Family wants to keep life support for girl brain dead after tonsil surgery #8

[lawstudent]

BBM

I appreciate many of your sentiments. More people could do with a little bit of your compassion. However, it is incorrect to say "much" of her brain died. All of it died-the entire brain and brain stem.

Also, I hardly think you can compare losing a finger to frostbite to losing one's entire brain. The brain isn't just a body part-it is where the "person" inside the body resides. In California, being brain dead IS dead just the same as if your heart stopped permanently. I disagree with calling her a corpse, but it doesn't make her any less dead, particularly from a legal standpoint, which is significant for many reasons. If you watch the video linked above, when you see the animated graphic of what happens to a person's brain after brain death, you realize why most states regard this as being irreversibly dead. Legally, and for all intents and purposes for this girl's "life," your last sentence is incorrect.

Thank you for the correction re: total brain death.

I'm not saying they are practical comparisons - of course not. Although people can lose a lot more than a finger to frostbite and have - all their limbs and parts of their face. Still not anywhere near brain death in terms of practical impact, but I'm saying that not everyone subscribes to the idea that the brain is inherently more valuable despite the fact that it very practically is the only thing that matters.

If you attribute everything to a soul and don't think someone's personality comes from neurons, you cling to the body. I know many religious people also try to reconcile biological truths with that idea, but many do not. For example, I don't visit graves, and I hate wakes - to me, that person is just gone. Other family members take comfort in it, because they believe the person is still there in heaven, although I don't understand why you'd need to be at the gravesite to feel close to them then. I believe when your neurons have died, you are gone. Many, many people disagree with this, often times just due to ignorance. They think the person is still "in there" and that's why they go and say good bye to someone who is brain dead and talk to them before they are removed from life support. I would never do that, but I know many like to.

Brain dead people are dead in every real way because in normal circumstances they would almost immediately die and would never have to be declared brain dead. But modern medicine created this weird ground where all the things that lead to death happen, but death still doesn't happen. It really isn't death yet - states define it that way because in our society, you have no function without a brain and it's just so pointless and expensive. People need a way to have the person declared dead to make certain decisions, such as organ donation, and to justify removal of medical care. But it's still legal fiction (and I mean that term in non-disparaging way - corporations are legal fiction - it's just a term that indicates that it's a man-made construction that can change definitions). That doesn't mean it's insignificant by any means, but there's a reason there are separate laws clarifying the issue of legal death or brain death that weren't needed before. A dead person's organ's aren't viable - a brain dead person's organs could be. I think that shows the difference. I don't think that the fact that decomposition of the brain occurs is what defines it - it's that there is just no hope of being functional ever again in any way, and so we react much more strongly to that than other conditions involving decomposition or severely limited functioning (severe paralysis). When a baby is born without a brain or with only the stem, they get into all sorts of legal issues to determine if they can rule it dead and harvest the organs - I don't think anyone would refer to that baby as a corpse, but it's alive in only the most fundamental way.

I think that is what makes it interesting. People think that Jahi and others are only "technically" alive through some "loophole." I'd say it is the opposite - they are alive in the most basic sense in that their bodies are functioning, through artificial means or not, and have not gone into full decomposition. All the stuff that we consider living - involving judgements of quality of life and higher cognitive functioning, is really not relevant to whether someone is alive, but is relevant to whether it is worth no longer keeping them alive and thus killing them (and I don't mean that negatively - I know withdrawing life support isn't intentional, but I just wanted to make it clear). The fact that we make this judgment that these people are only technically alive and would be better off dead instead of like this shows that we recognize they are fundamentally alive and need to be killed. We create legal descriptions to try and wade through this middle ground and so instead we can phrase it as they are dead and need to be killed, because it sounds better and goes more along with our understood definition of life, which has some meaning and dignity. But it doesn't make logical sense.

 

[Linda7NJ]

Thank you for the correction re: total brain death.

I'm not saying they are practical comparisons - of course not. Although people can lose a lot more than a finger to frostbite and have - all their limbs and parts of their face. Still not anywhere near brain death in terms of practical impact, but I'm saying that not everyone subscribes to the idea that the brain is inherently more valuable despite the fact that it very practically is the only thing that matters.

