February 1, 2018

"I think that the people who have done the deep and conceptual thinking about brain death are people with high I.Q.s, who tremendously value their cognitive abilities...."

From “What Does It Mean to Die?/When Jahi McMath was declared brain-dead by the hospital, her family disagreed. Her case challenges the very nature of existence” by Rachel Aviv (The New Yorker):
According to New Jersey’s 1991 statute on death, insurance providers can’t deny coverage because of "personal religious beliefs regarding the application of neurological criteria for declaring death." Alan Weisbard, the executive director of the bioethics commission that drafted the law, told me, “I thought our position should be one of humility, rather than certainty.”

Weisbard had previously served as the assistant legal director for the President’s Commission on death and, like Wikler, he felt uneasy about the result. He said, “I think that the people who have done the deep and conceptual thinking about brain death are people with high I.Q.s, who tremendously value their cognitive abilities—people who believe that the ability to think, to plan, and to act in the world are what make for meaningful lives. But there is a different tradition that looks much more to the body.” The notion of brain death has been rejected by some Native Americans, Muslims, and evangelical Protestants, in addition to Orthodox Jews. The concept is also treated with skepticism in Japan, owing in part to distrust of medical authority. Japan’s first heart transplant, in 1968, became a national scandal—it was unclear that the donor was beyond recovery, or that the recipient (who died shortly after the transplant) needed a new heart—and, afterward, the country never adopted a comprehensive law equating brain death with the death of a human being. Weisbard, a religious Jew, said that he didn’t think “minority communities should be forced into a definition of death that violates their belief structures and practices and their primary senses.”

30 comments:

traditionalguy said...

Brain activity leaving the intubated/ ventilated body is usually a cause to gather the relatives and discuss their wishes on Turning Off the heroic measures. After 3 days the MDs make the decision.

The cases of younger brains shot by criminal thugs in a robbery are easier, and in a few hours that person's organs are being transplanted. Maybe that is why the Mayor of Philadelpia wants bullet proof glass outlawed so the young folks working C-stores all night can donate their organs faster.

Bad Lieutenant said...

"I think that the people who have done the deep and conceptual thinking about brain death are people with high I.Q.s, who tremendously value their cognitive abilities...."

And Jack Handey, don't forget him.

Original Mike said...

Deep thinking about not thinking.

Inga...Allie Oop said...

What is so tragic about keeping a brain dead patient suspended in artificial life, as opposed to brain injured, is that the brain is needed to keep certain bodily functions working properly. The ventilator will keep the blood and oxygen moving and keep the heart beating, but doesn’t keep the GI system, kidney, hormones, BP, etc. functioning. Drugs are needed to keep the BP from crashing, and other interventions are needed to keep the body from crashing in numerous ways. This isn’t even close to being a normal way to, exist, it’s not life.

Ann Althouse said...

The article is about a young woman who was being kept alive at a cost of $150,000 a week, paid for by insurance, after tests led doctors to declare the girl brain dead. The article is very supportive of the family, who seem to have a legitimate grievance about the way the girl was treated before she died/"died."

Inga...Allie Oop said...

“Alan Shewmon, who had just retired as the chief of the neurology department at Olive View-U.C.L.A. Medical Center, read Machado’s report and wondered if Jahi had a condition, first proposed by the Brazilian neurologist C. G. Coimbra, called ischemic penumbra. Coimbra hypothesized that this brain state could lead to a misdiagnosis of brain death in patients whose cerebral blood flow was diminished enough that it couldn’t be detected by the standard tests. If blood was still flowing to parts of the brain, however slowly, then, in theory, some degree of recovery could be possible.”

Wow, I’ve taken care of brain injured patients with far less devastating injuries to their brains than this poor girl, they had sufficient blood flow to their brain, but the brain doesn’t recover with damage that is severe and diffuse enough. Not one of my patients ever improved significantly, but they were profoundly injured. I’ve had brain injured patients that had less severe injuries and needed months and even years of therapy, they were the lucky ones.

tcrosse said...

