I can see the utility of having a “legal” definition of death as being equated to “brain dead” but I also see that it is essentially an artificial line. As a matter of policy I support using it for determination of when a hospital is obligated to provide care as an ethical matter regardless of other factors: living people cannot be allowed to die because the hospital elects not to treat them. I find it less compelling as a justification for choosing to refuse to do so at the request of family.</p>
<p>Well, Kluge, on this we apparently agree: We are long overdue for a nationwide, eyes wide open debate about medical futility. </p>
<p>I know a fair amount about the medical consensus on brain death; of course outliers can be found to claim otherwise but the scientific basis of their claims is far shakier than those who deny climate change is happening. Others have posted the legal definition of brain death here, it is widely accepted legally as well as medically. And if we cannot, as a society, agree that providing scarce and expensive care to a dead body meets the definition of futility then we are accelerating an economic trend in which costs for medical care crowd out so much of our public and private spending on other positive goods that we will risk a significant rupture in our social fabric.</p>
<p>What about anencephalic babies (born without a brain), that will absolutely die, no questions asked? Right now it’s my understanding that they are simply provided comfort care til the inevitable happens, typically within a few hours. Are you suggesting, kluge, that if someone gives birth to such a baby, they get to decide the treatment, and that if a grieving mother wants the baby put on a vent so she can watch it “breathe” she should be able to do so?</p>
<p>Kluge - that’s the Alan Shewmom guy who is well known for being “contrarian” on this issue. He doesn’t represent mainstream neurologist thinking at all. He’s rather like what Behe is on evolution.</p>
<p>Oh, I agree with you wholeheartedly, 3Trees. In fact, I’d probably be more aggressive than you about cutting back on medical spending on the hopelessly ill - particularly in the case of the elderly who have one foot in the grave.</p>
<p>It’s just that the “definition” of “dead” being “brain dead” - even when the rest of the person’s body is alive and as viable as Christopher Reeve’s was for many years - is, in fact, artificial. I’m not saying that’s a bad thing, or even unnecessary. It’s just that pretending it’s somehow the word of God rather than a consensus based on practical considerations is not accurate. Dr. Shewmon’s point is, I believe, well taken: we declare a brain dead person to be “dead” because we are confident that they will never regain “personhood.”</p>
<p>But we keep lots of people breathing who are in the same situation. In recent weeks, while visiting potential homes for my aged father in law I’ve seen many of these people. But no one argues that they’re not “alive” or that they should not receive the medical treatment that is required to keep them breathing.</p>
<p>Pizzagirl, if the mom can pay for it and the treatment doesn’t prevent others from getting needed care (triage), yes. If she can’t, then I don’t think the taxpayers (or her insurer) should be required to pay for that treatment. To me that’s the simple line to be drawn.</p>
<p>There are also different guidelines and requirements in different states. NY allows for “reasonable accommodations” for religious reasons, including continuation of artificial respiration in some cases. There are responsibilities of the medical facility, as well as rights of the surrogate for the patient. These things don’t spell out the details of every eventuality, so there is certainly plenty of room to litigate. I don’t think there is any way around that if there is a real dispute between both parties. There may be scientific consensus (but I don’t think so), but the laws and rules in 50 states are pretty messy.</p>
<p>Kluge, I suspect I agree with you about the futility of much care offered at the margins of life (including to anencephalic infants as PG suggests). The problem with premising futile care on the ability of a private party to pay for it is what happens when they run out of money or decide they would prefer to use their funds elsewhere? Would we not be outraged at “pulling the plug” solely on the basis of failure to pay? We are much safer, I think, aiming to achieve consensus (unanimity may not be possible if there is so much disagreement about whether or not it is a good thing to provide intensive, invasive, expensive care to even a dead person) about where to draw the line in terms of accepted medical facts. Zoosermom is usefully reminding us that the court has not yet drawn a line and I think we are all hoping that when their original order goes into effect the legal precedent will remain that care facilities are not required to provide care to dead bodies when the family requests it.</p>
I think it will do that. But I do think that the requirement the care provider must cross its Ts and dot its Is will remain. And I think that’s the right thing.</p>
<p>No matter where you draw the line, there will be someone just on the other side of it. And it’s not true that “no one” argues that certain individuals should not receive treatment that keeps them alive. Decisions are made every day by next of kin, POA’s, doctors, or patients themselves to cease treatment that sustains life. Not just mechanical ventilation, but things like medications, feeding tubes, chemotherapy, etc.</p>
<p>That is a very good article, but I was talking about procedures for what to do in the event of brain death. I don’t think there is consensus on that at all and I don’t think there can be because hospitals in at least some states (I would bet most or all) are allowed a lot of discretion.</p>
Exactly. ANd that is why the court is the final decision maker and we should all be glad that anyone can have a fair and impartial hearing from the judiciary.</p>
<p>I thought the consensus was that once someone is declared brain dead, it is standard to give the family a brief amount of time to absorb the loss and then take the person off the ventilator?</p>
<p>I didn’t get the Christopher Reeve comment either. He certainly was not brain dead.</p>
<p>“I thought the consensus was that once someone is declared brain dead, it is standard to give the family a brief amount of time to absorb the loss and then take the person off the ventilator?”</p>
<p>Isn’t this exactly what was happening when the family called the news media with claims that the hospital wanted to kill their child?</p>
<p>And, yeah, Christopher Reeve’s brain was fine, his body was not.</p>
<p>That is usually the way it goes. Other times, the family says goodbye at the bedside and permission is given for organ donation. And rarely, there is a legal challenge.</p>
<p>There are different rules and legal requirements in every state. Standard can be whatever, but if the parties are in dispute, then the law has to be followed.</p>
<p>The judge’s ruling is what’s difficult to understand in this case. He agreed she was dead but elected to give them another week of “life support” and then another. That’s puzzling.</p>