If you attribute everything to a soul and don't think someone's personality comes from neurons, you cling to the body. I know many religious people also try to reconcile biological truths with that idea, but many do not. For example, I don't visit graves, and I hate wakes - to me, that person is just gone. Other family members take comfort in it, because they believe the person is still there in heaven, although I don't understand why you'd need to be at the gravesite to feel close to them then. I believe when your neurons have died, you are gone. Many, many people disagree with this, often times just due to ignorance. They think the person is still "in there" and that's why they go and say good bye to someone who is brain dead and talk to them before they are removed from life support. I would never do that, but I know many like to.

Brain dead people are dead in every real way because in normal circumstances they would almost immediately die and would never have to be declared brain dead. But modern medicine created this weird ground where all the things that lead to death happen, but death still doesn't happen. It really isn't death yet - states define it that way because in our society, you have no function without a brain and it's just so pointless and expensive. People need a way to have the person declared dead to make certain decisions, such as organ donation, and to justify removal of medical care. But it's still legal fiction (and I mean that term in non-disparaging way - corporations are legal fiction - it's just a term that indicates that it's a man-made construction that can change definitions). That doesn't mean it's insignificant by any means, but there's a reason there are separate laws clarifying the issue of legal death or brain death that weren't needed before. A dead person's organ's aren't viable - a brain dead person's organs could be. I think that shows the difference. I don't think that the fact that decomposition of the brain occurs is what defines it - it's that there is just no hope of being functional ever again in any way, and so we react much more strongly to that than other conditions involving decomposition or severely limited functioning (severe paralysis). When a baby is born without a brain or with only the stem, they get into all sorts of legal issues to determine if they can rule it dead and harvest the organs - I don't think anyone would refer to that baby as a corpse, but it's alive in only the most fundamental way.

I think that is what makes it interesting. People think that Jahi and others are only "technically" alive through some "loophole." I'd say it is the opposite - they are alive in the most basic sense in that their bodies are functioning, through artificial means or not, and have not gone into full decomposition. All the stuff that we consider living - involving judgements of quality of life and higher cognitive functioning, is really not relevant to whether someone is alive, but is relevant to whether it is worth no longer keeping them alive and thus killing them (and I don't mean that negatively - I know withdrawing life support isn't intentional, but I just wanted to make it clear). The fact that we make this judgment that these people are only technically alive and would be better off dead instead of like this shows that we recognize they are fundamentally alive and need to be killed. We create legal descriptions to try and wade through this middle ground and so instead we can phrase it as they are dead and need to be killed, because it sounds better and goes more along with our understood definition of life, which has some meaning and dignity. But it doesn't make logical sense.

You're gonna be one hell of a lawyer!
Thank you again. You've said in two posts exactly what I have been trying to convey in the countless failed attempts ....

Thanks again!



Sent from my iPhone using Tapatalk

 

[K_Z]

Interesting recent discussion, lawstudent, and everyone, and well expressed opinions. Some I agree with, some I don't.

Medicolegal issues are always thorny, and usually involve some degree of ethical or social dilemma. Such as the issue of whether a fetus which lacks a brain can be declared “brain dead”. Or whether a fetus with anomalies incompatible with life should be forced to develop to full term. Or whether a catastrophically head injured person (ie, functionally decapitated and missing most of the brain) should be aggressively resuscitated “just in case”. These situations where the damage or anomalies are readily apparent to the untrained layperson are typically easier to navigate than situations like Jahi’s, where the body appears undamaged, and the catastrophic damage is hidden within the skull.

It is situations like Jahi’s that promote the most aggressive expressions of false hope, in my experience. And sadly, it is also true (backed by a number of studies that I can quote again if needed) that the lower the socioeconomic and educational level of the families, the more they tend to engage in false hope, resistance, and denial, in the diagnosis of brain death, and the desire to prolong ventilator and other support measures.

