Jahi’s family wants her declared 'alive again’

[TJL]

Sorry, I meant to quote this post and I don't know how to fix it.

"I guess instead of proving a reversal of brain death, perhaps it will cover his extensive writings about the concept of "whole body death", as opposed to just "brain death"? Now I'm really looking forward to reading it. We already know he's been riding that train for some time now (if the rest of the body is alive, we can't call the person truly dead.)"

Well that's the impression given at hospitals because Under normal circumstances, when a brain dead patient is on life support they disconnect the vent, wait for the heart to stop beating, then call the time of death and only then does the morgue come for the patient. I'm not opposed to doing things that way and I suppose it is just a courtesy to the family but it gives people the impression that death doesn't occur until the body is dead.
I think that when a person is declared brain dead and all the tests have been done to validate the death, the time of death should be called and noted. Instead they discuss with the family about when to disconnect the ventilator and that is just asking for trouble. They could be typing up a death certificate while the family is thinking about it.
Does that sound too harsh?

Nope, doesn't sound harsh at all. It's my understanding that hospitals do things this way as a compassionate measure to give the family time to grieve and accept the reality that their loved one is gone and not coming back. They don't want to be put into the "cold hearted" position of just walking a family into a patient's room and the family unexpectedly seeing their loved one deceased and covered head-to-toe in a sheet. The shock of such a thing would likely cause more harm than good. So they approach it with a compassionate understanding to help the family come to terms with what happened, give them some sense that they (the family) have a bit of control in what happens next, and let the grieving process work its way naturally. And for the most part this seems to be extremely effective.

It's only extremely rare that a family becomes so incredibly defiant and refuses to accept the reality of what happened, and things turn messy. Hospitals then are forced into a position of having to put their foot down and set some finality to the matter ("we will turn off the machines on this day and time, we're sorry, but that is what's best"). And then this does usually work...until you get the super duper exceptionally rare cases where the family takes the FIRM stance of, "the hospital lacks compassion or wants to treat us badly/unfairly", so they get TRO's.

People grieve in different ways, and for the most part this is a predictable process based on years and years and years of seeing people die and how their families handle it. Some come to terms with it much easier than others. And some are so incredibly defiant to accept something they don't want to hear, that they choose to fight the reality of death rather than accept it.

 

[joypath]

Judging by the title of that article, I can only guess that it'll have something to do with furthering IBRF's campaign to "prove" they can reverse brain death. I'm sure it'll be at least a brow-raising read.

edit: looked into it myself, too:

Machado's contribution to it, according to Pope's writing, is: "Death as a biological notion
Calixto Machado"

I guess instead of proving a reversal of brain death, perhaps it will cover his extensive writings about the concept of "whole body death", as opposed to just "brain death"? Now I'm really looking forward to reading it. We already know he's been riding that train for some time now (if the rest of the body is alive, we can't call the person truly dead.)

BBM:
Totally agree that's the ticket he's punched for the ride BUT the proverbial "can of worms" opened is HUGE and widespread, 'cause THAT philosophy crashes into therapeutic "living cell"/biological treatment...tissue grafting, blood product donations, corneal transplants....etc., all human tissue with mitochondrial "engines". Perhaps his future revolves around his casket and the " bell rope, tied to his finger" to ring out the erroneous classification as a "decedent"

 

[TJL]

It appears that Calixto Machado wrote a letter to the editor in response to the Shemie/ Baker article. It's not a peer reviewed article; it's an opinion statement/ response/commentary on Shemie and Baker's article.

Here's the journal link, and a link to Calixto Machado's letter.

http://www.jccjournal.org/current

http://download.journals.elsevierhealth.com/pdfs/journals/0883-9441/PIIS0883944114003189.pdf

(And he quotes some of his own work again in the section on Integration!)

*moooaaaaaan* How can anyone call themselves a professional at anything, when they quote their own opinion pieces as evidence to support their newer opinion pieces?

I'm just at a loss for words here...

Edit: okay, after reading it my thoughts:

He's parroting much of the same stuff we discovered in some of his other writings last week. (We can't call someone brain dead without evidence of a complete loss of consciousness and awareness...but oh, by the way, we have no way to test for the complete loss of consciousness and awareness, because we don't know where exactly these things reside in the brain...so we'll just call it "the entire brain, including every neuron of the entire brain stem and the cerebral cortex.")

