Family wants to keep life support for girl brain dead after tonsil surgery #1

[Donjeta]

I think someone can last a long time on a ventillator.
So I don't think hospital is hoping/assuming her heart will stop before December 30. My understanding it could take years.

It's only five more days until December 30, I think it might be longer as well. But perhaps not years. I'm not sure if there is any research into how long brain dead people can sustain a heartbeat while on life support. It seems a little Frankensteinian and it would be hard to find research subjects and get ethics committees to agree to such projects. But I believe that a brain dead person may be more vulnerable to many kinds of ailments than many other kinds of people who need a ventilator because he is unable to recognize, communicate and seek help when something is wrong and because his now-nonfunctional brain would ordinarily play a role in regulating the homeostatic processes in the rest of his body. For one thing, if there is no blood flow to the brain there is no blood flow to the pituitary gland which secretes a number of important hormones, including ones that regulate blood pressure and thyroid function, and if blood pressure and thyroid function are messed up it tends to cause other problems. Patients on life support who get their fluids through an IV are also more prone to infections, and even a trivial infection might turn out to be fatal. If you're already legally dead it might be hard to find doctors to prescribe aggressive treatments and get anyone to finance them. And the brain with no blood flow is basically necrotic tissue and necrosis anywhere in our bodies can lead to death pretty fast.

 

[jjenny]

BBM. No, not years. Days at best, depending on how much support her body is currently on (other BP and heart rhythm meds, etc.), and how fast systems are deteriorating.

Sad and difficult to say, but her brain has no perfusion at all. For 2+weeks. It is already decomposing, which will be documented on the autopsy report.

It isn't like her body is perfectly fine, inert, and physiologically intact on the ventilator. Every single body system is altered and erratic. She is not in a coma or vegetative state. It is extremely complex physiologically to be brain dead with a beating heart.

Everything from cell permeability to oxygen transport is affected and deteriorating. Drugs can't work properly. Hemoglobin can't bind and release oxygen normally at the tissue level-- despite high levels of oxygen delivered via the ventilator. Acid/ base balance becomes increasingly impossible, electrolytes are deranged and can't be corrected, distal airways collapse, muscle tissue breaks down, kidneys and liver stop working, coagulopathies, the gut begins to bloat and break down, etc. Her body is dying and deteriorating more and more every hour that goes by. Brain death is not a survivable state for the rest of the body.

I'll see if I can find a few references to post.

http://books.google.com/books?id=v4gbsXJ3bxAC&printsec=frontcover#v=onepage&q&f=false

Link to a textbook called "The Brain Dead Organ Donor: Pathophysiology and Management". You can hit the "preview" button here and read quite a bit.

We have another thread on a pregnant woman that collapsed. My understanding she is also brain dead and is on a ventillator (that her husband wants to be turned off). But doctors can not turn off her life support because she is pregnant. So far she has been in that condition for a month and they are talking of potentially bringing the fetus to full term. So, if not years, seems someone can at least last many months on life support.

 

[Donjeta]

We have another thread on a pregnant woman that collapsed. My understanding she is also brain dead and is on a ventillator (that her husband wants to be turned off). But doctors can not turn off her life support because she is pregnant. So far she has been in that condition for a month and they are talking of potentially bringing the fetus to full term. So, if not years, seems someone can at least last many months on life support.

I'm pretty sure that if there is a fetus to save there is more medical effort to keep the brain dead person's body systems working properly than if the doctors would be ready to stop life support.

 

[SwampMama]

BBM. No, not years. Days at best, depending on how much support her body is currently on (other BP and heart rhythm meds, etc.), and how fast systems are deteriorating.

Sad and difficult to say, but her brain has no perfusion at all. For 2+weeks. It is already decomposing, which will be documented on the autopsy report.

It isn't like her body is perfectly fine, inert, and physiologically intact on the ventilator. Every single body system is altered and erratic. She is not in a coma or vegetative state. It is extremely complex physiologically to be brain dead with a beating heart.

Everything from cell permeability to oxygen transport is affected and deteriorating. Drugs can't work properly. Hemoglobin can't bind and release oxygen normally at the tissue level-- despite high levels of oxygen delivered via the ventilator. Acid/ base balance becomes increasingly impossible, electrolytes are deranged and can't be corrected, distal airways collapse, muscle tissue breaks down, kidneys and liver stop working, coagulopathies, the gut begins to bloat and break down, etc. Her body is dying and deteriorating more and more every hour that goes by. Brain death is not a survivable state for the rest of the body.

