Jahi’s family wants her declared 'alive again’

[TJL]

Here is a curious question. If Dolan does get his proposition passed, would it be retroactive to Jahi's case? After all, technically her death occurred before the proposition was voted on. Or is having Jahi declared "alive" again part of a plan to reset her date of death as to occur after the proposition passed so that the family gets more than the "chump change" that Uncle O was so indignant about.

No, it wouldn't retroactively effect Jahi. She's dead. They'd need to get her declared "not dead", and then anything occurring going forward from that day could be considered. But the past is the past, and if it wasn't law at the time, they can't apply a future law to a past case.

 

[Supernovae]

There is no delicate way to ask this question, but how long can Jahi continue to exist in her present state without decomposition?

I think this is where people get confused. It's not like Weekend at Bernie's with a cadaver propped up in the corner, because brain death, while a valid concept, isn't the same as death as most people conceptualise it (or at least it's not the whole story- but I'll get onto that later). Parts of her brain have died and turned to liquid, and she cannot breathe independently because her brain stem isn't functioning to direct her lungs to breathe, that's why she has to be on a ventilator. However most of the rest of her cells and organs continue to function as cells and organs as long as her heart continues to beat, the ventilator is pumping in oxygen, and she's given nutrition and hydration. This is where Prof. Shewmon makes the comparison with a high spinal cord injury, the rest of her body essentially functions as a living organism, which is what he's talking about when he talks about "somatic integration." The peripheries of her body will suffer from poor circulation and there are a number of complications (mainly endocrine, as I understand it) that will eventual finish the dying process (for want of a better way of describing it) without continuous heroic intervention, but until that happens she will not "decompose" as such.

As I said way back in a previous thread, death is a process (with the ultimate endpoint of the cessation of all endogenous metabolic processes within the body, at which point the body will begin to decompose) not a bright red line, brain death is one (inevitable) part of that process. Modern medicine can essentially press the pause button on that process, and that is what, in essence, has gifted us these philosophical difficulties. For most of human history this would have been angels on pinheads stuff, because when one critical system failed the rest would also fail in short order: where exactly you drew the line in that process, between alive on one side and dead on the other, was, for every practical intent and purpose, irrelevant.

 

[Hiandmighty]

Of course she would update, as the donations saw an uptick with this "alive!" news. "Chump change...."

 

[Lippy]

Why didn't Jahi's brain liquefy completely as is expected in brain death patients? Why do parts of her brain still have form? Even laymen such as myself can see that the brain has atrophied and shrunk, we can see that parts are missing. I assume that the brain is slowly deteriorating, not healing. Why has this brain deteriorated more slowly than it should have?

 

[kaRN]

I agree, the courts need to get this resolved. But I'm not sure what guilt trips anybody would be taking. I think all Dr. Showman is saying in his affidavit is that the current criteria in determining brain death are not as reliable as the scientific and medical community has believed. He points out that Jahi had a flat EEG last December and now it shows electrical activity and that a truly "dead" brain would not be able to show any activity. He said her heart rate changes when her mother speaks. He points out a corpse can not menstruate.

iow, Jahi was never actually brain "dead" even though she was properly diagnosed. The doctors weren't wrong, the criteria is wrong. Showman's point is that the statutory/legal diagnostic criteria need to change.

JMO

The courts will no doubt be required to get involved but only to support the existing criteria for determining death already established worldwide by the medical community. I found this article while attempting to determine if the laws in California differed from those in Ontario where I practice. They don't.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071196/

This link is to an excellent article- Withdrawal of medical treatment in children by Anne E Tournay that I can't copy and paste here.

There are 5 circumstances that allow for the withdrawal of medical treatment to a child. They are Brain death, permanent vegetative state, 'no chance', 'no purpose' and 'unbearable'.

