In one way, the cases are polar opposites: the parents of Jahi McMath in Oakland, Calif., have fought to keep their daughter connected to a ventilator, while the parents and husband of Marlise Muñoz in Fort Worth, Tex., want desperately to turn the machine off.
In another way, the cases are identical: both families have been
shocked to learn that a loved one was declared brain-dead — and that
hospital officials defied the family’s wishes for treatment.
“These cases are quite different from those we’ve known in the past,” like Karen Ann Quinlan, Nancy Cruzan or Terri Schiavo,
said Dr. Joseph J. Fins, director of the medical ethics division at
NewYork-Presbyterian/Weill Cornell hospital. He explained: “Those
patients could all breathe without a ventilator. They were in a
vegetative state, not brain-dead, and that distinction makes all the
difference.”
A
person who has received a brain-death diagnosis cannot breathe on his
or her own and is legally dead, in all 50 states. In two states, New
York and New Jersey, hospitals must take into account the family’s
religious or moral views in deciding how to proceed in such cases. In
all others, including California and Texas, hospitals are not required
to consult the family in how to terminate care.
Doctors
at Children’s Hospital in Oakland pronounced Jahi, 13, brain-dead on
Dec. 12. She developed complications after surgery for sleep apnea and
lost a large amount of blood. Ms. Muñoz , 33, got the diagnosis at John
Peter Smith Hospital after she collapsed from a blood clot when she was
14 weeks pregnant. The hospital, citing a state law, refuses to remove
the ventilator because it would harm the fetus, now in its 20th week.
The
two cases are poignant in part because of a biological quirk of the
body: The patients’ hearts continue to beat. Hearts have their own
pacemaker, and with ventilation, the heart can continue to beat for
days, even up to a week. But with more aggressive care, it can last
months and longer after brain death, experts say, depending on the
health of the patient and how much treatment is provided.
That
ventilation saved the fetus in the Muñoz case, and probably in the nick
of time, said Dr. R. Phillips Heine, director of maternal and fetal
medicine at Duke University’s medical school. The diminished blood flow
to the fetus when the mother collapsed — she is thought to have been
passed out for about an hour before receiving care — “may lead to
adverse effects over time, but we have no way to predict that,” Dr.
Heine said.
Full Article and Source:
At Issue in 2 Wrenching Cases: What to Do After the Brain Dies
The common theme of these two cases is the arrogance and illegality of the medical care providers.
ReplyDeleteThe next of kin have the right to make these difficult decisions, period.
Doctors have been wrong before, and will be wrong again.
Just look at the case with the child, who is brain dead after routine, usually outpatient surgery. Doctors continue to flood the NYTimes website with arrogant comments about what THEY should decide, oblivious to the huge irony that it was their failing that created this tragic situation.
The question is not what is the right decision, but who is charged with making these decisions. Under the law of every state, family members, not doctors.