I'll see if I can find a few references to post.

http://books.google.com/books?id=v4gbsXJ3bxAC&printsec=frontcover#v=onepage&q&f=false

Link to a textbook called "The Brain Dead Organ Donor: Pathophysiology and Management". You can hit the "preview" button here and read quite a bit.

Thank you so much for this. This was vital information that I wanted but did not even know where to find (I did look a bit but mostly found articles on ethics and legalities). This is information that people need to know to see the futility of "life" after brain death while on a respirator.

 

[wendiesan]

snipped by me

Would a hospice even take Jahi? I'm not sure they would.

I was wondering about this too. Especially if the case involved legal proceedings. IMO, a facility would want funding to be in place, so insurance or private financing would have to be assured. It's awful to think about such a situation to revolve around dollars and cents, but that aspect of medical treatment can't be ignored.

 

[SwampMama]

I understand this. There could always be that person that comes out of the woodwork though and says they will pay for her care. Or the next case that comes along, someone may have the money to pay for care at home if a facility won't do it. A judge or other authority could intervene, depending on their beliefs or sympathy towards the family and prolong things even further.

My curiosity still has me asking general questions and I believe it's because there seems to be a lack of knowledge in the GP and a lot of misinformation spread in circles and over the internet. There needs to be better education and clarification for the next case that will follow.

I guess I am caught up in the general topic and because of misinformation I am seeing, I may be going O/T on this thread. I apologize and will leave it at that.

No need for an apology. Your viewpoint is valued along with your thoughts and questions. I think a lot of us are all learning a lot of this as we go. The fact that you have curiosity and interest in this and want to know more is a great thing. This is something that ALL of us need to know more about and conversations like this. How wonderful that we have input from such diverse people, including quite a few WSers who are RNs, attorneys, an anesthetist, and others with personal experiences with brain death, that contribute to the knowledge here.

I spent hours and nights to learn all that I did about laws, court cases, medical stuff, etc and I am nowhere near knowing enough. (You may not have all night to sit up and read non stop for 8 hours like I do, most people don't.) I am learning so much from this conversation and all of the different views and ideas that everyone here has.

The discussion has been intelligent, informative, insightful and very empathetic to the parties involved. So I value everyone's input here even if someone had an entirely opposite opinion than mine. Those are the things that cause us to think and consider our viewpoints.

For me, because any opposite viewpoints come from many posters that I have come to know (even if just by name) I have a respect for their opinion, experiences and a sureness that their heart is in the right place, because they are a WS member.

 

[otto]

Has decision been made? I heard that an independent report was due any day now ruling one way, or the other regarding, whether there was any possibility of a recovery. I can certainly understand that the parents are grieving, and it must be so much more difficult looking at what appears to be a perfectly complete child and accepting that there is no life.

 

[SwampMama]

I was wondering about this too. Especially if the case involved legal proceedings. IMO, a facility would want funding to be in place, so insurance or private financing would have to be assured. It's awful to think about such a situation to revolve around dollars and cents, but that aspect of medical treatment can't be ignored.

In the case of Baby Mariah from 1995-96 ( I think ??), the 5 month old was shaken by her father so severely that she ended up brain dead). Her parents went to court to keep her on life support. Her dad obviously wanted to keep her alive to keep himself from being charged with murder. Her mom insisted her dad was innocent. Interestingly, her dad was an anesthesiologist and her mother was a lawyer. If Mariah was on life support, police could not get the evidence of her injuries that could only be obtained in an autopsy.

Cardinal John OConnor stepped in and used his influence as a Catholic Cardinal to get a Hospital that he held a position at to take Baby Mariah, after all others had declined to step into the controversy. She was transferred and died about a month later and the autopsy revealed the undeniable proof of what her father had done. he was charged and served 4 years and the wife stood by him and they are still together.

http://www.deseretnews.com/article/...S-MOVE-ENDS-COURT-FIGHT-OVER-BABY.html?pg=all

"A court fight pitting the parents of a brain-dead 5-month-old girl against doctors who wanted to take her off life-support came to an end after Cardinal John O'Connor intervened.
The leader of New York's Roman Catholic archdiocese persuaded St. Vincent's Hospital to take the baby. Mariah Scoon arrived at the hospital Thursday afternoon from Long Island Jewish Medical Center, escorted by eight police motorcycles and nine police cars."


So it would be hard to find a place to take Jahi. There is no treatment available for her. many hospitals would not want their name involved in this legal mess.

I'd like to know where Dr Byrne is at this point. Him, with his views that brain death is not death and all his mumbo jumbo. If he feels so strongly about that then, is there ANYBODY that he has interceded on behalf of and helped? I mean "help" such as actually taking them on as a patient or arranging care for and such, . I don't mean someone that he just babbled about and used to further his beliefs against organ donation.