One of the things that is very distressing to me (and other medical professionals I’ve discussed it with) about Jahi’s case, is that the very act of compassion on the part of the medical professionals and the judge (to delay withdrawing somatic support after the diagnosis, and repeated confirmation of total brain death) has created a disturbing precedent whereby several issues have been further confused in the minds of the public:

1. That “families” can (and should) define death, not doctors
2. That brain death is just another kind of brain damage, and is like a deep coma
3. That brain death is not true death, and there is reasonable hope for the brain to “recover” as long as the heart beats
4. That families have the “right” to determine if or when somatic support can be withdrawn
5. That families can recruit the public for the purpose of protesting and civil disobedience over the diagnosis of death, and can coerce the courts into making exceptions to well established law
6. That families may lawfully engage in harassment of medical professionals
7. That families may recruit others to engage in harassment and interference with the function of a hospital, and the rights of other families and patients
8. That it is “okay”, and even commendable, to act on personally held beliefs that are in direct opposition to laws.

Basically, this case has demonstrated, and continues to demonstrate to the public, that it is okay to disregard established law regarding when and how someone is declared dead. And that public protests and disruptions in and on the grounds of a hospital, and targeted and recruited harassment of the staff, produce an atmosphere designed to force exceptions to law and procedures. This family has been “rewarded” with donations, given an “award” for their behavior, been given numerous exceptions not available to other families, and have publicity and pseudo celebrity status.

That may sound harsh, but the compassion that was extended to them by the judge, hospital, and doctors has now created an example others will likely emulate. Consider the implications of that. If you don’t like a diagnosis, just march, protest, harass, coerce, and threaten until you get “your” way. That’s how I see this unfolding, and my colleagues do as well. Granted, as health professionals we have a unique perspective.

This was not a case that was so unique that it should have created any special exceptions, IMO.

If Jahi had been removed from the ventilator in early December, like any other brain dead patient, NW would be home and available to parent her living children, helping them cope with the loss of their sister. Not carrying out a months- long, sad and angry vigil sitting next to her daughter’s brain dead body, desperately clinging to false hope. And worried about nail polish and hair styles for her daughter’s body. Those public comments, IMO, indicate how deep her denial is. She is in serious need of intense psychiatric care, IMO.

I have tremendous compassion for NW in the tragic and sad loss of her daughter, which is why I am so disgusted with those that continue to support and indulge her delusions and denial, and promote her false hope. Those that support her actions with regard to the body of her daughter are manipulating a very vulnerable woman. They are not doing her, or her other children, or family members, any favors, IMO. There are situations where hope is reasonable, and there are situations where there is none. Promoting false hope is cruel, IMO. Leading a mother to continue to believe her brain dead child has any hope of recovery is especially cruel, IMO.

And IMO, the judge should not have allowed loopholes to allow this situation to unfold. Sadly, I think he made the wrong decision, from a place of compassion. And in doing so, he also encouraged NW's journey of false hope.

 

[nrdsb4]

I have tremendous compassion for NW in the tragic and sad loss of her daughter, which is why I am so disgusted with those that continue to support and indulge her delusions and denial, and promote her false hope. Those that support her actions with regard to the body of her daughter are manipulating a very vulnerable woman.

I agree, KZ. At the top of the list of people for whom I have undisguised revulsion is Dr. Paul Byrne. Absolutely disgraceful.

 

[CHERIE.T]

BBM

I appreciate many of your sentiments. More people could do with a little bit of your compassion. However, it is incorrect to say "much" of her brain died. All of it died-the entire brain and brain stem.

Also, I hardly think you can compare losing a finger to frostbite to losing one's entire brain. The brain isn't just a body part-it is where the "person" inside the body resides. In California, being brain dead IS dead just the same as if your heart stopped permanently. I disagree with calling her a corpse, but it doesn't make her any less dead, particularly from a legal standpoint, which is significant for many reasons. If you watch the video linked above, when you see the animated graphic of what happens to a person's brain after brain death, you realize why most states regard this as being irreversibly dead. Legally, and for all intents and purposes for this girl's "life," your last sentence is incorrect.

bbm

:gthanks:

 

[CHERIE.T]

interesting recent discussion, lawstudent, and everyone, and well expressed opinions. Some i agree with, some i don't.

Medicolegal issues are always thorny, and usually involve some degree of ethical or social dilemma. Such as the issue of whether a fetus which lacks a brain can be declared “brain dead”. Or whether a fetus with anomalies incompatible with life should be forced to develop to full term. Or whether a catastrophically head injured person (ie, functionally decapitated and missing most of the brain) should be aggressively resuscitated “just in case”. These situations where the damage or anomalies are readily apparent to the untrained layperson are typically easier to navigate than situations like jahi’s, where the body appears undamaged, and the catastrophic damage is hidden within the skull.

