Fascinating article/discussion among many doctors from different hospitals (and countries) about their protocol in dealing with "Brain death and uncooperative families". Very interesting and insightful reading.
http://www.ccm-l.org/discussion1/Ethics/uncoop.html
From the link: (using initials of those who contributed these opinions and experiences.
TB says
"Here in Virginia, and in most states of which I am aware, the diagnosis of death by brain criteria is death, and no legal action can be taken to reverse the diagnosis or to prevent one from discontinuing support which is futile for the patient (and the only purpose of which is to maintain the organs for potential transplantation).
That being said, a family that cannot accept the diagnosis of death by cerebral criteria is, in my experience anyway, unlikely to accede to organ donation within a useable (for the organs) period of time. My own feeling, and practice, has been to put the patient out of the ICU in a regular bed (may require a special dispensation for the ventilator in some hospitals), and allow the family to stay with the corpse for as long as they wish. Without fluids or vasopressors the blood pressure is almost never maintained for more than a day or two. We don't draw blood, do chest films, or anything else except occasional suctioning to decrease the family's distress from the sound of rattling secretions. I know there are many people who think it is wrong to keep ventilating a corpse, but as long as resources are not being diverted from the living and potentially salvagable, I don't see this as a major ethical problem"
LB (speaking of a case he had, nothing to do with Jahi) says:
"I met with the family with our transplant coordinator/couselor. I told them of the brain death protocol result, and that we would be ready to turn off the vent at any time. Just as the counselor brought up the concept of donation, they were letting us know that it was going to take a couple of days for them to "let us" disconnect the vent. At that point I knw I had a problem. It is difficult to explain to the family that the ICU is not a funeral home, that the patient is already dead, and that we can't hold a wake for him here. Hospital rules prohibit a non DNR to go the the floor, and , despite his brain death, if he doesn't have a signed DNR, he can't go to the floor (I am in the process of working this out). I then get the statement that I dread from families in this area - "You are only treating us this way becasue we are hispanic; you wouldn't be doing this if we were white and had insurance."
Despite this, after sessions alone with the counselor...... they are still clinging to the belief that they have to "allow" us to disconnect the vent. I then get the other thing that I have dreaded the last few months - the statement that they will go to court."
Very insightful reading, the discussion does not mention or discuss Jahi but you can see how similar situations are dealt with. It also evolves into some of the matters of organ donation but mostly it is about a family that refuses to "allow" their loved one to be disconnected from the life support, even though the patient is actually already dead and has been but is simply being kept oxygenated and ventilated. The hospital does not need their permission or consent to remove this support. It is not so much "support" as it it is prolonging the inevitable.
Once brain death is declared, the patient is considered dead. The insurance companies do NOT pay for hospital care of dead people so the hospitals have to bear the cost of these exceedingly expensive extra weeks of care, when they know it is all in vain.
I can see that her family has problems facing the reality of the situation, even before the surgery took place. She stated Jahi was a perfectly healthy child when we know in fact she was morbidly obese and had the surgery at Children'd Hosp, including her pre-planned post opt in ICU, which indicates there were serious concerns about Jahi from the medical people from the beginning. Her mother stated "When I walked her into that hospital, she was perfectly fine, there was
nothing wrong with her. She had
no health problems.'
Her mother also states that Jahi is in a coma and we know that is not the case. She is brain dead, as verified by 2 doctor/experts doing a series of tests at different times which all that was legally required to remove the life support. But the hospital also arranged that THREE MORE experts unaffiliated with Children's and either selected by or approved by Ms. McMath's family/next of kin -- examined Jahi and came to the same conclusion.
