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A chorus of 'learned' medical ethicists have been making the media rounds to blast the anguished family of brain dead teen Jahi McMath after a horrific tragedy following what they assumed was a routine tonsillectomy surgery.

Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center, told the LA Times last month, “I think it’s disrespectful to the dead in a fundamental way, and it opens the floodgates for other people to say, ‘Oh, you don’t really know when we’re dead, do you? So please make more efforts for my loved ones.’”

http://www.salon.com/...

This African American family dared to stare down the doctors of Children's Hospital Oakland demanding that they do not turn of Jahi's ventilator after what they described as negligent treatment which precipitated her cardiac arrest from massive bleeding. They perceived that they were dealing with a set of bean counters cloaked in medical degrees who are often immune to the personal tragedies that unfold in the wings of their hospitals. They clinically refer to patient deaths from medical procedures as 'adverse events,' call the coroners, issue death certificates and then retreat in silence behind HIPPA laws.

The 'ethicists' are virtually silent on the Texas law requiring brain dead pregnant mothers to remain on life support despite the wishes of their families. There are no rampant ghoulish commentaries and editorials referring to these women as corpses or 'the deceased.' No one is speculating about the rapid decomposition of their bodies. They are often housed inside hospitals for months until they spontaneously abort, but few argue about wasted precious bed spaces and equipment and little is said about the costs incurred. Certainly not these 'medical ethicists' that have suddenly emerged from their crypts to create a storm about Jahi.

Marlise Munoz, a 33-year-old paramedic, has been in the intensive care unit of a Fort Worth hospital since collapsing on 26 November. Several medical procedures have been performed on her as they monitor the development of her fetus.

The doctors at Childrens Hospital Oakland claimed they did not perform procedures on deceased persons, refusing to insert a feeding tube into Jahi's body to keep her nourished. They had no problem beginning the process of euthanasia by withdrawing her food supply and were livid when they could not turn off her ventilator. Those concerns have never been raised when they are harvesting organs. Is the organ donation industry behind this firestorm over the brain dead? Will keeping them on ventilators for long periods of time slow down the harvesting of organs for lucrative transplant surgeries?

So one must ask: are doctors and families of the brain dead in Texas shielded from criticism by a rabid, wealthy and politically connected pro life, anti abortion lobby, while a poor pro life African American family and their attorney are mercilessly pilloried in the press and threatened with death?

Originally posted to truthseeking missile on Tue Jan 07, 2014 at 10:15 AM PST.

Also republished by Barriers and Bridges.

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Comment Preferences

  •  Caplan spoke out against the Texas situation (7+ / 0-)

    as well. I heard him. Probably on MSNBC, but it could have been elsewhere.

    I guess "virtually" covers you on that and every other counter-example, though.

    •  Well, he wrote this up (10+ / 0-)

      on xmas eve.

      http://www.nbcnews.com/...

      Why the legislature of Texas has any right to get involved in the care of Marlise Munoz when her wishes are so well informed and so clear is not self-evident. Even in their desire to protect fetal life the way the law has been written forces care in situations where the fetus is either not able to live or may be severely impaired. That restriction is far too strong given the clarity of this family’s wishes.

      Guns don't kill people. People kill guns. -- this message brought to you by the Night Vale chapter of the N.R.A.

      by tytalus on Tue Jan 07, 2014 at 10:37:25 AM PST

      [ Parent ]

      •  His tone is not nearly as harsh (3+ / 0-)
        Recommended by:
        mookins, I love OCD, tytalus
      •  and has been quoted in a number of news (19+ / 0-)

        articles, I see, from the most cursory of Google searches. He's been one of the go-to medical ethicists for such stories for many years.

        “I think the Texas law cannot apply to the dead,” said Art Caplan, director of medical ethics at NYU Langone Medical Center in New York. “I think the hospital is wrong to insist that it does.
        “I think the husband should find a lawyer and go to court to challenge the law both in terms of its application to a dead woman and as an unconstitutional infringement on his right to do what his wife would want,” Caplan said.
        Star-Telegram

        And there's Princeton bioethics professor Peter Singer, who said the Texas law:

        "imposes the view of the state on the adult pregnant woman, as to whether or not the fetus counts as a human being"

        And bioethicist Craig Klugman, who wrote about both cases in a column, noting:

        The confusion is that a body on a respirator and receiving other support measures may still appear to breathe, will feel warm to the touch and will have a heartbeat. To a family member who lacks understanding of the underlying biology, the loved one may appear to be asleep while attached to a number of machines. However, the only thing keeping the body functioning is mechanical support. Unlike comas or minimally conscious states, no one recovers from brain death. Brain death is death by both legal and medical criteria.