It is situations like jahi’s that promote the most aggressive expressions of false hope, in my experience. And sadly, it is also true (backed by a number of studies that i can quote again if needed) that the lower the socioeconomic and educational level of the families, the more they tend to engage in false hope, resistance, and denial, in the diagnosis of brain death, and the desire to prolong ventilator and other support measures.

One of the things that is very distressing to me (and other medical professionals i’ve discussed it with) about jahi’s case, is that the very act of compassion on the part of the medical professionals and the judge (to delay withdrawing somatic support after the diagnosis, and repeated confirmation of total brain death) has created a disturbing precedent whereby several issues have been further confused in the minds of the public:

1. That “families” can (and should) define death, not doctors
2. That brain death is just another kind of brain damage, and is like a deep coma
3. That brain death is not true death, and there is reasonable hope for the brain to “recover” as long as the heart beats
4. That families have the “right” to determine if or when somatic support can be withdrawn
5. That families can recruit the public for the purpose of protesting and civil disobedience over the diagnosis of death, and can coerce the courts into making exceptions to well established law
6. That families may lawfully engage in harassment of medical professionals
7. That families may recruit others to engage in harassment and interference with the function of a hospital, and the rights of other families and patients
8. That it is “okay”, and even commendable, to act on personally held beliefs that are in direct opposition to laws.
SNIPPED
And imo, the judge should not have allowed loopholes to allow this situation to unfold. Sadly, i think he made the wrong decision, from a place of compassion. And in doing so, he also encouraged nw's journey of false hope.

Excellent post, thank you k_z!

RESPECTFULLY SNIPPED FOR SPACE.

 

[gitana1]

Yes, this is ridiculous to me as well. It's unnecessary nastiness. I'm all one for stating the truth, and I don't believe in religion - I believe Jahi is gone and beyond saving, and no miracle will occur. I would never do what her parents have done.

But huge portions of society do tend to believe in miracles long after they should - the situation just isn't as easy to mock. Her brain is nonfunctional - she is not a corpse. She is not rotting away, her body is still functioning, even through artificial means. I don't believe she has any thoughts or awareness, nor will she ever. But she's not a corpse, and making the parents sound like people who keep a corpse in their attic because they are deranged is not funny. A lot of parents would keep life support going long beyond when they should, especially if they don't know much about brain injuries. And they'd just keep insisting that God can do everything. They are desperate.

Her brain was deprived of oxygen and much of it died - people are making this sound like some freak thing that means she's just a a corpse rotting from the inside. That could happen to any part of your body - before modern medical treatment, people's limbs died from lack of blood flow and rotted off but we didn't say they were dead. Parts of them were. People with frostbite have the same issue. You are not dead until everything is dead.

Again, I don't agree with the parents by any means, but I also don't think this is a case of first impression craziness. Many people have been kept alive much longer than they should have been to to misguided ideas they would recover, brain dead or not. Some people see life as more than having the ability to think. Quality of life judgments are opinions. I know in this case there's really no life and the quality doesn't matter. But her parents see her and she looks fairly normal, and she does not look like a corpse, and they have false hope. It's not fair to keep emphasizing how dead she is - and how she can't be a patient.

That's just not true - it's not politics driving semantics - it's just we don't refer to people as dead outside of a clinical setting until they are actually dead. There is a clear difference between brain and real death in terms of decomposition. It makes no difference for Jahi, but it does to her family. They certainly don't want to sit with a corpse, and they aren't. They take comfort in the parts of her body that still work, and it's sad and pathetic and desperate, but I don't know why people need to be nasty about it. Even if it's a big waste of money, that's not the proper response. Education about brain injuries is.

And although I know the doctors in this case were up front about her prospects, I've seen a lot of doctors be a bit too hesitant with the truth. No one wants to give bad news, but some seem to be unable to tell cancer patients they are terminal in my experience. We need to make people more aware, because most are really ignorant about basic medicine. Religious and old-fashioned ways of looking at things get in the way (I'm sure there are social media pages out there with everyone giving prayers for recovery). People need to understand what brain death is and how it differs from other traumatic brain injuries, before they get into a traumatic situation and can't process new ideas. Anger won't teach them.