I do believe Jahi met (meets) the criteria for brain death at the time she was pronounced, however at this stage she also meets the criteria for permanent vegetative state, 'no chance' and 'no purpose'. NJ may allow a challenge to the definition of brain death, but that doesn't mean it would be appropriate to continue life support indefinitely. I certainly don't believe that if Jahi went into cardiac arrest in a healthcare facility in NJ, that great heroics would be taken to restart her heart. For what purpose? I believe that's why she was transferred to a home care setting. She could pass quietly with no heroics and no media frenzy and her parents could save face.
Just home from a long night shift so my brain is a little mushy myself. I see the photos of Jahi lying so peacefully, like a corpse. I see the photos of edematous feet that appear on my monitor anyway, to show signs of necrosis in the toes. I'm not even sure what I was looking at with the object they attached to her hand or perhaps was held there by Mom who is standing right behind it. I'm not sure why her toe nails are painted one colour and her finger nails another and I definitely don't understand why Jahi would need as many blankets covering her as she has if her brain stem is intact and she is able to control body temperature. The weight of the blankets alone would impede movement. They do a good job hiding the sensors that could be placed to provide electro stimulation of her muscles so it might appear she is moving purposefully. Remember the commercials for the Dr Ho massage device with the hand held controller?

 

[kaRN]

Respectfully snipped

You know, it would have been a simple enough matter to have the St. Peter Hospital ICU staff conduct a repeat brain death examination, in accordance with standard guidelines and statutes. It kind of appears that all of the "miracle" testing that Dolan has touted since filing his memorandum with the court Sept 30, has taken place AFTER Jahi went from St. Peter to the private home living situation.

I'm wondering, wouldn't the transfer of care from whoever transported Jahi from the coroners office (LOL) in CA to the hospital in NJ have also included a thorough assessment of the newly admitted patient including verification of BD on arrival? That would have been the final diagnosis made by the sending facility to warrant Jahi being transferred to the Coroners Office, vent and all. My guess is St Peters verified brain death at the onset but continued to provide life support. They would not agree to heroics above and beyond respiratory support however so Jahi was moved to a home care setting where no additional heroics would be possible.

 

[K_Z]

Good thoughts, kaRN. I actually don't know if they were obligated to do "another" battery of tests to re-establish that Jahi was in fact, brain dead under NJ state law, too. She had a death certificate from California-- that should have relieved them of any legal obligation to do "anything" at the St. Peter's hospital. It's an interesting dilemma!

Apparently, St. Peter DID keep patient records for Jahi, and Dr. Shewmon's declaration to the court mentions that, as well as the persistent brainstem dysfunction documented in her records from there that he reviewed.

At one point, I wondered if they kept any traditional patient records, or just provided routine and custodial care without records. I don't think the family could have sued any of the providers or the hospital for malpractice or negligence, since the patient was legally dead on admission. (Imagine having to write the policies and procedures for THAT kind of a situation!)

It has crossed my mind that it's possible that Dolan and NW actually wanted St. Peter's to repeat the tests, but St. Peter's refused, due to costs or other reasons. Or St. Peter's refused to allow Dolan's team of experts to do their tests in their hospital, with their equipment? Machado doesn't even have a U.S. license, but would he need one? Was Prestigiacomo credentialed at the St. Peter's hospital-- I kind of doubt it, hence the MRI at Rutgers, where he works. Do you need to do emergency privileges for a provider to evaluate a patient who is already legally dead? Elena Labkovsky almost certainly wasn't credentialed to work in the St. Peter's hospital, either. But St. Peter has LOTS and LOTS of credentialed providers who could have done the EEG and MRI there, as well as a repeat brain death diagnostic process.

Maybe St.Peter's admin just put their foot down, and said we won't help you try to have her declared un-dead, or "alive again"? Maybe St. Peters told them if they planned to pursue court action to have Jahi declared "alive again", they needed to leave their facility, due to the kind of publicity the case would draw? That they didn't want their facility embroiled in that kind of controversy, but they were willing to provide custodial care, as long as there was no publicity or media attention? That seems more than a little bit likely to me. Especially given the months of silence when no one knew where Jahi was being cared for.

It does seem strange that NW fought so hard to find a facility clear across the country to take Jahi and provide the 24/7 care in an ICU setting (and let's not forget the surgical procedures to place the permanent trach and g-tube)-- then suddenly appears to be totally comfortable and willing to just take her home to an apartment in a strange city? That decision seems rather sudden, from what the New Beginnings "pack the truck" publicity implies. Which then makes me wonder (like SwampMama), if there was some adversarial falling out between St. Peter's and NW, just like CHO, just this time without the parking lot marching protests, and calls to clog up the phone lines of the St. Peter administrators. IDK.

