Tuesday, January 21, 2014

Sometimes, one has to just "let go"

"Caplan: The case against care for those who are brain dead"


Arthur Caplan

January 9th, 2014


Thirteen-year-old Jahi McMath died on Dec. 12 at Children's Hospital & Research Center Oakland.

Yet about a month later, Jahi is still on a ventilator because her parents refuse to accept her death. Aided by a misguided legal decision, she has been moved to another facility to be kept on artificial life support, which makes no medical or moral sense. What's being done to her corpse is wrong, but a bigger issue is the threat her case poses to the rational and moral use of health care resources.

Her parents had taken her to the Oakland facility for surgery to remove her tonsils to help her sleep apnea, a condition that disrupts sleep. Things went tragically wrong, although exactly how is not known. Her parents hired a lawyer and won a court order to keep Jahi on artificial life support.

Jahi suffered complications post-surgery, including a heart attack and hemorrhaging of her brain. Experts in neurology could not find any sign of brain activity. They knew with certainty that she was brain dead.

To keep Jahi's body on machines is ethically wrong because definitive brain death is death and maintaining a corpse by artificial means is only slowing the inevitable decay and collapse of bodily remains.

Jahi's case is different from that of a pregnant woman in Texas whose husband said was diagnosed as brain dead by a hospital. That hospital denied the husband's request to take her off life support because it says a state law bars it from following a family directive when there's a pregnancy. In Jahi's case, keeping her on a ventilator amounts to desecration of a body.

Medicine cannot do anything for patients diagnosed as brain dead. Unlike those in a coma or in a permanent vegetative state like Terri Schiavo, a Florida woman whose family fought unsuccessfully to keep her alive, or Ariel Sharon, the former Israeli prime minister who's been in a coma for eight years, no one recovers from brain death.

Take away the machines and breathing and the heart stop. Keep the machines going and the body goes into slow, inevitable deterioration in which digestion fails, skin breaks down, and the body loses control of temperature and blood pressure, as well as the ability to urinate and defecate.

Jahi's parents must be experiencing horrible pain, but their wishes for medical care should not be honored. Doctors have said there's nothing more that medicine can do.

If such decisions are left to family members, our intensive care units will fill with bodies on machines surrounded by those hoping and praying that maybe death has not happened.

It is wrong for health care providers to treat someone who is dead. It is wrong for lawyers to ask judges to overrule medical expertise when it is doctors -- not jurists -- who know when death occurs. It is immoral in the extreme not to try to get Jahi's parents to come to terms with her death.

Also, there is some risk that the decision made by the McMath family may embolden others to follow in their footsteps.

It is not cheap to occupy a bed in an intensive care unit -- as much as $7,500 per day. Also, doctors and nurses don't want to treat the dead because it's futile and violates their ethical duty to not abuse the dead. So the chance that more beds might be occupied by the dead surrounded by families armed with court orders waiting for miracles would add stress to already overstressed hospitals.

Americans seem to treat death as an option because we hope for miracles. But the mix of hope, faith and technology ought not to lead us to blur the line between life and death so that brain death becomes a state in between. To do so leaves families in a hellish limbo of denial and our society facing a huge bill for providing futile care when there are so many other health care needs going unmet.

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