I think I love you, lawstudent. Eloquent and rational post.

Only one thing. I do think semantics is controlled by politics. In other words, when people continually refer to Jahi as a corpse or when they refer to her as a patient, they are using terms in a manner designed to support their position or argument or belief, much like people use the terms "pro-life" "pro-choice", "anti-choice", "pro-death".

The "politics" part doesn't have to refer to government. But here, I think it does have something to do with the law.

You're gonna be one hell of a lawyer!
Thank you again. You've said in two posts exactly what I have been trying to convey in the countless failed attempts ....

Thanks again!



Sent from my iPhone using Tapatalk

Agreed!!!

 

[lawstudent]

1. That “families” can (and should) define death, not doctors
2. That brain death is just another kind of brain damage, and is like a deep coma
3. That brain death is not true death, and there is reasonable hope for the brain to “recover” as long as the heart beats
4. That families have the “right” to determine if or when somatic support can be withdrawn
5. That families can recruit the public for the purpose of protesting and civil disobedience over the diagnosis of death, and can coerce the courts into making exceptions to well established law
6. That families may lawfully engage in harassment of medical professionals
7. That families may recruit others to engage in harassment and interference with the function of a hospital, and the rights of other families and patients
8. That it is “okay”, and even commendable, to act on personally held beliefs that are in direct opposition to laws.

Basically, this case has demonstrated, and continues to demonstrate to the public, that it is okay to disregard established law regarding when and how someone is declared dead. And that public protests and disruptions in and on the grounds of a hospital, and targeted and recruited harassment of the staff, produce an atmosphere designed to force exceptions to law and procedures. This family has been “rewarded” with donations, given an “award” for their behavior, been given numerous exceptions not available to other families, and have publicity and pseudo celebrity status.

That may sound harsh, but the compassion that was extended to them by the judge, hospital, and doctors has now created an example others will likely emulate. Consider the implications of that. If you don’t like a diagnosis, just march, protest, harass, coerce, and threaten until you get “your” way. That’s how I see this unfolding, and my colleagues do as well. Granted, as health professionals we have a unique perspective.
, , ,
If Jahi had been removed from the ventilator in early December, like any other brain dead patient, NW would be home and available to parent her living children, helping them cope with the loss of their sister. Not carrying out a months- long, sad and angry vigil sitting next to her daughter’s brain dead body, desperately clinging to false hope. And worried about nail polish and hair styles for her daughter’s body. Those public comments, IMO, indicate how deep her denial is. She is in serious need of intense psychiatric care, IMO.

I agree that cases like this are very dangerous in terms of calling attention to exactly the wrong issues and baiting public outrage based on ignorance. But I also don't think it is settled that families don't have the right to do some of these things. I may strongly dislike the fact that they do, but it's such a new issue that it really is not settled, and honestly the law is never settled.

I was reading a case for work the other day involving a man who had a massive stroke - he was not brain dead, but he had lost all cognition and a lot of his brain was destroyed. His wife wanted to remove his feeding tube, so it was like Terri Schiavo, except he had even less "activity" than she did, and there wasn't a big fight going on - his relatives agreed.

The doctors refused, and the court allowed the wife to remove him to a hospital that was willing. This was one of the first such cases in the 1990s in my state. The judges clearly felt it was cruel to prolong it, and he had expressed a desire not to be kept alive through extraordinary means (which is what creates the feeding tube issue - not extraordinary, necessarily). They found a way to justify it even though there wasn't much law in their favor.

There were a few dissents, and I was shocked by how much things have changed in that time. Several judges were going on and on about religion and how wrong suicide and euthanasia are and how disgusting this was and how it went against all the established values of human history and morality. Today, such a dissent would be shocking, but these judges felt quite strongly about it. I'm not saying they were wrong, but their justifications were coming from a totally different legal and social era, and so their reasoning is quite offputting now. They basically thought everyone was a monster for wanting to stop the feeding tube, whereas I feel most people today would think it was cruel to keep it going.

1. That “families” can (and should) define death, not doctors

Agreed that this is problematic medically, but people do have a right to have their own beliefs on what constitutes death, and there have been times where social pressure did contribute to some medical improvements (or what some would consider improvements), even though it's a dangerous line. Doctors used to classify all sorts of things as mental illness and commit people with relatively minor disabilities to mental hospitals for life - they used to offer lobotomies - it's not always good to let doctors say what is best. They are human and some of these issues are complicated and it's not clear what is best. Sometimes non-doctors are needed for another perspective.