 

[joypath]

Sorry, I meant to quote this post and I don't know how to fix it.

"I guess instead of proving a reversal of brain death, perhaps it will cover his extensive writings about the concept of "whole body death", as opposed to just "brain death"? Now I'm really looking forward to reading it. We already know he's been riding that train for some time now (if the rest of the body is alive, we can't call the person truly dead.)"

Well that's the impression given at hospitals because Under normal circumstances, when a brain dead patient is on life support they disconnect the vent, wait for the heart to stop beating, then call the time of death and only then does the morgue come for the patient. I'm not opposed to doing things that way and I suppose it is just a courtesy to the family but it gives people the impression that death doesn't occur until the body is dead.
I think that when a person is declared brain dead and all the tests have been done to validate the death, the time of death should be called and noted. Instead they discuss with the family about when to disconnect the ventilator and that is just asking for trouble. They could be typing up a death certificate while the family is thinking about it.
Does that sound too harsh?

BBM:

Your thinking is "right on point", THAT is how time of death is determined by the pronouncing medical staff for the death certificate! The continuation of mechanical interventions is done for a variety of reasons: transplant being just ONE. The issue of mechanical support IS presented as just that, "support"! IF a family is considering organ donation, the OCME is notified and in some jurisdictions, attends the post-mortem organ evaluation/collection. Before anybody asks, yes that attendance can/does become part of the medico-legal OCME autopsy protocol & charting.
Discussion of the absolute time "when to remove" mechanical support is not part of a family democratic process, ALL cases I've attended have been arranged by medical staff with the families being informed of the absolute time. It is emphasized that the time of death is XX.XX as when the medical pronouncement occurred.

AND to clarify........................these are steps taken AFTER the determination of brain death, NOT the steps taken in other pathologies.

IMO

 

[TJL]

Discussion of the absolute time "when to remove" mechanical support is not part of a family democratic process, ALL cases I've attended have been arranged by medical staff with the families being informed of the absolute time. It is emphasized that the time of death is XX.XX as when the medical pronouncement occurred.

I'm glad you said this. I took some time today to review all the court documents in Jahi's case, and time and time again every medical professional who was a part of this process reiterated that the time and place of death was not a debatable issue, nor was it something the family has any legal authority to intervene or "make decisions" in. The fact of someone being declared dead is a finality reached by the attending physicians, and once that is determined then the hospital and/or physicians have no obligation whatsoever to continue any type of mechanical support - regardless of what the family believes or doesn't believe. It's not a case of someone who's still alive and needs a family member to make informed medical decisions (as the McMath family attempted to argue for this right, unsuccessfully.) The only remaining decision the family has control over is, as you suggested, organ donation. And that's just a mere, "yes or no", do they want to allow it or not?

I also came to the realization - and I guess it had long been forgotten about - that Dolan did in fact attempt to send this case through federal court concurrently with it going through Grillo's court, for all the same reasons. It seems it was completely dropped from the federal docket the moment a settlement was made in Grillo's court to have CHO release the body to coroner's custody for the mother to assume full responsibility thereafter.

Dolan tried specifically to argue in federal court the same issues of the mother somehow having the legal right to decide further medical intervention as the guardian of her child. CHO countered that argument, same as they did in Grillo's court, that a family's right to make medical decisions to continue medical care for their child applies to a living person, and since Jahi was dead, then they no longer had any right to demand CHO to insert a trach or feeding tube.

 

[Hiandmighty]

As a reminder, Jahi's date of death is December 12, 2013. (I had to go back and look)

 

[TJL]

As a reminder, Jahi's date of death is December 12, 2013. (I had to go back and look)

:shame::laughing:

 

[Donjeta]

Hence, my definition of human death supports the statement of Baker and Shemie
[1,8,12] . “It is the brain function of the capacity for consciousness and self-awareness that is paramount in defining life[1]"

Agreed that consciousness and self-awareness are quite important but it's more a philosophical definition than useful operational criteria for clinical situations. We can't observe consciousness and self-awareness directly, only test behavior and clinical signs that are associated with the capacity for consciousness or the lack of it

 

[MyBelle]

Sorry, I meant to quote this post and I don't know how to fix it.

"I guess instead of proving a reversal of brain death, perhaps it will cover his extensive writings about the concept of "whole body death", as opposed to just "brain death"? Now I'm really looking forward to reading it. We already know he's been riding that train for some time now (if the rest of the body is alive, we can't call the person truly dead.)"

