<p>Not puzzling. The week is for the federal court to accept briefing and make a ruling. As I said, the federal briefs are due tomorrow and the state court judge has to accommodate that.</p>
<p>“I didn’t find him to be either pompous or self important, although I can see how his stated views might seem threatening to those who disagree with him.”</p>
<p>I am not threatened by idiots, no matter how many degrees they have.</p>
<p>I think that 3Trees and Nrdsb4 have both made excellent policy arguments in posts 688 and 691 (as has Zoosermom in 693.) </p>
<p>To me the matters they address are in fact the crux of the issue: rather than relying on a talismanic pronunciation such as “She’s dead, Jim!” and acting as if that resolves all of the conflicting interests, addressing the consequences of different courses of action and what they mean to society - in this case and those to come - is relevant. Yes, if the parents win in this case (and assuming, best case scenario, that the girl is trached, transported somewhere, and lives a few more weeks or months) that will make some hospital corridor conversations more difficult, as some people will demand similar treatment. That’s a negative outcome. But I see people making what I consider equally irrational demands with regard to their elderly parents all the time. I keep bringing this up because the issue is huge with the elderly - far greater in terms of expense and baseless hopes for miracle recoveries than what is at stake in this case. But we don’t face that as a society. </p>
<p>I sat with my Mom until she died after her hydration tube was removed a day after she had a stroke. She didn’t even require a ventilator; to accomplish the end of her life it was necessary to essentially starve her body of needed nutrients. That was her wish and we all agreed. But many families would have hooked Mom up to all the apparatus in the world and kept her breathing until some other merciful event happened. I get that people like simple answers and “brain death” is a simple, physically verifiable status which can trigger a simple list of responses. “This means X, therefore we must do Y.” Of course that leads to “This is not X, therefore we should not do Y” which may not, in fact, be a wise course of action. </p>
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I don’t know how many degrees you have, EMM1, and I certainly don’t have an M.D. myself. But I was able to glean enough from Dr. Shewmon’s article to see that he’s not an “idiot” or a crackpot. His point is simple: if you reason that “brain dead” means “dead” because a person cannot survive without a functioning brain, that’s medically false. (Obviously, I haven’t personally attempted to test that.) On the other hand, if your basis for equating “brain dead” with “dead” is based on the fact that they’ll never recover anything resembling humanity, then Dr. Shewmon would appear to agree with you.</p>
<p>The significance of Christopher Reeve is that without a ventilator his entire body would have died, too. If your definition of “dead” is “can’t survive without a ventilator” then he was dead, too. Dr. Shewmon’s point is that as long as a person who is “brain dead” is attached to a ventilator their body won’t die, either.</p>
<p>Again, I understand the policy issues alluded to by 3Trees. But I think it’s valuable to recognize that they are policy decisions, not a scientific determination that the soul has left the body or whatever “dead” means in a cosmological sense.</p>
<p>On reflection, I realized that I should have given a more reasoned response to kluge’s condescending characterization of me and my views.</p>
<p>We begin with a reasoned argument–in a society with scarce medical resources, those resources should not be devoted to preserving the bodily functions of an entity that has no emotions, no physical sensations, no thoughts, and no possibility of evolving into an entity that has emotions, physical sensations, and/or thoughts, simply because that entity used to be what we describe as human. Now, if someone else says that he has a religious belief that people in the girl’s situation should be kept alive, or a gut feeling that that should be our social policy, that person in not necessarily an idiot; he is simply someone with whom I disagree, and because God has not spoken to me personally on this point and therefore I see no reason to change my position (although, under the Angels in the Outfield rule, it could happen).</p>
<p>But talking about a “conscience-based approach” as if that advances the argument is nonsense, as is the implication that we should give the family time to raise the money (whose going to pay for the costs of the interim care if they don’t) or indeed suggesting that there is going to be some facility somewhere which which not suck up any public resources in continuing this level of support. That comes under the SDW principle (Seriously, dude? Whatever) and the fact that this guy thinks that he is making an important contribution to the debate makes him an idiot.</p>
<p>Because our posts crossed, I have one last point. This is not a medical question. To my knowledge, no one can point to any case of a person who was brain dead and then recovered function. The question is how many resource should be devoted to maintain the entity in this situation.</p>
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<p>But she’s not <em>living.</em> She is a dead person whose body is being mechanically supported. If I exhumed someone and put them on something mechanical to make their lungs inflate / deflate, I haven’t brought them back to life. They’re still dead, but with lungs that are responding mechanically to pressure. </p>
<p>Anyway, the fact that there could be multiple definitions doesn’t mean that we can’t agree on at least <em>some</em> standards. To your point about making medical decisions for elderly people who are incapacitated (which of course happens everyday in this country) – yes, there are folks like you, who would do X for your mother, and other folks who would do X, Y and Z, but even those who are doing X, Y and Z haven’t been arguing that if resuscitation fails, that their loved ones should still be maintained in a state of suspension as is being advocated with this young lady.</p>
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<p>What prevents me from saying that my (hypothetical) miscarriage at 16 weeks shouldn’t be hooked up to ventilation, etc., then, because I’m so devastated and shocked over it? 16 weeks is far below viability. Maybe I should say this fetus isn’t “dead” because I haven’t declared it to be, or that it’s viable because I want it to be.</p>
<p>Is anybody (cleric, therapist) talking to the mom/parents and trying to get them to “let go”?</p>