I'm with Inga. There truly is a Fate Worse than Death.

Leland said...

“Who’s ‘we’?” Sandra remembers thinking. “We African-Americans? I felt so belittled. Yes, a lot of black children die in Oakland and people do have funerals for their children—but that don’t mean all of us are like that. Do you think we’re supposed to be used to our children dying, that this is just what black people normally go through?” She said, “At that point, I just lost all my trust.”

At this point in the article, I lost all my trust as well in the people relating the story. Especially later when we get to:

Sandra said she sometimes wonders, “If the hospital had been more compassionate, would we have fought so much?”

So this is really about Grandma Chatman feeling like she was insulted, and not about objectivity.

I can agree it seems the hospitalist and nurses may have missed the ENT Rosen's note about possible hemorrhaging, but really that paragraph is vague. It says Rosen made the note in his medical records, and that the nurses did not. But were his medical records given to the hospital? Did he make those records when initially examining his patient before surgery? They don't seem like notes to make post surgery, and if they were, I would think another note would be to tell the nurses to look for signs of hemorrhaging and to contact him immediately.

But oddly, Grandma Chatman really isn't upset about Rosen. She's mad at the hospitalist that had his arms cross and didn't introduce himself when he arrived to assess the patient. The grandmother asserts by the hospitalists manner, that "he thought we were dirt." And that seems to be the kernel that started the endeavor to go through extraordinary means to keep Jahi's body alive.

By the way, how many people caught that there were two doctors? The original ENT that performed the surgery and another doctor that was present post-op.

CWJ said...

Why did we need, much less want, a President's Commission on death? Seriously! About how did such a thing come?

Mark said...

Why is it that the people who are the biggest idiots in the room are so often held out as being super smart? Gobbling up the fruit of the Tree of Knowledge does not make one smarter, but stupider -- and not only effectively "brain dead," but spirit dead.

gbarto said...

This has generated a lot of news locally (SF Bay Area) and one of the problems is the hospital already had a rep for half-assing things and a few prior cases that looked not so good. The disrespect and lack of compassion were read not just as a personal slight but as indifference to getting the information needed to properly care for the patient. And the way the hospital spokespeople sounded as this unfolded did little to reassure that they cared nearly as much about patients as paperwork. I don't find much wisdom in continuing to keep the girl alive, but if I had a child with a medical condition I'd be damn wary of letting him or her into that hospital.

Francisco D said...

I used to be agree with tcrosse and Inga (surprisingly).

20 years ago, my ex-wife was unresponsive to deep pain stimulation after 8 hours of surgery. Everyone in the ICU thought she was dead or dying. There were tubes coming out of every orifice. She had septicemia and was on a ventilator.

Three days later she was awake and alert, but in need of further surgery. She was assumed to be brain dead by the medical staff who were present. (The surgeon and anesthesiologist were home sleeping after a very long night).

She heard the doctors talking at the end of the initial operation. She also heard a pastor praying over her the next morning. (I was not allowed to enter the room without pastoral counseling). Her cognitive state was due to exotic anesthetics used for a long operation.

She made me promise to never let them take her off life support, regardless of how long she was on it. She believes that medicine is constantly advancing and may be able to rescue her from what is assumed to be brain death.

CWJ said...

Francisco D,

Thamk you for that. Trusting the "experts" is as frightening as not trusting the "experts." At the end of the day, you have to ask yourself whose ass is being protected. Good fortune to you and your wife!

Mark said...

a young woman who was being kept alive at a cost of $150,000 a week, paid for by insurance

There is an historic term for that -- it is "useless eater."

Ralph L said...