        Except in Texas.
        ...
        What we need is a new law that says “dead is dead.” This law is required so that a dead girl’s body cannot be maintained only due to her mother’s fantastical hope, and so that a dead woman cannot be maintained against her wishes merely as a fetal incubator. We should allow the dead to die legally, medically, culturally and socially in order to honor the life that was lived. Let the dead rest in peace.

        Link
        There's plenty to criticize in the handling of both cases without creating a false narrative about medical ethicists and trying to make them look inconsistent or, more bizarrely, racist. There's no evidence of either.
  •  And what about all the brain-dead (3+ / 0-)
    Recommended by:
    la motocycliste, Samer, Sue B

    legislators in Texas?

    •  Not just Texas (8+ / 0-)
      Texas is not the “lone star state” in prohibiting the living wills of pregnant women from having effect: the majority of states have similar pregnancy exceptions for women with living wills.13
      Since 197614 every state, as well as the District of Columbia, has enacted a living will statute or an advance-health-care-directive statute that allows people to direct their health care in the event they become incompetent.15 Twenty-nine of these states have exceptions in their statutes limiting the effectiveness of the living will or advance directive when the patient is a pregnant woman.16 Eighteen states automatically void the living will at any stage of the patient’s pregnancy.
      http://lawreview.vermontlaw.edu/...

      But even those who drafted the Texas law say this was never their intent.

      Three Texas experts, including two who helped draft the 1999 law, told The Associated Press last week that it doesn’t apply in the Muñoz case. “This patient is neither terminally nor irreversibly ill,” said Dr. Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System. “Under Texas law, this patient is legally dead.”
      http://www.star-telegram.com/...

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Tue Jan 07, 2014 at 11:09:00 AM PST

      [ Parent ]

  •  I sympathize with the poor girl's parents (9+ / 0-)

    but agree that brain dead is dead and there's no point keeping her body alive.

    That said, the thrust of this diary is exceptionally valid -- forcing brain dead women who happen to be pregnant to literally have their bodies forced to be kept alive for the sole purpose of serving as incubators -- literally! -- is ghoulish and vile and there's precious little outcry.

    "Much of movement conservatism is a con and the base is the marks." -- Chris Hayes

    by raptavio on Tue Jan 07, 2014 at 11:04:20 AM PST

    •  Agreed. It's not an either/or situation, (5+ / 0-)

      the hoopla around keeping a dead body breathing in order to force the birth of a badly damaged fetus is almost nil.  If mom is brain dead from lack of oxygen how functional can her passenger be?

      I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

      by I love OCD on Tue Jan 07, 2014 at 11:09:56 AM PST

      [ Parent ]

      •  Well, (9+ / 0-)

        I can speak from direct experience that babies can be born past the brain death of the mother -- or even the body death of the mother.

        The children thus born can have a variety of physical and neurological ailments (particularly the ones born maternally postmortem) but they can be perfectly healthy too.

        However, this is a decision for the family, not the state, to make. (Or in the event of a living will, the woman herself.)

        "Much of movement conservatism is a con and the base is the marks." -- Chris Hayes

        by raptavio on Tue Jan 07, 2014 at 11:13:23 AM PST

        [ Parent ]

        •  I'm no expert. Just find it curious that (1+ / 0-)
          Recommended by:
          MaryAskew

          Dead women can have healthy babies- why all the fuss about maternal health?  Why shouldn't women smoke or drink or take drugs if the fetus is so independent and such a survivor?  Is that part of the cult of the womb?  

          I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

          by I love OCD on Tue Jan 07, 2014 at 09:01:43 PM PST

          [ Parent ]

    •  They're not keeping her alive. (1+ / 0-)
      Recommended by:
      MaryAskew

      They're keeping both women pseudo-alive. It's just as ghoulish in both cases.

      And I've seen plenty of outcry on both cases -- the difference is that in the Texas case, the family has little recourse because of the Texas law. I don't know if they're fighting it in the courts, but it's hard to see on what grounds, and the husband may have decided to just go home and grieve instead of spending his time ginning up public outrage on Facebook and Twitter.

      •  Surprisinghly, not (1+ / 0-)
        Recommended by:
        MRA NY
        I don't know if they're fighting it in the courts
        I did not know that until reading a recent local article today.
        Erick Muñoz has neither sought advice from attorneys nor been approached by any, he told the Star-Telegram. He said he doesn’t know his options but would look at challenging the law in the future
        http://www.star-telegram.com/...

        (That ran yesterday, so I'm pretty sure the part about not being approached by any attorney's has changed by now.)