<p>Pizzagirl, That Baby K link I posted (#687) was about a little girl with anencephaly (which you brought up earlier). Another example of a parent insisting that their child be ventilated and treated despite medical advice and the futility of it.</p>
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Actually, I believe that the federal court steps in on Monday, so its unfortunately possible that this will not all be over with the state court ruling on Monday. What is it that the Federal courts will be considering? Anyone know?</p>
<p>I’m not sure what Pizzagirl’s miscarriage hypothetical has to do with my argument. Wouldn’t the fetus be dead? And in any event, I wasn’t saying anything about where the line should be drawn; just that, in my view, this case is clearly on the pull the plug side.</p>
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<p>It wouldn’t do any good as the mother believes she is alive and has stated that she believes there will be a miracle and her daughter will wake up and recover. If I truly believed that, telling me to let go would make no impact whatsoever. She would have to believe the child is gone before she can begin to grieve. If even one person tells her that her daughter is alive, she is hanging in there, and she has many people telling her just that. Thus, her refusal to give up is not surprising.</p>
<p>The federal court doesn’t have to take the matter and probably won’t. The state court date is later for that reason.</p>
<p>I assume those advancing the “scarce medical resources” argument are prepared to ban elective cosmetic surgery on those same grounds?</p>
<p>Pizzagirl, your post expresses the “talisman” aspect of the argument. You simply repeat: “She’s not <em>living</em>” as if making that statement is self-explanatory and resolves all issues. If her entire body were dead tissue, I’d agree. But it’s not. Most of her body is <em>living</em>. I agree with you (and, I believe, Dr. Shewnow and others who have addressed the issue) that as a policy matter, once a person is brain dead a line has been crossed which justifies moving them from category “A” to category “B.” And in my opinion crossing that line means we should let the person go. But simply saying she’s dead because she’s not <em>living</em> isn’t reasoning or being scientific, it’s being tautological.</p>
<p>As someone upthread mentioned, the local paper in the area, the San Jose Mercury News, has been an excellent source of up-to date information (and many of the links posted in this thread). A week ago they published this editorial [Mercury</a> News editorial: No one recovers from being brain dead - San Jose Mercury News](<a href=“Mercury News editorial: No one recovers from being brain dead – The Mercury News”>Mercury News editorial: No one recovers from being brain dead – The Mercury News)
I was going to post excerpts, but its hard to select the most poignant quotes. The whole editorial is an excellent read. And well said.</p>
<p>“I assume those advancing the “scarce medical resources” argument are prepared to ban elective cosmetic surgery on those same grounds?”</p>
<p>Without taking a position on the issue, the two situations are not analogous at all. Elective plastic surgery provides benefits to a sentient being. The girl is no longer sentient.</p>
<p>OK- changed my mind in response to kluge’s post above. First of all, much plastic surgery (referring to the typical elective cosmetic surgery, not, for eg, reconstruction after mastectomy or reconsruction after disfiguring accidents , dog attacks, etc) is done in day hospital settings, with post op recovery, not in an ICU. The analogy to Jahi’s case is ludicrous.
Here is a relevant quote from the editorial
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<p>But do you approve of this? Don’t you think that we should start looking harder about the appropriateness of futile, painful, expensive treatment? To say, other people use medical resources inappropriately so we should expand the universe of people using medical resources inappropriately seems to me to be moving in the wrong direction. If in some cases elderly or dying people are getting treatment that, if they were better informed, they would refuse doesn’t mean we should now start handing out more futile, expensive treatment. We need to move in the other direction.</p>
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I would argue that the parent’s desire to see their daughter continue to breathe is as much of a “benefit to a sentient being” as Barbie’s desire to have larger breasts is a benefit to Barbie (and Ken, for that matter.)
We’re talking abut banning this because of “scarcity of medical resources.” I’m sure those skilled plastic surgeons and their facilities and support staff could be repurposed to serve the medical need that’s currently perceived to be threatened by keeping this girl on a ventilator. I’ll even make it simpler; how about we just ban plastic surgery for octogenerians with Alzheimers? [East</a> Bay doctor disciplined in face-lift fiasco - SFGate](<a href=“http://www.sfgate.com/health/article/East-Bay-doctor-disciplined-in-face-lift-fiasco-5086984.php]East”>http://www.sfgate.com/health/article/East-Bay-doctor-disciplined-in-face-lift-fiasco-5086984.php)</p>
<p>CF, I think I said this up-thread, but I’ll say it again: yes. But to be honest, I’m more sympathetic to the parents of a 13 year old than I am with the children of a bedridden, senile 93 year old who insist on a full court press to keep Dad breathing another day. Others disagreed.</p>
<p>Here is the letter the hospital attorney sent to Jahi’s attorney on the 29th. [READ:</a> Oakland Children’s Hospital Releases Letter to McMath Family Lawyer | NBC Bay Area](<a href=“READ: Oakland Children’s Hospital Releases Letter to McMath Family Lawyer – NBC Bay Area”>READ: Oakland Children’s Hospital Releases Letter to McMath Family Lawyer – NBC Bay Area)</p>
<p>Kluge,
Your questions and arguments might be good fodder for medical ethics classes, but they are really stretching a bit too far. The parents wanting to see a dead body “appear” to be breathing is their fantasy, which has no medical basis. And the “sentinent being” is one person removed. As others have said, in this circumstance, the medical and legal determination of her death trumps the family’s desire to see her dead body appear to be alive. It is really morbid. </p>
<p>And you really think that plastic surgeons should be “repurposed” to serve the needs of patients who need to be on a vent in an ICU? Come on. This is silly. But, I agree that a “lifestyle lift” for an 82 yr old man with multiple medical problems, including dementia (have to wonder how severe the dementia was) is also perhaps not a good medical decision. How long did it take you to find that article?</p>