Also interesting that in the process of filing the petition for Jahi to be considered "alive again", and all the media splash, NW has had not one kind word to say publicly in support of all the care, consideration, and kindness St. Peter's hospital and staff have provided for her for months on end. Not. One. Word. I know she is capable of writing a heartfelt thank you note-- just look at the Facebook site, and the donation site. But she never seems to be able to dig down deep and publicly thank the hospitals, and medical and nursing staffs, that are in the trenches doing the really hard work of caring for her, and her daughter's body 24/7.

 

[Hiandmighty]

Why didn't Jahi's brain liquefy completely as is expected in brain death patients? Why do parts of her brain still have form? Even laymen such as myself can see that the brain has atrophied and shrunk, we can see that parts are missing. I assume that the brain is slowly deteriorating, not healing. Why has this brain deteriorated more slowly than it should have?

Welcome, Lippy. I think her brain is on the way to liquefied status-- I mean total liquidation.

Her body is getting support-- electrolytes, nutrition, hormones (we assume), 240.00 worth of supplements each week. Jahi's dead body is getting unprecedented support. I think all it shows is you can slow decomposition, but can't stop it. Her fingers, feet, tear duct areas appear to show slight decomp from the photos I have seen.

 

[Donjeta]

Good thoughts, kaRN. I actually don't know if they were obligated to do "another" battery of tests to re-establish that Jahi was in fact, brain dead under NJ state law, too. She had a death certificate from California-- that should have relieved them of any legal obligation to do "anything" at the St. Peter's hospital. It's an interesting dilemma!

Apparently, St. Peter DID keep patient records for Jahi, and Dr. Shewmon's declaration to the court mentions that, as well as the persistent brainstem dysfunction documented in her records from there that he reviewed.

At one point, I wondered if they kept any traditional patient records, or just provided routine and custodial care without records. I don't think the family could have sued any of the providers or the hospital for malpractice or negligence, since the patient was legally dead on admission. (Imagine having to write the policies and procedures for THAT kind of a situation!)

It has crossed my mind that it's possible that Dolan and NW actually wanted St. Peter's to repeat the tests, but St. Peter's refused, due to costs or other reasons. Or St. Peter's refused to allow Dolan's team of experts to do their tests in their hospital, with their equipment? Machado doesn't even have a U.S. license, but would he need one? Was Prestigiacomo credentialed at the St. Peter's hospital-- I kind of doubt it, hence the MRI at Rutgers, where he works. Do you need to do emergency privileges for a provider to evaluate a patient who is already legally dead? Elena Labkovsky almost certainly wasn't credentialed to work in the St. Peter's hospital, either. But St. Peter has LOTS and LOTS of credentialed providers who could have done the EEG and MRI there, as well as a repeat brain death diagnostic process.

Maybe St.Peter's admin just put their foot down, and said we won't help you try to have her declared un-dead, or "alive again"? Maybe St. Peters told them if they planned to pursue court action to have Jahi declared "alive again", they needed to leave their facility, due to the kind of publicity the case would draw? That they didn't want their facility embroiled in that kind of controversy, but they were willing to provide custodial care, as long as there was no publicity or media attention? That seems more than a little bit likely to me. Especially given the months of silence when no one knew where Jahi was being cared for.

It does seem strange that NW fought so hard to find a facility clear across the country to take Jahi and provide the 24/7 care in an ICU setting (and let's not forget the surgical procedures to place the permanent trach and g-tube)-- then suddenly appears to be totally comfortable and willing to just take her home to an apartment in a strange city? That decision seems rather sudden, from what the New Beginnings "pack the truck" publicity implies. Which then makes me wonder (like SwampMama), if there was some adversarial falling out between St. Peter's and NW, just like CHO, just this time without the parking lot marching protests, and calls to clog up the phone lines of the St. Peter administrators. IDK.

Also interesting that in the process of filing the petition for Jahi to be considered "alive again", and all the media splash, NW has had not one kind word to say publicly in support of all the care, consideration, and kindness St. Peter's hospital and staff have provided for her for months on end. Not. One. Word. I know she is capable of writing a heartfelt thank you note-- just look at the Facebook site, and the donation site. But she never seems to be able to dig down deep and publicly thank the hospitals, and medical and nursing staffs, that are in the trenches doing the really hard work of caring for her, and her daughter's body 24/7.