        “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

        by Catte Nappe on Tue Jan 07, 2014 at 01:33:36 PM PST

        [ Parent ]

  •  TX took another poor person off life supports (1+ / 0-)
    Recommended by:
    tytalus

    during the Terry Shaivo thing, they could not pay

    "The poor can never be made to suffer enough." Jimmy Breslin

    by merrywidow on Tue Jan 07, 2014 at 11:15:49 AM PST

  •  I think I see what may be affecting your (7+ / 0-)

    view of the apparent inequities -- you say

    are doctors and families of the brain dead in Texas shielded from criticism by a rabid, wealthy and polictically connected pro life, anti abortion lobby, while a poor pro life African Amercian family and their attorney are mercilessly pilloried in the press
    as though it's the doctors and families insisting on keeping the body of Marlise Munoz hooked up to machines. It's not. Her family is united in opposing the hospital's action, and the hospital appears to be doing it only because Texas law requires it. There's no reason for ethicists to be criticizing anyone but the Texas legislature, which they have done.

    The cases have some issues in common, but they are not really analogous.

  •  This sentiment (10+ / 0-)
    Those concerns have never been raised when they are harvesting organs. Is the organ donation industry behind this firestorm over the brain dead? Will keeping them on ventilators for long periods of time slow down the harvesting of organs for lucrative transplant surgeries?
    is in my opinion wrong.  When my husband was on life support I signed papers for donation but asked if we could delay because some of the family was not ready for him to be gone.  The nurses told me that with every passing hour the organs of someone on life support deteriorate and eventually will be not viable for transplantation.

    Everyone! Arms akimbo! 68351

    by tobendaro on Tue Jan 07, 2014 at 11:52:02 AM PST

  •  it's the msm, not the ethicists (3+ / 0-)
    Recommended by:
    Skipbidder, erush1345, Be Skeptical

    Brain death is death.  That the teenager on the vent is accepted as dead speaks to the widening experience americans have with brain death, and their acceptance of the concept.  

    The pregnant corpse on the vent caries a living fetus & raises the question of autonomy, which I feel is the clincher in this case, but a harder question for the public.

    Autonomy, Beneficience & Non-Malfeasance.

  •  Ethicists are talking, and have been (3+ / 0-)

    You are incorrect about the lack of discussion about Texas. Ethicists are certainly talking about it. And have been. And will continue to do so. Caplan has talked about it multiple times.

    http://medicalfutility.blogspot.com/...

    http://www.lifemattersmedia.org/...

    http://www.star-telegram.com/...

    http://freethoughtblogs.com/...
    “This patient is neither terminally nor irreversibly ill,” said Dr. Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System. “Under Texas law, this patient is legally dead.”

    The plural of anecdote is not data.

    by Skipbidder on Tue Jan 07, 2014 at 01:09:03 PM PST

    •  You missed a very important part in that quote (1+ / 0-)
      Recommended by:
      Skipbidder

      Dr. Fine helped draft the law in question.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Tue Jan 07, 2014 at 01:50:16 PM PST

      [ Parent ]

      •  Sorry (1+ / 0-)
        Recommended by:
        Catte Nappe

        Didn't realize that the idea that he was part of the process of writing the law didn't across.

        It certainly wasn't my intention to hide this at all. I thought it came out from the "This patient is neither terminally nor irreversibly ill" bit. He was explaining why the law DIDN'T apply.

        This is the paragraph prior to the quote I gave:

        "But three experts interviewed by The Associated Press, including two who helped draft the law, said a brain-dead patient’s case wouldn’t be covered by the law."

        Fine is a frequent author on ethics issues in the medical literature.

        The plural of anecdote is not data.

        by Skipbidder on Tue Jan 07, 2014 at 02:03:46 PM PST

        [ Parent ]

        •  Sorry (3+ / 0-)
          Recommended by:
          Skipbidder, BlackSheep1, MaryAskew

          Didn't mean to suggest you were hiding something. For all I knew you were not aware he participated in drafting the bill, since the articles all indicate only 2 of the 3 interviewed experts helped with the bill, and it's not necessarily clear he was one of the two.

          As to why I found it important - a guy who helped write the bill presumably has some extra insight on what the law was intended to do in the first place.

          “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

          by Catte Nappe on Tue Jan 07, 2014 at 02:09:24 PM PST

          [ Parent ]

  •  Euthanasia (8+ / 0-)

    The term euthanasia as used in your article and as a tag is quite inappropriate. It borders on conspiracy theory.

    This young woman died. She was declared dead December 12th. Using a set of criteria from which no human in the history of the world has ever had a documented recovery.

    "They had no problem beginning the process of euthanasia by withdrawing her food supply"

    You cannot begin "the process of euthanasia" on someone who is already dead.