Well that's the impression given at hospitals because Under normal circumstances, when a brain dead patient is on life support they disconnect the vent, wait for the heart to stop beating, then call the time of death and only then does the morgue come for the patient. I'm not opposed to doing things that way and I suppose it is just a courtesy to the family but it gives people the impression that death doesn't occur until the body is dead.
I think that when a person is declared brain dead and all the tests have been done to validate the death, the time of death should be called and noted. Instead they discuss with the family about when to disconnect the ventilator and that is just asking for trouble. They could be typing up a death certificate while the family is thinking about it.
Does that sound too harsh?

I believe that IS the way it is done. In organ transplantation, the body has to be declared dead BEFORE the organ is removed. Hospitals will keep the patient attached to the ventilator because it helps preserve the organs being harvested.

Parents such as Jahi's who are of a faith that believes the soul does not die until the heart stops beating and wish to keep their child on life support--no matter how damaged--should have the right to do so. The Judge in this case preserved that right. It is no different than a terminally ill patient getting moved to a rest home or hospice.

End-of-life brain activity just may be a sign of the soul.

http://www.huffingtonpost.com/deepak-chopra/end-of-life-brain-activit_b_684176.html

 

[TJL]

Someone who is brain dead is not terminally ill. A brain dead person has already had death established. A terminally ill person is still alive, with a known illness or disease process that will eventually lead to their death. Hospice does not accept the bodies of people who are already deceased. That is a coroner's job.

Judge Grillo did not preserve "any rights" that were a matter of contention in Jahi's case. As a matter of fact, he issued a final judgement denying the petition to continue medical treatment. He also issued a final judgement denying NW's stance that she had the "right" to demand CHO to perform surgical procedures on the body (the tracheotomy). What he allowed, and actually ordered the parties to do, was the Petitioner and Defendant to come to a settlement outside of his courtroom that would satisfy the requests of both parties without him having to intervene. He accepted their out-of-court settlement. Accepting a settlement is not issuing a decision that supports one side or the other, or rules in either side's favor. But he most certainly did rule against NW where she claimed she had the right to disagree with the BD diagnosis and thereby force CHO to perform unethical medical procedures.

 

[forthelost]

Her heart will stop beating and her lungs will stop working if they disconnect the vent. Why isn't that death? If a person's heart stops and that's considered death, then should CPR or ALS not be used?

 

[TJL]

Her heart will stop beating and her lungs will stop working if they disconnect the vent. Why isn't that death? If a person's heart stops and that's considered death, then should CPR or ALS not be used?

I suppose if we also want to get further technical, her heart did in fact stop (she went into cardiac arrest) after the severe blood loss. It was only restarted with aggressive intervention. A point the mother has never really conceded to...but she claims on religious grounds that she doesn't believe in death until the heart stops? It DID stop.

 

[Lippy]

My husband was not a candidate for organ donor at the time we were told he was brain dead. They told us he was brain dead two days before he was taken off the vent. The time of death was called when his heart stopped after the vent was shut off. That was over ten years ago. I assumed that was how it was done when the patient is not an organ donor. Maybe it isn't.

I don't think that it is that uncommon for families to object to the vent being removed.

Jahi's surgery and subsequent brain death occurred on December 9, 2013. She was declared dead on the 12th. How long does it take to do the testing to confirm brain death?

 

[katydid23]

I believe that IS the way it is done. In organ transplantation, the body has to be declared dead BEFORE the organ is removed. Hospitals will keep the patient attached to the ventilator because it helps preserve the organs being harvested.

Parents such as Jahi's who are of a faith that believes the soul does not die until the heart stops beating and wish to keep their child on life support--no matter how damaged--should have the right to do so. The Judge in this case preserved that right. It is no different than a terminally ill patient getting moved to a rest home or hospice.

End-of-life brain activity just may be a sign of the soul.

http://www.huffingtonpost.com/deepak-chopra/end-of-life-brain-activit_b_684176.html

Except that a terminally ill patient is not yet DEAD. Jahi is dead. Even if her parents deny it, she is dead. Her brain stem is not functional. Her heart is beating only because it is hooked up to machinery. If you unplug the electrical current, her vitals will cease. She is dead. She has been dead for almost a year now.