2. That brain death is just another kind of brain damage, and is like a deep coma.

Agreed that this is a ridiculous belief, but people do have a right to be stupid about medical issues, and most are.

3. That brain death is not true death, and there is reasonable hope for the brain to “recover” as long as the heart beats

Same as my last answer - ridiculous, but many people believe in miracles in all sorts of ridiculous situations and that is their right.

4. That families have the “right” to determine if or when somatic support can be withdrawn

I don't know that this is settled - I actually was not aware until this case that doctors generally made this call. I know they decide brain death, but I thought it was up to the family to pull life support, if the hospital was being paid. I guess as we know more about brain death, it does start to become a "do no harm" issue, and the doctors should have more control.

5. That families can recruit the public for the purpose of protesting and civil disobedience over the diagnosis of death, and can coerce the courts into making exceptions to well established law

Families are allowed to recruit the public to create false outrage all the time and regularly do. It's become crazily overdone and is irresponsible. But they do have the right, and I disagree it is well-established. And courts are not supposed to be coerced by this - of course, they sometimes are,
but that's true of every legal issue - if the courts didn't change their minds due to public pressure, think of what some of our laws would still be like.

6. That families may lawfully engage in harassment of medical professionals

They do have the right to do this, although obviously some forms of harassment are criminal. But I think everything they have done is completely acceptable under well-established law. You are allowed to bash people in the media pretty much as much you want, unless it veers into defamation territory, and that is hard to prove. We can't have it be against the law to question the judgements of those in power.

7. That families may recruit others to engage in harassment and interference with the function of a hospital, and the rights of other families and patients

Same as above.

8. That it is “okay”, and even commendable, to act on personally held beliefs that are in direct opposition to laws.

This is a pretty commonly held belief. Some laws need to be questioned. It is recognized as commendable by many people, but obviously the situations in which people support it vary. If you directly break the law, I think you should face the consequences, but to simply keep going on about how you think the law is wrong and you know better is a pretty common thing.

I really don't like what the family has done, but I also recognize the importance of allowing unpopular and ridiculous opinions to be expressed, because everyone has a different idea of what that is. I hate how the media covers these stories. It is disgusting, and the public should be ashamed for falling for it and not doing their own research. But it is legal, and forcing silence doesn't really solve these problems - it creates more ill-informed people who believe in a conspiracy.

Also, I don't think this is going to end well for Jahi, not that it ever could have, and will have more of a deterrent effect than an encouraging one. It will show that there is no hope. Most people are not inspired by this story, and the ones that are would probably have been idiotic regardless.

I also can't criticize the judge until I read more about it - sometimes there are reasons for rulings that aren't related to what the judge wants to happen.

And, I don't know what would have happened if Jahi had been forced off life support a while ago. Maybe her mom would have adjusted, but it's also possible she would have totally snapped due to her belief she was forced to betray her daughter and become more dedicated to a crazy cause. That happens quite a bit. That's why I believe in allowing these opinions to be expressed rather than forcing compliance in some situations - the person doesn't always realize it's right, and often gets more devoted to the craziness, and creates a community of supporters.

And I know this post is going on forever, but I was shocked at how the hospital's attorney behaved. I support the hospital's decision, but it's clear the family is not getting it and it's not pure malice for no reason. The statements seemed to keep disparaging the family, instead of defending the hospital's decision. There was just no reason to drop to that level - the appropriate thing to do was repeatedly say "we understand how difficult this can be to accept and how desperate the family is, but she is brain dead and it is not in her interest or feasible to continue life support - she cannot recover and it must be withdrawn - she is legally dead. We express our sorrow to the family and hope they can find peace." Even if the family was being awful to them, a hospital should never get into those squabbles. I was not impressed by what the hospital put forth, but of course I'm sure the individual doctors did everything they could and have nothing to do with writing statements.

 

[lawstudent]

I think I love you, lawstudent. Eloquent and rational post.

Only one thing. I do think semantics is controlled by politics. In other words, when people continually refer to Jahi as a corpse or when they refer to her as a patient, they are using terms in a manner designed to support their position or argument or belief, much like people use the terms "pro-life" "pro-choice", "anti-choice", "pro-death".