    The plural of anecdote is not data.

    by Skipbidder on Tue Jan 07, 2014 at 01:12:42 PM PST

  •  Looks to me like the Texas family (4+ / 0-)

    unlike the California one, is not seeking the limelight or seeking to use social media to publicize their case and make a big brouhaha about it (and they apparently don't need to raise money the way the California people do).

    Since the media tend to react to buzz, if the family is grieving in private, and their lawyer isn't a publicity-hound either, there will be less ink or pixels used on that story. IMO that's fine. I would hate to have my loved one's final days plastered all over every news site and newspaper in the country.

    •  They don't have a lawyer (at least as yet) (1+ / 0-)
      Recommended by:
      tytalus

      And they rather welcome the publicity since they want to use the opportunity to alert other families to this problem.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Tue Jan 07, 2014 at 02:00:45 PM PST

      [ Parent ]

  •  Terrible diary (3+ / 0-)
    Recommended by:
    erush1345, Be Skeptical, Mber

    Would your conclusions be different if the dead woman in Texas was African-American?  If the dead girl in Oakland was a cute blonde?

    Brain dead is dead.  There is no possibility of the brain regaining activity.  What is your question?

  •  The discussion is mixing two different patients (1+ / 0-)
    Recommended by:
    MaryAskew

    with some what different physical conditions in two different states.
    Each state has its own laws and it own medical and hospital codes and directives.

    To discuss the the two simultaneously is confusing the issues I think are trying to be made.

    It sounds like medical ethicists are making the medical decisions and not the physicians or the hospital.  They are probably advising, along with insurance companies and lawyers, but the final decisions are not theirs.

    It is those "bean counters' in medical garb who do the statistical and on site studies and investigations that have lead to many many medical advances in patient care, in protection against infections, in better surgical techniques, in better equipment, better medicines, in discovery of the 100+ blood types, some of which can cause fatal reactions, and a host of other medical advances.  It is medical ethicists who have helped formulate things like the Patient Protection Act.

    I can't really tell tell what point the diary is trying to make except the difference in how the case of an African American patient in one state is being handled relative to a different case in a different state on a presumed non African American patient.

    Is there, in fact, any indication that race has anything do do with the handling of either patient?  Or, if the patients were in the other state that the discussions and decisions would be any different, based on race alone?

    Those are points worth discussing but do they relate to these two cases?

    •  Diarist didn't make the case, (0+ / 0-)

      but I think there is a case that can be made for race being a factor.

      Distrust of the medical profession is certainly a factor here.
      And that distrust is pretty understandable.  

      The plural of anecdote is not data.

      by Skipbidder on Wed Jan 08, 2014 at 06:08:26 AM PST

      [ Parent ]

  •  So the doctors would have resurrected her if she (2+ / 0-)
    Recommended by:
    BlackSheep1, Skipbidder

    had been a white girl?  

    What a steaming crock.  Gets my nomination for the Worst of Kos for the day.

  •  Several comments have sidestepped the fundamental (0+ / 0-)

    point I am trying to make: that the rampant macabre comments in the media and on the internet about Jahi McMath's decomposing corpse are not being directed toward the dead pregnant mothers on ventilators in Texas and I am still wondering why there is no hew and cry about Marlise Munoz..

    •  Fundamental point? (3+ / 0-)

      What is your fundamental point?

      You said ethicists weren't talking about Texas. They are. You were shown this. You didn't respond. You didn't acknowledge your error.

      You use scare quotes around "deceased" and the term euthanasia, which suggests you either don't understand that brain death is actually death. If you do understand that brain death is death, there was no reason for you to say: "They had no problem beginning the process of euthanasia by withdrawing her food supply". The assertion that brain death is not death borders on conspiracy theory.

      You now say that your diary was really about tone. You used scare quotes in multiple places to impugn medical ethicists. You didn't seem to care much about tone then. You also seem to have shifted the goalposts in another way. If the tone concerns are about the "rampant macabre comments in the media and on the internet", then why did are you disparaging the ethicists at all?

      The plural of anecdote is not data.

      by Skipbidder on Wed Jan 08, 2014 at 05:59:06 AM PST

      [ Parent ]

      •  I'd stop short of the CT analogy, but otherwise, (0+ / 0-)

        spot on.

        However, it sounds to me like the diarist is coming from a place of pain that makes fact-based discussion unlikely at this point. I acknowledge that pain even as I reject the assertions and conclusions, and plan to move on. YMMV, of course.

    •  Pick a lane (2+ / 0-)
      Recommended by:
      Be Skeptical, Villanova Rhodes

      Are you upset because the comments are "too clinical"
      or because they are not clinical enough?

      The plural of anecdote is not data.

      by Skipbidder on Wed Jan 08, 2014 at 06:10:40 AM PST

      [ Parent ]

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