Reading Defina's statement it gives me the notion that the IBRF people weren't allowed to do testing in St Peter and he says Dolan told him St. Peter refused to do testing because of the publicity.

 

[I Object!]

It's interesting that the MRI Dolan shows states "NOT FOR MEDICAL USAGE" at the bottom. Personally, I've never seen a brain MRI before so I googled images of random MRIs from people who are alive and well. There's a remarkable difference... and I have zero medical diagnostic training.

 

[Hiandmighty]

Well, maybe because she has a death certificate, it isn't for medical use... Just a routine scan of a deceased brain. Can't get medical diagnoses on dead people, I assume :thinking:

 

[Donjeta]

I think the banner is a function of some image viewers, e.g. some versions of Osirix post the banner as default

 

[MyBelle]

The courts will no doubt be required to get involved but only to support the existing criteria for determining death already established worldwide by the medical community. I found this article while attempting to determine if the laws in California differed from those in Ontario where I practice. They don't.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071196/

This link is to an excellent article- Withdrawal of medical treatment in children by Anne E Tournay that I can't copy and paste here.

There are 5 circumstances that allow for the withdrawal of medical treatment to a child. They are Brain death, permanent vegetative state, 'no chance', 'no purpose' and 'unbearable'.

I do believe Jahi met (meets) the criteria for brain death at the time she was pronounced, however at this stage she also meets the criteria for permanent vegetative state, 'no chance' and 'no purpose'. NJ may allow a challenge to the definition of brain death, but that doesn't mean it would be appropriate to continue life support indefinitely. I certainly don't believe that if Jahi went into cardiac arrest in a healthcare facility in NJ, that great heroics would be taken to restart her heart. For what purpose? I believe that's why she was transferred to a home care setting. She could pass quietly with no heroics and no media frenzy and her parents could save face.
Just home from a long night shift so my brain is a little mushy myself. I see the photos of Jahi lying so peacefully, like a corpse. I see the photos of edematous feet that appear on my monitor anyway, to show signs of necrosis in the toes. I'm not even sure what I was looking at with the object they attached to her hand or perhaps was held there by Mom who is standing right behind it. I'm not sure why her toe nails are painted one colour and her finger nails another and I definitely don't understand why Jahi would need as many blankets covering her as she has if her brain stem is intact and she is able to control body temperature. The weight of the blankets alone would impede movement. They do a good job hiding the sensors that could be placed to provide electro stimulation of her muscles so it might appear she is moving purposefully. Remember the commercials for the Dr Ho massage device with the hand held controller?

Sorry, I don't recall it.

I think from a medical ethics standpoint in the U.S. it is unethical for a physician to provide an invasive treatment to a corpse and legally, that is what Jahi's body is. It is why CHO couldn't provide the feeding tube and the Court couldn't order them to do it.

There is an ethical exception for organ transplantation which allows the vent to remain on but it must be promptly turned off after organs are harvested. But if Jahi's brain is now in PVS, no matter how damaged it may be, she no longer meets the criteria for brain death so the vent can't be turned off and the feeding can't be discontinued unless her mother consents. Which is what your article also points out:

Summary points

There are 5 circumstances in which withdrawal of support may be considered in children—brain death, permanent vegetative state, “no chance”, “no purpose,” and “unbearable”
Effective palliative care must be provided after withdrawal of curative treatment


I'm not a physician or a legal expert but I do understand how seriously physicians and hospitals take medical ethics and legal liabilities. Especially if not all physicians agree on a child patient's condition. We have another thread in this forum about physicians not agreeing on a child's medical care and that ended up in court as well.

JMO

 

[wendiesan]

Dr. Ho refresher

http://www.youtube.com/watch?v=J4UfN-BoCVI

If you skip about 20 - 25 seconds at the beginning, I think you can see the muscle stimulation to which ksRN is referring.

 

[TJL]

Sorry, I don't recall it.

I think from a medical ethics standpoint in the U.S. it is unethical for a physician to provide an invasive treatment to a corpse and legally, that is what Jahi's body is. It is why CHO couldn't provide the feeding tube and the Court couldn't order them to do it.