Also in the 90's, my second cousin kept putting off getting a mitral valve replacement and keeled over one day without warning. They got his heart restarted after 45 minutes, but his brother told me he was essentially brain dead, not in a coma. His son insisted on keeping him on life-support for 3 weeks, against the wishes of the rest of the family (apparently pushing his mother). Caused a lot of stress. The widow's insurance covered it--she was the longtime secretary to the CEO of a successful fastfood chain.

Several years later, the son's mother and grandmother died in the same week, and the son did something strange right after: either touring Europe or crashing his car, or both, I can't remember.

Inga...Allie Oop said...

“Three days later she was awake and alert, but in need of further surgery. She was assumed to be brain dead by the medical staff who were present. (The surgeon and anesthesiologist were home sleeping after a very long night). “

There is no “assuming” brain death. There are very strict criteria that must be met to be declared brain dead.

American Academy of Neurology Guidelines for Brain Death Determination

Francisco D said...

They were no neurologists present, nurse Inga.

Reading comprehension is not your strong suit. That's why those of us with doctorates and medical degrees have to tell you what to do. That's also why you cut and paste - no original thoughts.

Stick to bedpans. You really are an asshole and a stupid one to boot.

Michael said...

I see that no one has actually read the article. Understandable. It is long. Excruciating.

Inga you should read the whole thing since you have had experience. The article is chilling on many levels.

Inga...Allie Oop said...

Oh blah blah blah, stick to bothering the poor geriatric patients. That’s your speed. You’re obviously very ignorant when it comes to medical knowledge.

#NursingHomePsychologist

Freeman Hunt said...

At this point, considering how horribly these people have been treated, it seems to me that the family should be allowed to decide whatever they want, and everyone else should go along with it.

Inga...Allie Oop said...

“Inga you should read the whole thing since you have had experience. The article is chilling on many levels.”

I have read the entire article and yes it is chilling on some levels. Obviously her brain had enough blood flow to not start decomposing, as most brains do after a true brain death diagnosis. I’ve seen the nasal discharge, it’s horrid. I don’t have much hope for Jahi to regain alertness, she is in a deep vegetative state or something of the sort. I’ve taken care of patients in a vegetative state that didn’t need ventilation, they had no significant improvement. I’ve seen families devastated by well meaning medical staff that have given them false hope.

Mark said...

Good thing you are there to help "ease the way" for these poor wretches.

Inga...Allie Oop said...
This comment has been removed by the author.
Yancey Ward said...

Here is the truth- no one knows what the experience is for any particular unconscious person- no one. I can imagine a variety of states that they may exist in, but there is no certainty that any of them are valid, or that any of them are both valid and general. You have to act on the data available, and I come down on the side of those who turn the machines off when there is no measurable brain activity as seen on EEGs.

Freeman Hunt said...

But when you have a vested interest in turning off the machines because you've committed malpractice and want the payout limited, the situation gets a little more complex.

Daniel Jackson said...

"But when you have a vested interest in turning off the machines because you've committed malpractice and want the payout limited, the situation gets a little more complex."

To say nothing of the increasing market demand for used body parts.

Howard said...

Brain Dead ain't what it used to be. In fact, it sounds like it's actually a paralyzed torture chamber of consciousness.
Into the Gray Zone

Howard said...

Blogger Francisco D said...

They were no neurologists present, nurse Inga.

Reading comprehension is not your strong suit. That's why those of us with doctorates and medical degrees have to tell you what to do. That's also why you cut and paste - no original thoughts.

Stick to bedpans. You really are an asshole and a stupid one to boot.

Great job highlighting why people don't respect over-educated cunts.

dgstock said...
This comment has been removed by the author.
dgstock said...

The operation is mistakenly described as a tonsillectomy when in reality it was a three part procedure also involving septoplasty and resecting part of the pharynx. Grounds for determining malpractice will be complicated by observations that family members were ignoring postop protocols and encouraging Jahi to eat something. An early interview with Sandra Chatman revealed she had been doing (possibly incorrect or inappropriate) suction.