Family wants to keep life support for girl brain dead after tonsil surgery #9

[Frigga]

My thoughts turned to this case last week while I was watching one of those reality ER shows, many of which were filmed in the late 90's early 2000's. One of the ER cases they followed was a young man who had an accident and after a short while he was found to be brain dead. I felt for the poor parents who just couldn't accept that, they kept telling the doctors to do something to get the blood into his brain, to put a tube in or something. Through the whole conversation the doctors just kept telling them that there was nothing they could do because he was dead. They said that over and over, to every argument the parents put up the reply was always he's gone, he's dead, he's not coming back. It reminded me of what this family said how the hospital kept pounding in that she is dead over and over again. The doctor on this show commented later on to the camera that its' something they don't like to do but something they have found over their years of practicing is that answer, telling families that over and over is often the only way family finally gets it, finally accepts it. Watching this whole thing happen let me further understand what others considered callous was simply practiced responses that all to often are needed.

Really great post- thank you.

 

[Spangle]

A HOSPITAL can also reject a diagnosis of brain death. I'm not sure why you want to totally ignore that fact.

JMO

Can you provide a link to information stating that is what happened here? At least something to validate it as a theory?

Katydid mentions that in NJ the family can reject brain death, and you respond that A Hospital can. Are you trying to say that the Hospital rejects brain death? Which Hospital does this? Or are you trying to say that THIS hospital has rejected HER diagnosis of brain death? Again, I would be interested in the link or something to back that up.

what is your theory on how she got from point A to point B, based upon known facts and procedures?

 

[K_Z]

This was posted a long while back, but it seems particularly relevant to the current discussion. An online conversation by physicians as to how they handle the situation when there is a brain dead patient, and uncooperative family members. Every single health care provider has to deal with the reality of difficult patients, and difficult families, in many different areas of healthcare. Some providers encounter difficult families more often than others. It's good to have a strategy with several layers of options, in these cases.

Note that there is no debate or conflict in the discussion about the diagnosis being "wrong" or incorrect,-- they all accept the process to arrive at the diagnosis. However, there is difficulty getting some families to accept the finality and certainty of the diagnosis. Each doc has some tidbits as to how they handle these difficult ethical situations, and difficult families. I think it's a good read.

http://www.ccm-l.org/discussion1/Ethics/uncoop.html

I also wanted to add that within this group of physicians, many different states, and several countries are represented. So there is not really any debate about the correctness of the means of arriving at the brain death diagnosis across a broad geographic area.

 

[Spangle]

Where do you get that she is being cared for at no cost and how long she has been there? Do you have a link? Thanks.

Where do you get that her family is paying for the bill or their insurance is? Do you have links?

In one of the recent article, her Mother mentions issues of her not being qualified for medical insurance in NJ . The family has a donation page stating they can not pay for it. So, if no medical insurance going to pay and no family is going to pay....

Yes, please explain who is paying if it's not being done for free.

 

[MyBelle]

You don't know what you are talking about in this particular instance. My hospital accepted a brain dead patient and performed no "medical procedures" on him. There is NOTHING unethical with providing minimally supportive care on a brain dead patient. It is done ALL THE TIME while families gather and/or until organs are procured (which requires more aggressive treatment to keep organs viable). We simply provided oral care and personal hygiene, turned him at intervals, etc., and kept the ventilator running (which are the same things CHO was ethically fine with doing in the short term) until the family agreed to turn it off or he died, as he was expected to do within a short amount of time.

Stating "beliefs" as though they are facts does not make you more credible. You ARE WRONG. You have not seen the medical record of the patient in question, while I was privy to it every day. Your statements are completely baseless.

I cited links to support my opinions. You haven't provided any link. A hospital ICU does not admit a person already declared brain-dead, provide "minimally supportive care" on a dead person and wait for a family to decide whether to turn off the vent. A brain dead person requires a ventilator. Oakland Children's Hospital cited ETHICS prevented them from performing medical procedures once Jahi had been declared brain dead. I think it really is absurd to suggest eight months later, another highly esteemed university hospital admitted a brain-dead patient to an ICU just to provide minimally supportive care.

I certainly am not under an obligation to believe anything a poster claims to be true, especially when no link is provided and it defies common sense.

JMO

 

[K_Z]

Having read volumes of scientific literature on brain injury, she's working to have Jahi's death certificate revoked so that she can qualify for medical benefits.

BBM for emphasis.

http://www.essence.com/2014/06/05/jahi-mcmath-nailah-winkfield

Forgot to add that this comment suggests that "wherever" they have taken Jahi's body (presumably St. Peter's in NJ), the death certificate IS apparently recognized by that facility and that state. Or else there would be no need for NW to work to have the death certificate revoked, right?

 

[MyBelle]

Where do you get that her family is paying for the bill or their insurance is? Do you have links?

In one of the recent article, her Mother mentions issues of her not being qualified for medical insurance in NJ . The family has a donation page stating they can not pay for it. So, if no medical insurance going to pay and no family is going to pay....

Yes, please explain who is paying if it's not being done for free.

I have not claimed to know who is paying the bill.