 

[katydid23]

My uncle was hit by a car. The hospital declared him brain dead and he was not eligible as a donor because he had recently battled cancer. The hospital did not force the family to unplug the machinery because his daughter and grandchildren were out of the country. It took 2 days for them to make it to the hospital bed. They wanted to be there before his heart stopped beating. Mostly, they wanted to be there for their mother while the sad process took place.

I fully support a family's right to have a few days to gather together, and to process and to grieve before pulling the plug. We had to make the decision for my father as well. [ my father and my stepfather.] It is very difficult and heartbreaking. It is tempting to stay in denial. But it is reality and you cannot just keep a dead body plugged into the wall for years, to avoid that sad reality.

 

[TJL]

My husband was not a candidate for organ donor at the time we were told he was brain dead. They told us he was brain dead two days before he was taken off the vent. The time of death was called when his heart stopped after the vent was shut off. That was over ten years ago. I assumed that was how it was done when the patient is not an organ donor. Maybe it isn't.

I don't think that it is that uncommon for families to object to the vent being removed.

Jahi's surgery and subsequent brain death occurred on December 9, 2013. She was declared dead on the 12th. How long does it take to do the testing to confirm brain death?

To be perfectly honest, I'm not certain why that delay occurred. I've seen notes in court filings and doctor statements talking about the day of the surgery and what happened in the PICU on the 9th. And then the next day mentioned was the 11th. Only thing I am certain of is there's apparently a minimum 12-hour window that must exist between both sets of brain death examinations in the state of California. Health and Safety Codes 7180 and 7181 apparently mandate this 12 hour window, and also apparently 7181 states that the second test must be performed and confirmed by an independent physician.

CHO stated in one of their legal responses (looking for it, there's tons of documents) that they ended up going beyond that 12-hour window, and had the 2nd set of tests performed more than 24-hours later. They didn't specifically state why, but this could be for any number of reasons (availability of the doctor to do so could be one).

So if she initially "died" on the night of the 9th, then the family and the hospital spent most of the 10th discussing what happened and what will happen going forward. Which brings us to the 11th where the first test was performed, and then more than 24 hours later...on the 12th...the second test was performed.

The part in 7181 about the "independent physician" became a point of contention that Dolan argued, saying the second physician didn't meet the standard of being "independent" because that 2nd physician also worked for CHO. Which is where Grillo allowed Dr. Fischer's appointment to come in as a completely independent, outside Dr. to repeat the examination. But by the time that happened, according to the court filings, a total of 5 doctors had performed the examination and came to the same conclusion. 2 Dr's from CHO, and 3 Dr's from the family's request (one being Jahi's pediatrician).

https://docs.google.com/viewer?url=...field_v._Childrens_Hosp_Oakland_Cal_2013_.pdf

 

[Zuri]

I consider all medical journals, associations, bioethics professors of law, medicine, etc. who are watching and sharing information to be consumer watchdogs. Knowledge does impact the delivery of medicine to consumers.

JMO

The consumer watchdogs are the people actually doing the hands on care. I don't need an ethics professor to tell me or teach me what my standard of care should be. I took my job very seriously and those I worked with did the same. "We" already hold ourselves to high standards. Journals etc not so much.

 

[TJL]

Can someone find for me any court ruling by "a Judge" stating that Jahi is not dead until the mother believes it to be true? I've looked and looked, and cannot find anything to this effect. Any help would be appreciated. This would be pretty groundbreaking, as the death certificate would not exist if a Judge made such a ruling. Thanks in advance.

 

[MyBelle]

The consumer watchdogs are the people actually doing the hands on care. I don't need an ethics professor to tell me or teach me what my standard of care should be. I took my job very seriously and those I worked with did the same. "We" already hold ourselves to high standards. Journals etc not so much.

I'm not sure of what point you are trying to make. Those who set standards of care are medical experts. Those who set public policy are not medical experts and they do rely on those who are.

JMO

 

[Zuri]

My MIL died today at 2:43 pm EDT. Today was her 85th birthday and she lived a great life. Her decline was sudden and rapid as only a week ago she was driving her car and shopping. I was at her bedside and watched her take her last breath, and it was a peaceful passing. We made sure she had pain relief and oxygen support.

Sure, we could have instituted CPR, IVs, cardiac meds, ventilation. We chose not to and let her die with dignity and grace. How selfish would we have been to inflict the horrors of active life support, which are indeed rough. There comes a time to just let go.