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<p>People have given you and this situation thoughtful consideration. There are well over 1,000 posts here. The fact that you go back to those with Alzheimer’s and those in a PVS makes it clear that something is not getting through. </p>
<p>Thought short, easy to digest bits might be better.</p>
<p>kluge,Though tempted to rip off this brace and go to town, it would take a lot of time to find some literature to explain this to you and/or try to articulate it myself. But I’m not going to. A)was soundly lectured for not seeking treatment u til today, and B)I don’t feel like spending that much time to edcuate you, kluge. It’s not my responsibility to satisfy you with a lesson in critical care and breakdown of the body after brain death. If you don’t want to take our word for it, don’t. Not a problem. Look it up yourself.</p>
<p>kluge, You sound like a good son in law and your example is a perfect example of why equating a brain dead child with an elderly person makes no sense. As you illustrate, your FIL is still there at some level. My mother was in the early stages when she died and MIL at late stage. Even my mother was getting confused, saying she just wanted to die (and had never said these kinds of things before). There are no easy answers but I think you will do what most faithful children end up doing-supporting him until the end. Unless we are going to start actively hastening the death of the elderly, all we can do is provide support. I highly recommend hospice care when he does qualify for it. It can be provided within a memory care unit.</p>
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<p>I do think what is at the heart of this situation is the various usages and interpretations of coma, PVS and brain dead. Equating coma or PVS with brain dead is almost like equating an infected hangnail to a horribly gangrenous finger. </p>
<p>The owner of the facility in NY, New Beginnings, keeps referring to her facility as one that treats victims of TBI (traumatic brain injury) and that that’s what makes her facility qualified to care for Jahi. TBI does not equate with brain dead.</p>
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People don’t have to wait to qualify for hospice care any longer. Most hospice organizations now offer palliative care, which can be initiated much earlier than when someone can qualify for hospice care. If someone takes advantage of palliative care, and is with an organization for some time, it then makes the transfer to hospice that much smoother when the time comes.</p>
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I wasn’t treating the two as interchangeable. I was comparing the functions required of a critical care transport team moving a brain dead person with the functions required of a critical care transport team moving someone who was in a coma or long term PVS. I’ve heard loud insistence that the functions of that team would be different, but no specifics about how they are different or why. Still waiting.</p>
<p>RGE, you were SHOUTING. SHOUTING the same thing that others have already said won’t “get through” to me. Sorry. And frankly, “she’s NOT ALIVE!” doesn’t strike me as particularly thoughtful. We all agree that she’s brain dead; we all agree that the family should let her go. I don’t agree that the family should be forced to do so beyond the inherent pressure of being told that the taxpayers won’t pay to keep their daughter on the ventilator. The vehemence and emotion behind the insistence that the family must be forced to comply is what I am surprised by. (PVS only came up in response to the assertion that a critical care transport team would be facing a “novel” situation in transporting this girl; I question whether that’s true, although I’m still waiting for some coherent explanation why I may be wrong about that. Kidney function? Blood pressure? Skin melting off, as suggested by Cardinal Fang? Whatever it is, no one has articulated it.) </p>
<p>You’ve made it clear that the “bright line” of a diagnosis of brain death is the end of the discussion for you. To me, it’s the starting point of the discussion of societal values, freedom of choice, prohibition and compulsion. It’s all right if you don’t want to talk about those things, but please don’t SHOUT at me, okay?</p>
<p>That is good info, teriwtt.</p>
<p>If Jahi’s body really is in a facility, I can’t imagine what kind of facility that would be. No reputable facility that I can think of would take her. All of the facilities here in the bay area and further out into Bakersfield specialize in TBI treatment. The patients that they accept have much higher motor function than my brother. I’ve had personal experience with 3 facilities, plus one extension campus in California and none of these would ever entertain the notion that they would take a brain dead person (an rightfully so). I’ve heard a rumor that the facility that housed Terri Shaivo has offered their services. If that’s true, ugh.</p>
<p>Sevmom - I should point out that palliative care is quite different from hospice care, but they both have their places and are better than the alternatives.</p>
<p>This brief scratches the surface of what is happening to Jahi’s body. BTW, kluge, a person in PVS may not even be vent dependent and could process nutrition just fine. That’s a hell of a difference. </p>