The "politics" part doesn't have to refer to government. But here, I think it does have something to do with the law.



Agreed!!!

Lol thanks! And I agree that politics has a huge influence on language choice and issue framing, but I don't think this in particular is a case of semantics. I was responding to the post about the boy kept on life support for decades - I don't see anything weird about death being established at the point of the actual death. I think that is pretty normal. I don't think people on life support who are brain dead are commonly described as dead - mainly because the discussion typically focuses on the need for them to be allowed to die, so it doesn't really work. It is all semantics in the sense that the words alive and dead can be interpreted in different ways and are simply too blunt to cover these delicate situations, but I don't think politics created that problem. I don't think anyone felt they had to refer to him as alive to appease somebody - it's just that he wasn't dead yet, and they needed to make the distinction when he actually died. A coroner doesn't look at brain-dead people - he looks at dead people. He's not going to date the death any earlier.

ETA: I think this makes my point even more, because if the coroner started doing an autopsy on a brain-dead person, it couldn't even be called an autopsy. You can't do an autopsy on a person who is still functioning, even at the most basic level. The cause of death would be the trauma from the "autopsy" and would be classified as homicide (not murder, those are different concepts). If life support was removed and then the autopsy was done, the cause of death would be brain death and resulting system failure.

 

[jjenny]

Lol thanks! And I agree that politics has a huge influence on language choice and issue framing, but I don't think this in particular is a case of semantics. I was responding to the post about the boy kept on life support for decades - I don't see anything weird about death being established at the point of the actual death. I think that is pretty normal. I don't think people on life support who are brain dead are commonly described as dead - mainly because the discussion typically focuses on the need for them to be allowed to die, so it doesn't really work. It is all semantics in the sense that the words alive and dead can be interpreted in different ways and are simply too blunt to cover these delicate situations, but I don't think politics created that problem. I don't think anyone felt they had to refer to him as alive to appease somebody - it's just that he wasn't dead yet, and they needed to make the distinction when he actually died. A coroner doesn't look at brain-dead people - he looks at dead people. He's not going to date the death any earlier.

ETA: I think this makes my point even more, because if the coroner started doing an autopsy on a brain-dead person, it couldn't even be called an autopsy. You can't do an autopsy on a person who is still functioning, even at the most basic level. The cause of death would be the trauma from the "autopsy" and would be classified as homicide (not murder, those are different concepts). If life support was removed and then the autopsy was done, the cause of death would be brain death and resulting system failure.

Turn the ventilator off and in five minutes it will be an "actual" death.

 

[Minette]

One of the tests in determining whether brain death has occurred is to turn off the ventilator and see if the person makes any attempt to breathe on his or her own. If so, there is remaining brain stem function. If not, the brain stem is dead. This test was performed by the doctors at CHO as well as by the court-ordered independent neurologist. IIRC, the court ordered assessment included taking Jahi off the ventilator for nearly 10 minutes. Her body made no attempt to breathe on it own. So as jjenny pointed out, there is no issue of performing an autopsy on a body with a heartbeat as once the ventilator is disconnected because once air is no longer being forced into the lungs the heart will stop beating.

Think about it: even if her brain had not been without oxygen since back in December (and everyone should go back a few posts and watch the EXCELLENT video on what brain dead means and how it is determined) and is therefore in a process of liquifying, she was without ventilator support for multiple times during the various assessments for brain death and at no point did her body attempt to breathe on its own.

 

[ArianeEmory]

As far as the family's "right" to hold anti-science opinions, that's fine, they can believe in Gandalf and smurfs and anything else they want. But how far--in terms of time, money, and medical resources, as well as spreading fear and misinformation--are we required to help support their belief? Religious belief is not an automatic right to turn every single real-world situation into a "gray" area because of "opinion". I can choose not to believe in gravity--it's my right--but I'll have to pay my own hospital bills. I also think people would be mad if I told some grade school kids that if they prayed really hard I could levitate.

