Should Religious Views Determined Death's Definition?
There is a tragic case ongoing in Washington DC that involves the definition of death and religious belief. A 12-year-old boy, known publicly as M.B., has been declared dead by neurological criteria (popularly known as brain dead). The doctors want to terminate the medical machinery that is keeping the boy's body functioning. But the family, who are Orthodox Jews, claim that since his heart is still beating, under their religion, he is still alive, and thus they want the "treatment" to continue. From the story:
Judge William Jackson told Jeffrey Zuckerman, a partner at Curtis, Mallet-Prevost, Colt & Mosle representing the boy's family, and Kenneth Rosenau, a name partner at Rosenau & Rosenau representing the hospital, that before he could rule on whether to suspend treatment--which includes drugs to sustain cardiac activity and a ventilator to maintain breathing--the hospital had to prove that M.B. is in fact dead under D.C. law.I believe, assuming the boy really is brain dead--I think there should be an outside consultation to confirm it--that the hospital has the right argument here. Death is not something that should be one thing for some people and something else for others.
Rosenau told the judge that the hospital understands the grief the family must be going through, but continuing to treat what he called "the earthly remains" is a strain on resources that could be better used to treat other children. The hospital has 32 beds in its intensive care unit and receives new admissions every day, Smith said in her affidavit.
Ironically, some bioethicists support that very approach, such as Georgetown University's Robert Veatch who wishes to permit people to decide ahead of time what is "dead" for them. Under this view, the hospital would have to continue to sustain the M.B.s body, while in the next bed, doctors would be permitted to actually kill a biologically living person for organs. (I do not accept the "bioethics" definition of personhood.)
No. Society has the duty to create the legal definitions of dead that can be determined based on objective medical criteria. If, as some believe, brain dead proves not to be really dead, then those diagnosed with the condition will have to be treated like living patients. But until then--and I know it is a controversial issue--the hospital should be permitted to apply the law.
(This case differs from the Golubchuck case in Canada significantly. That was a futile care theory case in which the hospital wanted to take an unquestionably living man off of life support, which would have violated his and the family's religion, again Orthodox Judaism, and desires about non elective treatment.)
posted by Wesley J. Smith @ 4:17 PM
16 Comments
16 Comments:
Here's a question, though: HOw much longer is it going to be, anyway? Eventually, so I understand, the heartbeat is going to get more and more erratic. I think one question that people assume they know the answer to is whether the situation here described can go on indefinitely. I've been told that this is not true and that the heart and other organs will eventually stop functioning even wiht the support in question. Then the family will have to agree. But perhaps I've been misinformed.
Generally in brain death cases, the body's functions cannot be maintained.
However, Dr. Alan Shewmon has identified a case where the body of a clinically brain dead person has been maintained for years. Indeed, cases like that convinced him that brain death isn't dead.
I think that discussion must continue.
I am skeptical regarding the hospital's declaration of death. Especially, when it is followed by the claim that beds are urgently needed for other patients.(However true might be the need for beds.)
My own belief is that if the person cannot survive without artificial respiration, etc. Then life support should cease.
However, if they can breathe on their own, etc. and need only nourishment, then their lives should be prolonged.; they are in fact still alive.
HHH O.C.O.D.
If my Brain is dead then I don't see any chance of enjoying life nor allowing my family to move on without me. For me such a life is worse then death. Pull the plug and let God look after my new beginning and let the family recover from my death so that they can move on with their own lives.
H.H., It's pretty clear that in this case the person is not breathing on his own, by a long shot. But actually, the need for ventilator support for breathing is not a sufficient condition for being declared brain dead, only a necessary condition. That is, everybody declared legally brain dead is unable to breathe on his own, but not everybody who is unable to breathe on his own meets the criteria for being declared legally brain dead. Some ventilator dependent patients are even fully conscious, for example.
Wesley, I think I had heard of the Shewmon example. Still, if that case is a statistical anomaly, the hospital shouldn't have too much to worry about here--it's a safe prediction that it'll all be over by everybody's definition before long.
H.H.: So since Christopher Reeve, as a quadraplegic, was ventilator-dependent, he should have ended his life by pulling the plug?
As Lydia said, you cannot declare brain death based on ventilator-dependence. I believe that you can only declare brain death with an EEG test and a test by a neurologist of all the various reflexes (including, but not limited to, the ability to breathe on one's own).
I clicked on the link to the original story. It said that other bodily systems are shutting down. If that means his kidneys, I don't think he'll survive much longer.
It is a sad case. If there is indication that his body is shutting down, but just not doing so as quickly as the hospital would like, it is very sad that the parents have to go through this with the hospital at what is already the saddest time in their lives.