<p>The average vent-dependent PVS would have had a trach by now. Transporting a trached vent patient -much safer than a vent patient such as Jahi, whose tissues are probably so eroded as to present a very unstable situation with regard to dislodging the cuff and ensuing problems with that. This is JUST the first thing that comes to mind. There are pages that could be written of other differences between the condition of a 3 week brain dead patient and a person in a coma or PVS who has blood flow to the brain. </p>
<p>In his press conference today, lawyer stated that Jahi’s body showed considerable deterioration apart from her brain issues. But they really have everything to do with her brain death.</p>
<p><a href=“http://media.nbcbayarea.com/documents/HeidiFlori.pdf[/url]”>http://media.nbcbayarea.com/documents/HeidiFlori.pdf</a></p>
<p>The fact that the lawyer is acknowledging that there is considerable deterioration but they continue to keep her on a vent is very troubling.</p>
<p>[Delay</a> in Jahi McMath Autopsy Complicates Cause of Death Ruling: Experts | NBC New York](<a href=“Delay in Jahi McMath Autopsy Complicates Cause of Death Ruling: Experts – NBC New York”>Delay in Jahi McMath Autopsy Complicates Cause of Death Ruling: Experts – NBC New York)</p>
<p>The lawyer is blaming this on lack of care by the hospital. Attempting to position them for a monetary award. “Oh, she wouldn’t have died if they had only taken care of her.” </p>
<p>Right.</p>
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<p>My mother is 90. She lives alone in her own house, which she takes care of herself. She is very fit, and takes 2 brisk hilly walks per day. She reads The Economist and The New Yorker, amongst other things. She recently had cataract surgery, which has made a huge difference in her sight, particularly night vision. I think that your assumptions regarding the elderly are excessively broad.</p>
<p>A crucial difference in my B’s care while he was PVS and that of Jahi’s care is that after a week on a ventilator and numerous tests, he was pulled off of it because he could breathe on his own. He still had a trach tube for a couple of years thereafter, but he never required the use of a ventilator in order to breathe after the first week. Jahi will always require this device to “live.”</p>
<p>Edited to add: Nrdsb4 beat me to it!</p>
<p>Kluge, I don’t actually think the unanimous opinion on this thread is that a family shouldn’t, in theory, have the right to reject the concept of brain death as death and do whatever they like with their child within the bounds of public health. However, this is ONLY possible in theory, because the reality is that the sophisticated medical technology needed to keep Jahi McMath’s body alive isn’t something available to anyone but the most fabulously wealthy of private citizens. Indeed, even that hypothetical wealthy person is probably going to have to take what may be a considerable amount of time to find medical professionals willing and able to do everything necessary to facilitate a transfer, which will itself require cooperation from hospital doctors. In the interim, the hospital and taxpayers are on the hook for expensive treatment and ICU resources are being spent on a legally dead person.</p>
<p>I may not agree, for instance, with a fundamentalist parent who wants to educate their child at home, but those parents aren’t relying on state resources to do it; while one could claim that their actions constitute social harm in the long run, it isn’t anything like the direct reliance on public resources we’re seeing here. In this case, it is simply not possible to allow these parents to pursue their uninformed belief without immediate public cost.</p>
<p>I actually agree with you that equating with brain death with death is a practical, rather than absolute, designation. But while it may not be a necessary fact, it is not an arbitrary opinion either. There are very good reasons that many posters have brought up to treat a brain-dead person differently from someone in a PVS or an advanced dementia patient. Given that, I don’t think we have a social obligation to just allow this family to do as they please, no matter how sorry I feel for them. Indeed, we have a social obligation NOT to. </p>
<p>Surely, there is some point where we have to draw the line, or else we could get to the point, given advanced enough science, where we artificially sustained all dead people. Nothing you have said has suggested to me that there is any compelling reason to reevaluate the decision to draw the line at brain death.</p>
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<p>That is the basis of the malpractice claim. Whether they assert it because she died because of a botched surgical procedure or because they starved her to death, they can only claim one death.</p>
<p>I sincerely hope her sibling(s?) is(are) not watching her deteriorate. I would think that might be really traumatizing to in our culture that can’t process death really well.</p>
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<p>[VQR</a> » Dead Enough?: The Paradox of Brain Death](<a href=“http://www.vqronline.org/articles/2005/fall/chen-dead-enough/]VQR”>http://www.vqronline.org/articles/2005/fall/chen-dead-enough/)</p>
<p>The Medical Director of Children’s Hospital’s pediatric ICU described in court documents on 1/3/2014 what has happened to Jahi’s body since she was declared dead on December 12.</p>
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<p><a href=“http://media.nbcbayarea.com/documents/HeidiFlori.pdf[/url]”>http://media.nbcbayarea.com/documents/HeidiFlori.pdf</a></p>
<p>^^^^That was the brief I mentioned above. Thanks for quoting that particular paragraph.</p>