 

[Linda7NJ]

As far as the family's "right" to hold anti-science opinions, that's fine, they can believe in Gandalf and smurfs and anything else they want. But how far--in terms of time, money, and medical resources, as well as spreading fear and misinformation--are we required to help support their belief? Religious belief is not an automatic right to turn every single real-world situation into a "gray" area because of "opinion". I can choose not to believe in gravity--it's my right--but I'll have to pay my own hospital bills. I also think people would be mad if I told some grade school kids that if they prayed really hard I could levitate.

You can't go around telling people their gods can't preform miracles. IMO


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[ArianeEmory]

You can't go around telling people their gods can't preform miracles. IMO


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Right, and they can't tell me I can't levitate. Who should pay for my hospital bill when I jump out of a window due to my belief that my god performs the miracle of levitation when he's in a good mood? Or do only big religions count?

 

[forthelost]

With all respect, if God wants to perform a miracle he'll just do so. She doesn't need to be attached to a vent.

 

[Linda7NJ]

With all respect, if God wants to perform a miracle he'll just do so. She doesn't need to be attached to a vent.

Maybe the miracle would be for everyone else's benefit...her mother already has faith.


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[katydid23]

I don't mind if the family wants to hold on longer nd pray for a miracle. My concern came from the harsh and denigrating words they had for the hospital staff. I feel there was a bit of character assassination coming from the family camp. And some unfair insinuations about the hospital wanting only the worst for this child. I think that is what rankled me the most.

 

[Donjeta]

I don't mind if the family wants to hold on longer nd pray for a miracle. My concern came from the harsh and denigrating words they had for the hospital staff. I feel there was a bit of character assassination coming from the family camp. And some unfair insinuations about the hospital wanting only the worst for this child. I think that is what rankled me the most.

Yes, that's it for me too... You can wait and pray for miracles without saying the people who know the facts and don't believe that a miracle is possible any more are murderers.

And there's miracles and miracles... It's different to wait for a miracle if there is say, a one in a thousand chance of a positive outcome than if there is none, zip, zero scientifically speaking.

But I suppose once the family had decided that removing Jahi from a ventilator would be murder there were only bad options left at that point. Either they'd be indefinitely tortured by the thought that Jahi was murdered or they'd be stuck in a hopeless and energy consuming fight for her recovery and it would inevitably take resources from the living.

Perhaps the law needs to make clearer provisions as to how long and to what extent and in what circumstances the medical profession is required to provide for the need of desperate families to hold out for a miracle, and I think the religious groups who advocate for keeping brain dead people on ventilators indefinitely could step up and provide places where it is possible for the families and hospitals to remove these people once it's been determined that medically it's hopeless and the patient's potential recovery is a religious theorem. It would have saved both the hospital and the family a lot of grief.

 

[Dr. Know?]

I don't mind if the family wants to hold on longer nd pray for a miracle. My concern came from the harsh and denigrating words they had for the hospital staff. I feel there was a bit of character assassination coming from the family camp. And some unfair insinuations about the hospital wanting only the worst for this child. I think that is what rankled me the most.

If my only wish was to have my child alive, I might say ugly things to others. I'd realize my situation at the time and later retract my words most likely about anything going on during this horrible time. So, I'll give them that. May God rest this child's soul if need be. jmo

 

[lawstudent]

Turn the ventilator off and in five minutes it will be an "actual" death.

Agreed - that's what I'm saying. You would have to remove the life support and it would be almost instant actual death. But that's the difference. If the coroner was performing an autopsy on someone who was brain dead, they'd still have to be attached to those machines and alive, or else they would be actually dead. Coroners only perform autopsies on actually dead people. So the coroner on that case referred to the person as being alive but brain dead up until actual death shortly after life support was removed. He wasn't going to refer to him as being actually dead for 20 years - if that were the case, there wouldn't be much to autopsy. The poster was upset that he wasn't referred to as dead until after the ventilator was removed and he actually died.

ETA: And yes, I believe we are forced to bear the burden of other's ridiculous beliefs in terms of misinformation. See all of human history.

Financially is another matter - I wasn't sure the financial details of this case were ever made explicit. Do I think tax dollars should be used to set up a home for brain dead people? No. But people can complain all the time about people like the Duggars getting state healthcare for all their kids and tax-exempt status for their church-house, and prisoners getting special accommodations to practice religion in prison - there's an element of it we have always paid for, right or wrong. I don't want to pay for any of it, but it's a hard line to draw.