There is an ethical exception for organ transplantation which allows the vent to remain on but it must be promptly turned off after organs are harvested. But if Jahi's brain is now in PVS, no matter how damaged it may be, she no longer meets the criteria for brain death so the vent can't be turned off and the feeding can't be discontinued unless her mother consents. Which is what your article also points out:

Well, there's only one organ in the human body that can regenerate its self, and that's the liver - and even still, there has to be a portion of it undamaged. So since we're talking about a dead brain and not a liver, PVS is not in the realm of possibility with Jahi's body. IBRF's motive and agenda of trying to claim they can bring a brain back to life, through the use of artificially tricking the rest of the body with synthetic hormones and chemicals, and electrical stimulation, is all just immaterial.

 

[SwampMama]

IF Jahi were now in a PVS state then her mother would surely consent to having her examined by fully qualified, reputable and respected experts. That would settle the matter so that Jahi's status would be undeniable. But Jahi's mom prefers to stick with experts of dubious backgrounds, views, and experience ( which are likely the only ones who will support her point of view and only because that view supports their agenda.)

Poor Jahi is dead and can't even rest in peace because she is being used as a prop to "prove" other people's agendas. Her mom is out to prove CHO and the real experts wrong. She will never admit that Jahi is dead and has been dead. Dolan uses Jahi for publicity and to bring attention to his proposition which would significantly increase his income. The same goes for the rest of the ones who are supporting the theory that Jahi is "alive". they have an agenda to promote, they want the publicity and it brings attention and income to their various publications/websites/etc.

Then there is the matter of the uneducated people who are preyed upon for donations to this lost cause. They are fed false information to prop up false hopes and many because of their great faith or lack of understanding of what brain dead means, are quite gullible to the realities of the situation.

 

[Hiandmighty]

IF Jahi were now in a PVS state then her mother would surely consent to having her examined by fully qualified, reputable and respected experts. That would settle the matter so that Jahi's status would be undeniable. But Jahi's mom prefers to stick with experts of dubious backgrounds, views, and experience ( which are likely the only ones who will support her point of view and only because that view supports their agenda.)

Poor Jahi is dead and can't even rest in peace because she is being used as a prop to "prove" other people's agendas. Her mom is out to prove CHO and the real experts wrong. She will never admit that Jahi is dead and has been dead. Dolan uses Jahi for publicity and to bring attention to his proposition which would significantly increase his income. The same goes for the rest of the ones who are supporting the theory that Jahi is "alive". they have an agenda to promote, they want the publicity and it brings attention and income to their various publications/websites/etc.

Then there is the matter of the uneducated people who are preyed upon for donations to this lost cause. They are fed false information to prop up false hopes and many because of their great faith or lack of understanding of what brain dead means, are quite gullible to the realities of the situation.

:cow: :moo: :cow: it's such a scam. You posted above how I see things...

 

[katydid23]

IF Jahi were now in a PVS state then her mother would surely consent to having her examined by fully qualified, reputable and respected experts. That would settle the matter so that Jahi's status would be undeniable. But Jahi's mom prefers to stick with experts of dubious backgrounds, views, and experience ( which are likely the only ones who will support her point of view and only because that view supports their agenda.)

Poor Jahi is dead and can't even rest in peace because she is being used as a prop to "prove" other people's agendas. Her mom is out to prove CHO and the real experts wrong. She will never admit that Jahi is dead and has been dead. Dolan uses Jahi for publicity and to bring attention to his proposition which would significantly increase his income. The same goes for the rest of the ones who are supporting the theory that Jahi is "alive". they have an agenda to promote, they want the publicity and it brings attention and income to their various publications/websites/etc.

Then there is the matter of the uneducated people who are preyed upon for donations to this lost cause. They are fed false information to prop up false hopes and many because of their great faith or lack of understanding of what brain dead means, are quite gullible to the realities of the situation.

There was also a fair amount of political race-baiting going on, implying that the hospital messed up because they didn't care about the life of a black child or the feelings of a grieving black family. And that is so ridiculous, because OAKLAND is heavily African American and that hospital has a very fine reputation and has cared for and cured and saved thousands of young black children.

 

[Lippy]

Who would ask NW to consent to more studies? Not the court, they don't have anything else to prove.

 

[TJL]

Who would ask NW to consent to more studies? Not the court, they don't have anything else to prove.

Dolan expected to be told in court that if he wanted to try and prove his case, he was going to have to submit the body to all the approved tests by independent examiners. So to head off this type of request, he withdrew the petition entirely and was then able to publicly pin the blame elsewhere.