<p>Sylvan, I was reading this just prior to you posting - pretty much what you said:</p>
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<p>From this link:
<a href=“http://medicine.utah.edu/internalmedicine/medicalethics/activities/newsletters/1436_March%20News%202005.pdf[/url]”>http://medicine.utah.edu/internalmedicine/medicalethics/activities/newsletters/1436_March%20News%202005.pdf</a></p>
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<p>What? Of course “somebody” has to declare somebody dead. Why wouldn’t it be the people who have spent their entire career studying the human body, diseases, and treatment, and who are knowledgeable about biological death and have the education and means to perform the tests which give them the critical information with which to make these calls? What, there should be a committee of lay persons and grieving family members to interpret the data? </p>
<p>Doctors are typically the ones to declare a death. In this case, because the family took the issue to court, the doctors had to present their data to the the judge, who, after looking at the evidence provided, legally endorsed their diagnosis…</p>
<p>And then went on to compel treatment in spite of it… very very bizarre.</p>
<p>Yes, that is what is so bizarre-she’s legally dead but the hospital is being compelled to keep her on a ventilator for such an extended period of time. Arthur Caplan, the ethicist, has said that there is no gray area in this case at all-that she is dead and that it is disrespectful to the young girl to have the hospital continue to have to treat her “corpse.” </p>
<p>It is too bad a close family member, friend, or pastor cannot help the mother to understand this.</p>
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<p>At what cost? No one here has addressed the fact that while this mother is trying to raise funds to bring one daughter back from the dead, she has another daughter who is very much alive and who is being forced to participate in this charade. In one photo I saw, this child was standing outside, holding a sign begging people to help “save" her sister.</p>
<p>I find it quite troubling that the adults in this family have opted to devote themselves wholeheartedly to the cause of their dead child, while utterly abdicating their responsibilities to her sibling, who most certainly needs both their support and an opportunity to mourn her lost sister.</p>
<p>Dodgers, the fundraising was addressed early on in the thread.</p>
<p>Sadly, they are not absorbing that fact at all. Rather they are continuing to vehemently deny it and are being aided by a publicity seeking machine. I’m not unsympathetic to their loss but the cause is more troubling the longer it continues for all of the reasons others have mentioned. The eventual outcome is obvious.</p>
<p>I’m not a medical person, but my understanding is that giving a family a short period of time if necessary to absorb the loss and to potentially gather (24-48 hours ) is more the norm, not keeping someone on a ventilator for weeks.</p>
<p>This is highly unusual, perhaps unprecedented. And the judges ruling that includes both a declaration of death and continued life support is just bizarre.</p>
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They need time to absorb the fact that their daughter went in for a routine operation and ended up dead"</p>
<p>A mother who gives birth to a stillborn or who has a child who does in the NICU doesn’t have unlimited time. They bring the child to her to grieve - and then at one point it’s taken away to be buried. Hospitals cannot indulge everyone’s whims.</p>
<p>I find the “medical ethics” issue to be interesting.
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<p>But Pizzagirl, no one is talking about sawing a healthy leg off of a living person. That would harm her. If this girl is dead, nothing that is done will harm her. Isn’t that the actual touchstone of “ethics?” By your standards all elective cosmetic surgery is “unethical.”
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<p>Neither of those things strike me as a valid exercise of the use of “ethics” to force a decision against that person’s family’s will. I understand that the dead body on life support was unpleasant for you, and that would be a valid reason for you to decline to particpate. But if another doctor is willing to provide the care - are you saying that your distaste for the procedure (which cannot harm the dead person) is sufficient to support a conclusion that that doctor is “unethical?” Even if he/she tells the family the truth about the situation while providing the requested medical care? I also agree that it’s a waste of resources, but I feel that a lot of the medical care given octogenerians in their last year of life is a waste of resources. Are the doctors who operate on the elderly “unethical?” (Actually, I’d argue that in too many cases I would say they are. But I’m less willing to say that when the patient is a child.) But again, if there are willing funders for the exercise - not the taxpayers - that’s not a valid ethical issue either, IMHO.</p>
<p>The bottom line, to me, is that the Texas law strikes the right balance: “The Texas law, signed in 1999 by Gov. George W. Bush, allows doctors to remove life-sustaining treatment over the objections of families, provided an ethics committee agrees and the hospital gives the family 10 days to see if another facility will accept the patient.” (And for those of you who think I never have anything good to say about G.W. Bush - so there!) If a medical facility agrees to take on the burden, and the taxpayers aren’t paying for it, I see no ethical issue here at all. And considering the religious perspective of some medical facilities, I can see that an institutional candidate for keeping brain dead people from ceasing to breathe is not far fetched. </p>
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How about we nominate Dr. Kevorkian, then? I know that’s flip but as a society we have a default decision maker, and it’s the courts. Judges don’t design and build buildings either, but if one falls down the issue of whether some recourse is appropriate falls to the courts, not the local society of architects. (And you can bet that there will be an architect giving an opinion on both sides of the issue when that happens.)</p>
<p>This story disturbs me on so many levels. 