Dr Byrne has had 3 decades to accomplish something if he feels so strongly that innocent "living" people are being cruelly killed for their organs or just because they are brain dead. has he set up a place where such a case could go? or has he just used the saddest or most extraordinary cases just to further his own views, without ever being personally a part of a medical team actively caring for such a patient. I think I already know the answer

 

[SwampMama]

Has decision been made? I heard that an independent report was due any day now ruling one way, or the other regarding, whether there was any possibility of a recovery. I can certainly understand that the parents are grieving, and it must be so much more difficult looking at what appears to be a perfectly complete child and accepting that there is no life.

The decision was that the court appointed Doctor found that Jahi is dead and therefore the hospital has the legal right to stop life support BUT she will remain on life support until Dec 30 to give her parents time to take it to a higher court and appeal. I assume that after DEC 30, the hospital will remove life support, as is their legal right to.

 

[otto]

The decision was that the court appointed Doctor found that Jahi is dead and therefore the hospital has the legal right to stop life support BUT she will remain on life support until Dec 30 to give her parents time to take it to a higher court and appeal. I assume that after DEC 30, the hospital will remove life support, as is their legal right to.

Thanks. If she is brain dead, and unable to live without life support, then the machines should be removed and life should take it's course. If she is brain dead, shouldn't it also be true that she won't last more than 30 minutes without life support? The idea of starving someone to death just doesn't sit well with me. If she is breathing on her own, would she be kept alive?

 

[txsvicki]

I'm a little suprised that there's not more religious discussion showing up on the net about this. It can't change the medical and legal stand points, but I personally want to know when the soul is released from all connections to the body. Is it when the brain ceases to support bodily functions or when the heart ceases to pump blood. I'm coming around to it being when that last breath was taken just as the brain function ceased to support life.

 

[jjenny]

Thanks. If she is brain dead, and unable to live without life support, then the machines should be removed and life should take it's course. If she is brain dead, shouldn't it also be true that she won't last more than 30 minutes without life support? The idea of starving someone to death just doesn't sit well with me. If she is breathing on her own, would she be kept alive?

She is brain dead. She therefore is not capable of breathing on her own. If ventillator is turned off, her heart should quickly stop.

 

[SwampMama]

Some more interesting reads about topics relating to brain death that has been covered in the media in the few decades.

When it truly is life or death
" Confusion about the meaning of brain death is not simply a matter of semantics. Misunderstandings about brain death often lead to incorrect ethical claims and cause families distress when they are trying to make difficult end-of-life decisions for a loved one" http://articles.philly.com/2005-08-10/news/25424475_1_brain-dead-brain-death-susan-torres

In America, Is It Possible To Die Twice?
" Brain death is the standard doctors use for determining death. However, it is a concept that many Americans do not understand or accept. The reason is no mystery. Medicine and the media continue to make a hash of explaining brain death to the public.......
To say a "brain-dead person was allowed to die" is the same as saying "a corpse died again."....... Is this simply a matter of splitting hairs without much practical import to the everyday reader? Absolutely not. http://articles.philly.com/2005-08-10/news/25424475_1_brain-dead-brain-death-susan-torres

 

[Trino]

I'm a little suprised that there's not more religious discussion showing up on the net about this. It can't change the medical and legal stand points, but I personally want to know when the soul is released from all connections to the body. Is it when the brain ceases to support bodily functions or when the heart ceases to pump blood. I'm coming around to it being when that last breath was taken just as the brain function ceased to support life.

There are quite a few blogs on this question but no real answer. It appears to be a matter of personal belief.

 

[Minette]

I was wondering about this too. Especially if the case involved legal proceedings. IMO, a facility would want funding to be in place, so insurance or private financing would have to be assured. It's awful to think about such a situation to revolve around dollars and cents, but that aspect of medical treatment can't be ignored.

I know, and I feel bad about even mentioning that aspect but it is the plain fact with our healthcare system. And to be fair, I don't know that in a country with government-funded healthcare the hospital would even have continued to maintain Jahi on a ventilator this long given that several (six, if I recall correctly) doctors have now given medical opinions following an actual examination that she is brain dead and there is no possibility of recovery. Perhaps someone with knowledge of the healthcare system of (for example) the U.K., etc. could weigh in.