Thank you, Heather and Lydia for your insights. I hadn't considered a situation like Christopher Reeve's. I stand corrected!
HHH
Wesley-aren't you concerned that siding with the hospital (as you seem to be doing in this case) helps the case of hospitals who desire to implement futile care policies based on their own prejudices regarding how long a comatose patient should be given care, particularly in light of the financial issues raised? Your post on this matter seems inconsistent with your overall opposition to futile care laws. I know that I don't want the hospital pulling the plug on me or my family when I say no. Period.
SAFEpres: That concern is why I brought up the Golubchuck case. If brain dead is dead--and I think it is albeit I respect those who don't--then it is physiologically futile to continue to keep the body functioning. In other words, "treatment" isn't being stopped. It isn't a value judgment about the worth of a patient's quality of life, as in medical futility, but it is a matter of physiology.
I struggled with posting on this. But I think we have to maintain proper definitions--even when it hurts.
I am hearing from people who are very unhappy with me about this. But if I don't speak honestly in the hard cases, I don't think I am much good to anyone.
When does it seem that God isn't going to return a life ,to normality? For me it would be after I am truly brain dead. Thus it becomes a matter of man & a machine preventing me the comfort of going to my creator when He has already watched my Spirit die with my Brain. In the days before we got to the point of machine assisted life these choices were removed from our control. Strange how we create our own moral dilemmas and there are no easy ethical answers.
This is where I totally concur with the position, "my body, my choice." If it's my body, than I think that I should have the right to decide when and if to terminate life support, even if the doctors do assert that I am 'brain dead.' My greatest suspicion in this case is that 'brain dead' may not be what many of us consider to be 'brain dead,' but may be a misnomer for something else, given its overuse in the last several years.
Safepres: People should and do have the right to refuse life sustaining treatment. As you know, I also believe that doctors don't have the right to refuse WANTED life sustaining treatment. But if the boy is dead, I don't believe people have the right to have the body maintained on medical machinery.
If the boy is not dead, treatment should continue. Indeed, I was heartened that the judge said the hospital would have to prove he is dead. That is the right approach.
But if he is dead, the hospital should be permitted to stop the intervention.
I have angered some of my friends with this post because they don't accept brain death as a legitimate concept. If they are right, the family is right. I am just not convinced that they are right about the concept. Indeed, in the wake of the very distressed private communication I received about this, from a leader I like and respect, I contacted people I trust on the matter and the acceptability of the core concept was reaffirmed to me. If the whole brain is not functioning as a brain, and if each and every constituent part of the brain is no longer functioning, and if this total loss of function is irreversible, the patient has died.
I am willing to be convinced otherwise, but that remains how I see it.
Some more disagreement with me, published with the writer's permission: "As always, I appreciate your perspectives, agree with almost all of them and appreciate your advocacy in these areas of medical ethics.
I, however, have to differ with you regarding the issue surrounding MB in Washington, DC. You stated:
“Death is not something that should be one thing for some people and something else for others.”
While this may be true, as we have seen with other similar issues, e.g., the definition of futility, the definition of “compassion,” etc., there are differing definitions based on philosophical/sociological, not biological/financial, approaches. The definition of death in Judaism is a concept that has been dealt with for centuries. It is not a new issue. While there may be some differences in understanding, the classical definition of death is when the heart stops and the person stops breathing. One has to examine why the contemporary definition is what it is. Is it based on saving money (which is what I suspect it is) or for utilitarian reasons (not a life worth living anymore), for example? If so, it would be inappropriate to require all to accept this definition. If it is somehow based purely on biological definitions (I don’t see how other influences would not insinuate themselves into the definition) then I would have to agree with you. If, however, there are other factors influencing the “accepted” definition, then it would be inappropriate to deny an individual’s definition, which is based on a philosophical/religious understanding of long-standing duration. It is no less valid than an “accepted” definition."
Would it comfort you to know that you haven't angered me. I also appreciate that the hospital must prove brain death by law in order to complete the loss of heart beat Wesley. That is a step in the right direction for sure. We certainly have placed ourselves into more and more ethical mind fields with the advent of machinery controlling the maintenance of life.
I don't understand the parent's problem anyhow, irregardless of what "dead" is. If, according to their belief in Judaism, the heart stops beating and the person stops breathing, what's the problem? The boy is no longer breathing or anything on his own, it is the machine. So, in reality, his heart isn't capable of beating any more... where's the issue?
Wesley-of course I continue to see you as a leader in opposing futile care and other laws that adversely impact the disabled community. I do disagree with you on this case, but it's good that we live in a society where people who occasionally (or often) disagree on matters can work together.
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