hospital, I ended up serving as an emergency witness for a family who was literally going door-to-door begging visitors to stand as witness for their father who was being moved to another facility. He was classified as DNR, but they were informed the order only applied to the hospital buildings or nursing care facilities. If he'd flatlined in transit, then "all attempts" would be made to resuscitate him, even though he wanted no such treatment, and the use of such techniques would have reduced his quality of life (there was a pain management issue, IIRC). They had to have a specific document for in transit care, and wouldn't allow him or his children to invoke the DNR without two signed witnesses.
The hospital's hands were pretty much tied in that case, too. They wanted to help this man out, but legally couldn't, and it was remarkably difficult for his (adult) children to locate another person willing to stand as witness for him.
I understand the idea of compassionate care, and even that of keeping someone on life support until their physical injuries have healed to the point that there's a chance their natural ventilation can support their body, but there's something intrinsically wrong with a system that makes it so difficult to carry out a patient's wishes no matter what route they decide to take.
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I'd like to add my thanks, ColoradoGuy for your input and insight on the matter.
It's a tough situation all the way around.
It's a tough situation all the way around.
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I would also like to thank CG for weighing in here and giving us the benefit of his years of real life experience.
I'd also like to say that I firmly believe that CG is far more representative of the medical profession than are the hypothetical doctors sometimes invoked who care only about money and nothing about their patients and their families.
I'd also like to say that I firmly believe that CG is far more representative of the medical profession than are the hypothetical doctors sometimes invoked who care only about money and nothing about their patients and their families.
Thank you for your insight, guided by actual experience.
And a reminder to all of us that we should have our own wishes in writing, no matter whether you are DNR or full code (complete attempts at resuscitation and keeping you breathing.)
http://content.healthaffairs.org/content/24/5/1311.full
I work in an ER and offer these papers every day. Some people don't want to even think about it, some people take them hesitantly, saying they'll look at them later. And some people accept them and are grateful for them.
As for this case - I think for a family that maybe had little knowledge of medical treatment and how the body works and what the real issues are - coupled with a few stories of "miraculous recovery" - it would be very difficult to say, "Let her go." But it would be the right thing to do.
Adding my thanks & appreciation of your post, ColGuy. Very descriptive with detailed context that provides the POV of individuals involved -- true-to-life-and death.
Agree completely. That statement really got to me, as well. It is the doctors' job to take care of a patient and do their best to make her well. To compare that to "death row" is really implying that the doctors could have done plenty to save her, but chose not to, because they wanted her dead. It's inflammatory and counterproductive.
I agree. In my experience, (which is 10+ years of clerical work in healthcare) those kinds of doctors do exist, but they are in the minority. As in any profession, there is a certain standard of professionalism, and in healthcare, that includes a concern for patients. The ones who have it are far more respected by their peers.
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I just wanted to clarify something here. While there are undeniably some doctors who are more interested in the money than the patient's well-being, my comments were actually more directed at the organizations and companies of the health industry. The ones who hire and fire doctors. The hospitals, insurance companies, HMO's, retirement homes, pharmaceutical companies.
In the end, they are the ones driving these life and death decisions. And the truth of the matter is – they are not in it to make their patient's lives better. They are in it to make a profit, pure and simple. And the rules of the game are the same for them as it is for all businesses: give as little as you can get away with and get as much as you can for it.
So while I have nothing but respect for the doctors and nurses and all those who work on the front lines in the health industry - with professionalism and humanity - I have nothing but contempt for the health industry companies that profess to do things in our best interests, when the reality is that the human body and our health is nothing but a resource to be manipulated for profit.
Why cure something when you can partially treat it and have a customer for life?
Why provide a life-saving procedure when there's another less effective one with a better cost-to-profit ratio?
Who cares if it really works or what the side effects are – prescribe our new medication and we'll deal with the lawsuits later.
Maybe some rest and better food might work for you, but here, take these pills anyway. It's easier for us and we make more money that way.
Yes, give us your old and defenseless loved one. And while you're at it, we can now take everything he or she owns to pay for her stay while charging exorbitant prices for her miserable stay.
Your kids might need a little more attention and care, but give them these pills anyway. This way we'll have a customer for life.
Anyway, just a clarification and some late night rants.
In the end, they are the ones driving these life and death decisions. And the truth of the matter is – they are not in it to make their patient's lives better. They are in it to make a profit, pure and simple. And the rules of the game are the same for them as it is for all businesses: give as little as you can get away with and get as much as you can for it.
So while I have nothing but respect for the doctors and nurses and all those who work on the front lines in the health industry - with professionalism and humanity - I have nothing but contempt for the health industry companies that profess to do things in our best interests, when the reality is that the human body and our health is nothing but a resource to be manipulated for profit.
Why cure something when you can partially treat it and have a customer for life?
Why provide a life-saving procedure when there's another less effective one with a better cost-to-profit ratio?
Who cares if it really works or what the side effects are – prescribe our new medication and we'll deal with the lawsuits later.
Maybe some rest and better food might work for you, but here, take these pills anyway. It's easier for us and we make more money that way.
Yes, give us your old and defenseless loved one. And while you're at it, we can now take everything he or she owns to pay for her stay while charging exorbitant prices for her miserable stay.
Your kids might need a little more attention and care, but give them these pills anyway. This way we'll have a customer for life.
Anyway, just a clarification and some late night rants.
Thanks, Colorado Guy
I had no idea how serious the complications from tonsillectomy could be.
I do have one medical question about brain death. Is there any chance once blood flow is restored over time the brain can recover?
I'm wondering if that is what the family is hoping for.
I had no idea how serious the complications from tonsillectomy could be.
I do have one medical question about brain death. Is there any chance once blood flow is restored over time the brain can recover?
I'm wondering if that is what the family is hoping for.
That seems rather harshly stated. The article says Doctors had recommended the surgery to treat pediatric obstructive sleep apnea, a condition which made her stop breathing in her sleep and caused other medical problems. It's not a liver transplant or PDA repair, certainly, but neither is it a boob job. There are definite health issues involved for individuals with obstructive sleep apnea.