 

[SwampMama]

Someone earlier had asked about a better clarification of religious views. I found some interesting reading that deals with some of that quite clearly. The first 3 are Catholic based since Dr. Byrne, as staunch Catholic doctor proclaimed that brain death is not death, etc. But the catholic church seems quite in line with the diagnosis of brain death and organ transplant and ascertaining that it is indeed death.

http://www.catholicnewsagency.com/n...hurch-teaching-on-brain-death-organ-donation/
Denver, Colo., May 3, 2011 / 06:17 pm (CNA).- Confusion about Catholic moral teaching on “brain death” may be leading some doctors and ethicists to forbid organ donations in cases where the Church would allow it. ..........Currently, the Church permits doctors to use “brain death” or “neurological criteria for determining death” in making end-of-life and organ donation decisions.

Organ transplants, 'brain death,' and Church teaching (Catholic)
http://www.catholicculture.org/commentary/otn.cfm?id=902
"It was Pope Pius XII who said that theologians must defer to doctors “to give a clear and precise definition of ‘death’ and the ‘moment of death’ of a patient who passes away in a state of unconsciousness.” This guidance from the Vicar of Christ is not particularly “recent” (although our reader might have come across it recently), and it is perfectly consistent with statements from Popes John Paul II and Benedict XVI."

On brain death, a reader's rebuttal
http://www.catholicculture.org/commentary/otn.cfm?id=903

An overview of various religion's beliefs:
Religious views on organ donation - Wikipedia, the free encyclopedia

 

[BeginnersLuck]

I know, and I feel bad about even mentioning that aspect but it is the plain fact with our healthcare system. And to be fair, I don't know that in a country with government-funded healthcare the hospital would even have continued to maintain Jahi on a ventilator this long given that several (six, if I recall correctly) doctors have now given medical opinions following an actual examination that she is brain dead and there is no possibility of recovery. Perhaps someone with knowledge of the healthcare system of (for example) the U.K., etc. could weigh in.

The fact is though this is really no different than someone who has died of a heart attack, cancer or any other condition. The only difference is this child is technically dead and it's an illusion, because a oxygen machine is able to keep her "appear" to be still alive. Modern day medicine
..it's a machine...she is dead..

 

[otto]

She is brain dead. She therefore is not capable of breathing on her own. If ventillator is turned off, her heart should quickly stop.

What happened to Terry Schiavo? She died after being starved for 13 days. That doesn't seem right. Not being able to feed oneself is not equal to brain dead. It's severely brain damaged, but not dead.

 

[otto]

I'm a little suprised that there's not more religious discussion showing up on the net about this. It can't change the medical and legal stand points, but I personally want to know when the soul is released from all connections to the body. Is it when the brain ceases to support bodily functions or when the heart ceases to pump blood. I'm coming around to it being when that last breath was taken just as the brain function ceased to support life.

The answer to that seems rather obvious. In theory, the soul is unconnected to the body. It is an entity that dropped into the body.

My mother had a brain tumor about 20 years ago. She had always been a very religious woman, wanted to be a theologian when it was not really allowed for women. After she recovered from her brain tumor, she said that there was no soul because her reasoning and perceptions changed according to her physical self, the brain disease of a tumor ... that there was no soul that existed and remained constant while her brain malfunctioned.

 

[otto]

I know, and I feel bad about even mentioning that aspect but it is the plain fact with our healthcare system. And to be fair, I don't know that in a country with government-funded healthcare the hospital would even have continued to maintain Jahi on a ventilator this long given that several (six, if I recall correctly) doctors have now given medical opinions following an actual examination that she is brain dead and there is no possibility of recovery. Perhaps someone with knowledge of the healthcare system of (for example) the U.K., etc. could weigh in.

"The Supreme Court of Canada has dismissed an appeal that would have permitted doctors to end life support for a severely brain-damaged man without the consent of his family or a substitute decision maker.

In a split decision on what the top court called a "tragic, yet increasingly common conflict," Chief Justice Beverley McLachlin wrote for the majority that, under Ontario's Health Care Consent Act, treatment cannot be confined to something that doctors consider to be of medical benefit to the patient.

Moreover, the court dryly observed that if death is considered a manifestation of ill health, then life support serves a preventive purpose.

... no therapeutic hope of recovery and that keeping Rasouli on life support will result in a series of progressively worse medical complications as his body deteriorates"

http://www.thestar.com/news/crime/2...p_dad_alive_he_talks_to_us_with_his_eyes.html

http://www.cbc.ca/news/canada/toron...op-court-upholds-life-support-right-1.2125140

There is also the Dutch Prince. He was caught in an avalanche and was without oxygen for more than 20 minutes, yet, as a Prince, he was kept alive. Eventually he died of complications due to being brain dead in a coma ... I believe cause of death was pneumonia. He was about 43 years old with a beautiful wife and two young children.

http://www.huffingtonpost.com/2013/08/12/prince-friso-dead_n_3743226.html