I wonder what good could have been done with the over 22.5 MILLION dollars used to keep a dead body “alive”. I’m sympathetic toward the McMath family. I can only imagine how painful losing a child must be, but I still believe they made a terrible decision, one for which the NJ taxpayers should not have been forced to pay.
It gets very messy when courts, judges and jurors are second-guessing medical experts. Courts give the legal system a bad name and create dangerous precedent when they choose to do so.
I don’t dispute the statement that Jahi was brain dead. I think her spirit left before she was declared dead. I would certainly not have looked for her to regain consciousness. It would have been impossible. But whether brain death must be regarded by everyone as complete death–I would not obtrude on the religious beliefs of those who say no, and apparently neither would the state of New Jersey.
I hope that medical costs in the US can be brought under control. The comparative costs for an uncomplicated birth in the US and in Northern Europe are quite interesting.
I am well aware that medical knowledge is uncertain. It may be sufficient in Jahi’s case, approximately sufficient in Alfie Evan’s case–though not quite–but unsettled in many other cases. There are quite a few people of my age cohort who are blind because they were born prematurely, and they were given too much oxygen. The physicians did not know better at the time. Even recently, parents of infants who are born prematurely had the option of enrolling the child in a trial, to determine exactly what level of oxygen was best. They did not get to choose the branch of the trial (high oxygen or low oxygen) on which the child would be placed. Too little, and you risk death or brain damage for the child. Too much, and you risk blindness (and possibly other complications). This is an example of a relatively simple issue where medical knowledge probably should still be regarded as incomplete.
It was not until 1994 that physicians figured out what the most fertile days of a woman’s period were. It is pretty astounding to me that this was such a short time ago. It is hardly any wonder that the rhythm method of birth control worked poorly, and that some couples who were trying to conceive were unknowingly doing a pretty good job of birth control, via the rhythm method.
I recommend Being Mortal by Atul Gawande to people who are dealing with an elderly relative’s situations. I found it thought-provoking, though it has no answers about coming to grips with mortality itself. The book ties in with a joke about an elderly woman who took cruises back-to-back, because she got comparable care and attention to the level she would get in a nursing home, but she got to see the world and have stimulating experiences.
“I would not obtrude on the religious beliefs of those who say no”
And how do we determine what is a religious belief or simply the desire of a person? Does there have to be any evidence that the person actually practices or has experience with a particular religion? Does it matter that the religion the person claims to believe in doesn’t have established dogma that states what that individual is claiming?
Can anybody simply state a preference, describing it as a “religious belief” and force others to pay to have that preference honored? How far and to what services does that extend?
I am trying to find a source that gives the total cost of Jahi’s care, divided between the bills while she was in the hospital, the time that she was in an apartment in New Jersey, and the final operation, but Google isn’t working out well for me. Can you help out with that?
I mentioned earlier the elderly woman who took back-to-back cruises. I didn’t mention that this was also cheaper than being in a nursing home!
There is a more general issue that we don’t have enough physician time, resources, and available donated organs to help everyone who could benefit from treatment. As I understand it, patients are currently rated in some way, to determine who has priority for organ transplants–it is not just a question of histological matching. It is also not just histological matching + the urgency of the case. Someone with medical knowledge could clarify this.
End of life care is a real challenge. An advance directive is a really great idea, though I hope it is still a few years before I need one. I am sure that Jahi did not think she needed one so early. Aside from Gawande’s book, I also recommend a book by Walter Bortz called something like “We Live Too Short and Die Too Long.”
There is a well-worn saying that hard cases make bad law. I think most people would agree that hard cases also make bad health-care policy, even if they see this particular case as an easy one–that Jahi should have been let go.
Once you start to ask whether people should be forced to pay for the medical treatments of others–whether via taxes or via high premiums for health insurance–it is not all that easy to figure out where to draw the line, and say, “No, this care is too expensive (or too pointless relative to its cost) for you to have it.”
In my view, there could be one-person religions. This view is probably not shared.
That’s an urban myth that won’t die. People who need to be in a nursing home can’t get that kind of care on a cruise ship. It may be cheaper than some assisted living setups.
California law (and most other states) HAVE drawn the line: brain death is death and physicians and hospitals cannot be compelled to continue treatment on dead bodies. The only reason we are having this conversation is this judge did not follow the law in his rulings.
Is this a serious question or are you being deliberately obtuse? Anyone who has a respiratory or cardiac arrest in a hospital who does not have a DNR on file will be “coded.”
The stimulus which triggers the initiation of each heartbeat is an automatic, ad infinitum, process. It is generated within specialized cells, located inside the heart. They are called pacemaker cells, and in normal conditions they are located in the Sinus Node, in the right atrium, near the connection with the Superior Vena Cava.
This means that if there is an adequate blood flow in the coronary arteries (the arteries that provide blood to the heart), an undamaged heart will keep beating on its own.
So a person with a completely dead brain can continue to have normal heart function as long as it receives oxygenated blood. That is what mechanical ventilation provides.
@milee30, Who gets to decide whether or not a treatment is too expensive or the prognosis isn’t good enough to make the treatment worth the cost? It’s easy to make those arguments for extreme cases, but apply that to cancer treatments and other medical interventions. We already know from the concierge medicine thread that there’s a premium standard of medical care available to those who can pay that’s not available to low income families – and people are okay with that – so you’ll have to excuse me if I don’t trust the average taxpayer to determine what treatments are medically necessary or worth the cost.