And I simply cannot imagine what the family is going through, or what they are thinking.</p>
<p>We don’t have to imagine what they are thinking since they have been on TV for weeks telling reporters and talk show hosts that they are thinking their D is alive. It’s disturbing.</p>
<p>“If this girl is dead, nothing that is done will harm her”</p>
<p>Then why not keep every dead body on a ventilator? What’s the harm?</p>
<p>I wonder where are their relatives and friends on this. I recently had to help my mom to let my dad go when he was pronounced brain dead. He looked like he was still breathing, but it was the machine which was doing the work. My mom couldn’t and wouldn’t believe my dad was gone. She kept on saying that my father was still alive. My brother and I had to convince my mom that it was best for my dad to let him go. I don’t think my mom could have made the decision by herself. My mom was angry with us for a while for not giving her more time, but now she feels better that we helped her with the decision. It is never easy. I think the parents may benefit to have support from their close friends and relatives.</p>
<p>kluge, if you have to ask how keeping a patient on a ventilator whose brain has herniated and died and which is now rotting to the point the patient begins to smell, all while giving the family the notion that there is hope of Dad “waking up,” which is what we are doing by providing treatment intended to save a life, then there is really no point in responding to that.</p>
<p>The fact that this treatment does not cause physical pain to the dead patient is not the determinant of ethical practice. It would be just as unethical for me to desecrate a corpse-saying the patient can’t feel pain doesn’t lessen the ethical breech. </p>
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<p>They certainly can be, depending on the situation! </p>
<p>Ethical questions are often difficult, which is why hospitals have ethics committees as well as patient/family advocates to look at these kinds of situations. Unless there is benefit of mechanical support (say, in the case of a pregnant brain dead patient with a near viable fetus), there are probably few to NO ethics committees which would advocate long term mechanical support of a patient who has been declared dead.</p>
<p>Keeping a dead patient on mechanical support simply because family wants a warm body to hold onto is indeed a terrible allocation of resources in a country where many live patients cannot get access to proper care and is a travesty imho. </p>
<p>Private facilities which want to fund this kind of thing at their own expense would be setting a precedent which they would not be able to continue to fund, as money happens to be a finite commodity regardless of how strongly someone believes these actions could be justified. The kind of care required here is extremely intensive and requires a whole team of professionals literally 24/7. That is incredibly expensive and in reality, there are few entities which could sustain that at their own cost for even one patient, plus the other cases which would inevitably follow the precedent being set.</p>
<p>romanigypsyeyes - It’s not the fundraising that’s the issue. It’s the fact that there’s a second child here - a very much living child! - who’s being utterly neglected.</p>
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I said there is no harm to the dead person. But there is a cost. If her family sees a benefit, wants to (and can) pay the cost, and finds a facility which is willing to provide the service there is no harm to anyone but the family which chooses to spend those funds in a way you or I might disagree with. That’s why we wouldn’t keep every dead body on a ventilator - those circumstances don’t align for every body.</p>
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My mother’s wish was to donate her dead body to science - which we did, enabling medical students to have a cadaver to “desecrate.” I don’t see the lack of ethics there.</p>
<p>I don’t think that a facility which provided the medical services without falsely supporting the family’s belief that the girl will “wake up” is being unethical. Just not assuming godlike omniscience. Remember - I agree with your opinion; the family should let go. The girl is not coming back to life. Prolonging treatment is a waste of money and I wouldn’t support having the taxpayers foot the bill. But the question here is whether it is unethical to continue ventilation, etc. if requested by the family, paid for by the family, and a facility (for whatever reason) is willing to provide it. I’m not suggesting that any doctor or medical facility should be forced to provide that care, but that a facility which chooses to do so is not engaging in unethical conduct. There’s a big difference; we have not yet reached the endpoint of “everything that is not prohibited is compulsory.”</p>
<p>Reading some of the responses of the idealistic who advocate keeping dead people “alive” mechanically so that family don’t have to truly face their loss makes me wonder if they have ever set foot in an intensive care unit or long term rehab facility which specializes in ventilator dependent comatose/persistent vegetative state patients. I wonder if they have seen the conditions of these patients over time and the toll all of this takes on the patient and the mental, emotional, and financial lives of the families involved. I truly wouldn’t wish this on my worst enemy. It’s horrible, horrible, and beyond horrible.</p>
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<p>Oh good grief, you really cannot see the difference between a person making a conscious decision to donate their body to science with positive benefits of same to humanity and “desecration” of a corpse from an ethical standpoint? Now I think you are just being deliberately obtuse or argumentative.</p>
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<p>The children’s hospital is currently being forced to do exactly that.</p>
<p>“Arthur Caplan, the ethicist, has said that there is no gray area in this case at all-that she is dead and that it is disrespectful to the young girl to have the hospital continue to have to treat her ‘corpse’.” </p>
<p>In my next life, I want to be a medical ethicist. Then I can make impressionistic, pompous pronouncements and act like they are significant insights. </p>
<p>While I continue to sympathize with the family, the real problem here is one of cost. The real problem is that there are resources devoted to maintaining the pretense that a dead person is alive when the same resources could be devoted to improving the lives of living people.</p>
<p>Haven’t researched the law, but my initial impression is that the judge is an incompetent fool. Perhaps zoosermom or someone else can enlighten me, but I cannot imagine that the rule is that the hospital is required to continue to provide life support for the body of person who has been determined to be dead by the competent authorities.</p>