" 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."
I agree I don’t want average taxpayers deciding what treatments are necessary and worth the cost; remember that sentiment the next time the subject of socialized medicine comes up.
In the Jahi case, though, the law in CA clearly defines death. According to the law, Jahi was dead.
“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.”
Yet in this case we trust a mother that has clear financial incentives to maintain that the body is alive, who claims an unspecified “religious belief” that isn’t held by the actual religion the family lists, who has no medical training to make the determination of what is medically necessary even when that is in direct opposition to an actual law and the consensus of the medical community?
As someone who has been flat-out told that I’m a burden on the system and that I’m too expensive to keep alive, I agree that I don’t want the average taxpayer making decisions about what treatments are medically necessary. But, that’s the system we live in. We already live in that world with every vote we cast.
It depends on the organ you are talking about. In certain cases, distance from the donor and recipient plays a part. There are other considerations as well, depending on the organ.
Nrdsb4, I just wanted to comment that I have found your posts very helpful in thinking about general medical issues. Until one starts to ask questions, one often does not know what questions to ask. Then the answers to those open up new questions.
So if you do not mind: When a person’s mental state causes the heart rate to increase, is that totally hormonal, or is the nervous system involved?
In case the moderators are looking over my shoulder for relevance to the McMath case, Jahi’s mother has stated that Jahi’s heart rate increased when she (the mother) talked with her, or when she entered the room (I have forgotten the specifics, but I know that an increase in heart rate was mentioned). Again, not trying to change the view of when Jahi died, just trying to understand the case better.
I honestly hope I never have to make this kind of decision. I think that it would much depend on how much brain activity existed and if there was enough to sustain breathing and heart rate. I think I would pull the plug and let them die naturally but you never know until you walk in those shoes.
A couple of additional questions, Nrdsb4, if you are still willing to provide expert information:
Reading at the Wikipedia level indicates that the release of adrenaline is controlled by the autonomic nervous system, so this could be a spinal-cord level of activity. Is that right?
Release of cortisol seems to be controlled by the anterior lobe of the pituitary in response to ACTH, which is produced by the hypothalamus. It does not appear to me offhand that the release of cortisol would occur for someone with no brain activity. Is that also right? Or perhaps there is another path, under the exclusive control of the spinal-cord?
I can see how ventilator setting, if they were changing, could affect the heart rate; but if they were unchanging, I would not expect the heart rate to change. I’d guess that the same is true for body temperature. An increase in body temperature might cause an increase in heart rate without nervous system involvement at all (but I am not sure about that). Are these guesses correct?
@QuantMech, with a dead brain, the hypothalamus would not factor in. Also, a body with a dead brain cannot properly regulate body temperature, which means that Jahi’s caregivers were having to manipulate that with blankets and other measures. I remember that being an issue they talked about in their blogs and facebook page. Often, photos of her showed piles of blankets on her.
Vent settings are often changed, depending.
Sorry, I don’t believe that Jahi was aware of her mother’s presence, so any change in heart rate had nothing to do with that. Dead brains cannot hear, see, or have knowledge of the comings and goings of others.