 

[Steft50]

From what I have read and seen it's pretty obvious that medical ethics are not cut and dried. No two situations are the same and each course must be decided separately based on the individual situations. If one thinks that all ethics are the same in all situations I'd have to say that would be incorrect and provides a very narrow view of ethics as a whole. If that were the case why would there be a need in the medical community to have such things as ethics boards or committees. Reading todays posts had me do a bit of searching and I found this good read concerning that medical ethic committees/boards are and what they do.

https://depts.washington.edu/bioethx/topics/ethics.html

 

[CCmakes3]

http://www.nj.com/news/index.ssf/20...lace_for_brain-dead_patients_expert_says.html


"New Jersey is the only state in the United States with a law requiring hospitals to accommodate brain-dead patients who belong to a religion that does not accept the diagnosis as a final verdict for death, Arthur Caplan, director of the division of medical ethics at New York University's School of Medicine, told the Contra Costa Times." More at link.

 

[Linda7NJ]

I have not claimed to know who is paying the bill.

Isn't the Terri Schiavo Foundation picking up the tab?

 

[K_Z]

A hospital ICU does not admit a person already declared brain-dead, provide "minimally supportive care" on a dead person and wait for a family to decide whether to turn off the vent.

JMO

Snipped for focus.

I think that's exactly the whole point of the current discussion.

A large tertiary care hospital HAS reportedly admitted a brain dead patient with a preliminary death certificate from another state 4000 miles away, to a PICU.

There is no indication anywhere that they are urging the family to discontinue ventilator support-- in contrast, they are taking a benign approach to providing supportive care in the case of a brain death situation that is medically well-documented, and verified as completely hopeless-- and apparently leaving this as an open ended amount of time/ care in their institution, despite the supportive care environment being exquisitely expensive, and highly specialized (and in limited supply). And with the family being unable to pay for it, and no insurance or other payor.

That is highly, highly unusual-- apparently unprecedented, and partly why this case continues to receive a lot of interest. It is potentially setting a very disturbing precedent.

I'd also like to point out that Arthur Caplan, the NYU bioethicist, stated a while back that the NJ "exception" to the brain death criteria, has not been tested in courts. Apparently some families have been accommodated with extended somatic support, and the NJ facilities have not sought to remove these brain dead patients from ventilators. So there is some precedence for maintaining brain dead patients diagnosed IN NJ on extended somatic support. This appears to be the first case from out of state that specifically sought out admission in NJ for benefit of this "exception".

http://www.nj.com/news/index.ssf/20...lace_for_brain-dead_patients_expert_says.html

 

[momrids6]

Snipped for focus.

I think that's exactly the whole point of the current discussion.

A large tertiary care hospital HAS reportedly admitted a brain dead patient with a preliminary death certificate from another state 4000 miles away, to a PICU.

There is no indication anywhere that they are urging the family to discontinue ventilator support-- in contrast, they are taking a benign approach to providing supportive care in the case of a brain death situation that is medically well-documented, and verified as completely hopeless-- and apparently leaving this as an open ended amount of time/ care in their institution, despite the supportive care environment being exquisitely expensive, and highly specialized (and in limited supply). And with the family being unable to pay for it, and no insurance or other payor.

That is highly, highly unusual-- apparently unprecedented, and partly why this case continues to receive a lot of interest. It is potentially setting a very disturbing precedent.

rsbm; I have a feeling they are going to somehow write this $ off as "research" if they don't get paid.

 

[MyBelle]

http://www.nj.com/news/index.ssf/20...lace_for_brain-dead_patients_expert_says.html


"New Jersey is the only state in the United States with a law requiring hospitals to accommodate brain-dead patients who belong to a religion that does not accept the diagnosis as a final verdict for death, Arthur Caplan, director of the division of medical ethics at New York University's School of Medicine, told the Contra Costa Times." More at link.

The law prevents the attending physician from DECLARING brain death if the family has a religious objection. It applies to patients already under the doctor's care in a hospital. It doesn't apply to Jahi because she was already declared brain-dead in California and a death certificate with date of death has been issued.

JMO

26:6A-5. Death not declared in violation of individual's religious beliefs The death of an individual shall not be declared upon the basis of neurological criteria pursuant to sections 3 and 4 of this act when the licensed physician authorized to declare death, has reason to believe, on the basis of information in the individual's available medical records, or information provided by a member of the individual's family or any other person knowledgeable about the individual's personal religious beliefs that such a declaration would violate the personal religious beliefs of the individual. In these cases, death shall be declared, and the time of death fixed, solely upon the basis of cardio-respiratory criteria pursuant to section 2 of this act. L.1991,c.90,s.5.

d. If death is to be declared upon the basis of neurological criteria, the time of death shall be upon the conclusion of definitive clinical examinations and any confirmation necessary to determine the irreversible cessation of all functions of the entire brain, including the brain stem. L.1991,c.90,s.4.

http://www.braindeath.org/law/newjersey.htm

 

[Kimster]

This thread is now closed. Because of the bickering and forum violations, it appears to be "sleuthed out". Alert this post if there is new news to be posted in the future.