Given that we know that people without financial resources have difficulty obtaining proper medical care now, it seems even more obscene to allocate the huge financial resources incumbent with keeping the heart of a brain dead person beating while denying living, breathing, thinking human beings care that could actually improve their health and quality of life.
No, Nrdsb4, my question was serious. When a person has gone into cardiac arrest, after two hours of no blood supply to the brain, if one does not have a DNR on file, the physicians will still keep working to restart the heart? Of course they would try right away, but how long would the physicians normally keep going? I assume that Jahi’s heart did not restart by itself, while the physicians were not working to restart it?
If it is generally known that two hours of no blood supply to the brain will render one completely, unavoidably brain dead, why would the physicians keep going? Was this the family’s call? This is a serious question also, and not obtuse.
I am aware that in cases where people have slipped into ice-cold lakes, they may be brought back, and that one should not declare someone dead until the person is “warm and dead.” But absent that situation, are there any known cases where someone has come back after two hours of no blood supply to the brain?
What is the length limit of lack of heartbeat (non-cold cases) where one can expect to come back more or less normal? Also, can Advance Directives (or whatever they are properly called) specify how resuscitation attempts should continue?
austinmshauri, you make fair points. However, I have read of many cases where insurance companies will not cover treatments that a physician recommends. Also, I have read of many cases where people had lengthy fights with insurance companies to get a treatment covered, that eventually was covered. I would not trust people to determine what treatments were medically necessary, if they or their employers had financial incentives to decline to cover a treatment.
Also, the story about the woman on back-to-back cruises, rather than going into a nursing home, was a joke. (I think I wrote that at the beginning, but perhaps in the heat of the moment, I omitted it.) I doubt that anyone has actually done that. But within the last year, I heard from a nurse that nursing home care in our area, would be $12,000 a month for a patient with Alzheimer’s.
@QuantMech, while one is doing a code (say for 2 hours), there is no way to know if the brain is being completely deprived of blood. The whole purpose of good CPR is to provide circulation to the body mechanically, all the while the code team is injecting drugs or delivering defibrillation or other interventions to get the heart to the point where it takes over without help. If they coded Jahi for two hours during her initial arrest, I’m guessing (and I don’t know that to be the case without access to the medical record), that’s because they were able to get a rhythm back at intervals, then would lose it again.
I don’t know where the 2 hours without blood supply to the brain you are talking about is coming from. I have no knowledge of a two hour code on the day she arrested. May have happened, I just haven’t seen evidence of it. I’ve seen all kinds of speculation on what caused Jahi’s brain to die. Was it lack of blood due to hemorrhage (we keep reading that she was bleeding out) or lack of blood to the brain as a result of brain swelling which occurred as a reaction to respiratory or cardiac arrest? Was it due to an obstruction in the respiratory tract caused by swelling in the throat or presence of massive quantities of blood? If it was due to brain swelling, that process occurred over a period of time after her heart was re-started, not during a code.
I’ve never seen any medical records which detail what actually happened on the day that Jahi had a respiratory or cardiac arrest, so I can’t answer your question.
The answer to that depends on whether or not the person is receiving quality CPR. CPR accomplishes what the heart beating would accomplish, if done well.
Of course. I’ve seen advance directives that allow for CPR but not intubation, or drugs only, etc.
Nrdsb4, a quick Google search on coding turned up the information that in a study of a large number of people who had gone into cardiac arrest (30,000 + people), the average length of CPR for those who had good brain function subsequently was 13 minutes. The average of those who had less favorable outcomes was 22 minutes. There was a case or perhaps cases where a person was restored to good brain function after 38 minutes. That was the longest this report contained.
I can see why they might continue for a total of 120 minutes, if Jahi’s heart keep restarting and then stopping.
This makes me aware that an Advanced Directive needs to be even more detailed than I would have guessed.
The 2 hours without blood supply to the brain comes from the news reports on Jahi’s case. That information is fairly widespread. It could of course be erroneous.
While we’re asking medical questions here, @Nrdsb4 Can you explain why the tests on Jahi showed no blood flow to the brain (when they were testing for brain death)? Why wouldn’t blood flow to her brain if her heart was beating? I mean, the vent/trach kept her body oxygenated for four years, so I’m just curious about why the brain doesn’t receive blood?
I agree with QuantMech’s points, both that this child’s spirit left her body long before she was declared dead and that there is a lot medical science still doesn’t understand. But it doesn’t sound like Milee30 is talking solely about life support in general or this case in particular.
Who gets to decide what treatments are worth the money? If proof of belief is the standard for doling out care, what would be acceptable proof? And who gets to make the determination? If we’re using religious beliefs to approve medical expenditures, can insurance companies use those beliefs to deny them?
@LeastComplicated, if the brain tissue was dead, it would no longer be able to receive blood due to severe vasoconstriction and degeneration of the blood vessels.
Physicians feel free to improve upon my explanation if need be.
Particularly with respect to women’s reproductive issues, that’s surely right around the bend.
Thanks for the explanation. ^^