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Human Exceptionalism

Life and dignity with Wesley J. Smith.

Should Federal Court Order Jahi Fed?



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A federal judge has been asked to order Children’s Hospital Oakland to insert a feeding tube into Jahi McMath’s stomach so she can receive adequate nutrition. From the San Francisco Chronicle story:

Christopher Dolan, attorney for Jahi’s family, has filed requests in three separate courts seeking orders to force the hospital to insert tracheostomy and feeding tubes, but judges have declined to do so.

In papers filed in federal court Thursday, Dolan again asked for an order for the tubes to be inserted. “At this point, Jahi has not had nutrition for nearly three weeks,” he wrote. “She is in desperate need of a tracheostomy tube and a gastric tube. This court should grant plaintiff the relief to allow for Jahi’s transport.”

I don’t see how the judge can do that. A state court has already ruled that Jahi has passed away. There is no basis in law for requiring a deceased person’s body to be nourished. 

I doubt a federal judge would hold an evidentiary hearing on that question. (Recall, it took emergency passage of a federal law to obtain federal court review of the Terri Schiavo situation.) I think that would have to occur for the “perform surgery” order to be made.

Jahi’s body must be receiving some form of IV support or her body would have ceased functioning by now. Details about this have not been published to my knowledge. She would almost certainly need a feeding tube for long-term maintenance.

The hospital claims it will cooperate in transferring Jahi, although it will not permit the procedures done on site:

The hospital would arrange for Jahi to be moved to another site for the procedure, or for long-term care, but has not heard from any facility, doctor or medical transport service regarding her case, hospital spokesman Sam Singer said.

This case is very unusual. The bodies of people declared brain dead are maintained for a very short period of time to allow organ donation. Or, they have life support terminated because death has occurred. 

Most bodies of brain dead people deteriorate relatively quickly regardless of support. There is no indication that that has happened to Jahi.

There are a few cases of people declared brain dead, whose bodies have been maintained for many years. Dr. Alan Shewmon believes these cases disproves the concept. Others say, these people may not actually be brain dead. 

These bodies/people–depending on your POV–do receive and process nutrients provided through feeding tubes. But, I don’t believe any of the cases that Shewmon cites involved coercion of doctors to perform the necessary surgical procedures.

Meanwhile, the sides are supposed to talk settlement in federal and state courts. Unless one side shifts from its basic position, I don’t see how a settlement is possible.

More as developments unfold.

Belgian Rapist/Murderer Wants Euthanasia



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Why not? Once killing is accepted as an answer to human suffering, who is anyone to judge what suffering qualifies as killable?

That’s certainly the thinking behind a vicious psychotic rapist/murderer who wants to be euthanized because he finds life in a mental hospital to be unbearable. From the Globe and Mail story:

For more than half his life, Frank van den Bleeken, a rapist and murderer, has been detained in the Belgian penal system, spending long stretches in solitary confinement in prison psychiatric wings, waiting for treatment of his violent sexual urges. Now he wants to die.

With little prospect of change, Mr. van den Bleeken has turned to his country’s euthanasia law and asked to be killed by lethal injection if he cannot get treatment.

A morally sane society would reject this out of hand. But Belgian doesn’t qualify as morally sane anymore:

Mr. van den Bleeken’s still unresolved case is the latest controversial example of applicants who are not terminally ill but suffer psychological pains. “Two prominent psychiatrists have seen him and said this is a man who is suffering in an unbearable, enduring way and that his mental condition can never be treated properly. That’s why he’s asking to be euthanized, because he’s suffering in an unbearable way,” Mr. Van Der Velpen said.

“It’s a medical question that is very, very, very delicate and very difficult.”

I don’t know whether a doctor will kill van den Bleeken. I suspect not because of the harsh light recently cast on Belgium’s wild euthanasia.

But at some point, euthanasia due to the anguish of long term incarceration or hospitalization for dangerous psychosis will become a reality: Saying no will be seen as either arbitrary or a cause of suffering.

I call that notion–already embraced in some circles–“cruel and unusual death with dignity.”

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“One Child” Tyranny the Why of Baby Selling



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It would be easy to dismiss the case of the Chinese doctor selling newborns to human traffickers as just one money-hungry criminal doing what those kinds of people do. That is true: Bad people will always be bad.

But we also need to look at the context–the ”why” that led to the “how.” From the Daily News story:

A Chinese doctor has admitted in court that she stole babies from the hospital where she worked and sold them to human traffickers, state media and a court said. Zhang Shuxia, a locally respected and soon-to-retire obstetrician, stood trial on Monday in northern Shaanxi province’s Fuping county, according to online postings from the court.

Zhang told parents their newborns had congenital problems and persuaded them to “sign and give the babies up,” the court postings said…The case exposed the operations of a baby trafficking ring that operated across several provinces centering on Zhang, who delivered babies at the Fuping County Maternal and Child Hospital.

First, how in the world could Shuxia ever convince parents give up their baby? Because they thought the child would have serious health and/or disability issues. 

I assume the parents thought the child would be euthanized or put in an orphanage. Why could they agree to that? Because that was the only baby they would be allowed to have under China’s tyrannical “one child” law. That created the atmosphere allowing the avaricious doctor to obtain her wares.

The one child policy, has led to a society in which there are not only eugenics laws on the books, but in which people get steeped with eugenics attitudes. In other words, if parents can only have one child, some will not want one seen as a potential burden. 

This is the same attitude and impetus that leads to female infanticide in China.” Not coincidentally, the bought babies were boys.

Digging deeper–and to thump on my ever-pounded tub–the entire debacle flows directly from the rejection of human exceptionalism.

HE insists on the equal intrinsic moral worth of every human being. Once rejected, tyranny follows.

Indeed, look at nearly every human-caused horror in history and you will see through the smoke and stench of death, a rejection of human exceptionalism. Also smaller-in-scale, but profoundly evil crimes against humanity such as here, a doctor who sold her tiny patients like they were so many i-phones.

The Chinese government comes down hard on traffickers. But its anti HE tyranny is the ultimate cause.

Jahi Lawyer Demands Tracheostomy



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Jahi McMath’s lawyer is demanding that Children’s Hospital Oakland preform a surgical tracheostomy on her. From his statement.

​​We continue to seek a tracheostomy procedure for Jahi McMath before she departs for or upon arrival in New York. However, many surgeons and hospital administrators are on holiday making our goal difficult to reach.

If Children’s Hospital Oakland would perform the procedure we could quickly move Jahi to a facility that provides innovative world-class treatments, of the type being given to Prime Minister Sharon in Israel. Amazing research opportunities exist but Children’s Hospital Oakland holds the key to Jahi’s death sentence – a simple tracheostomy procedure, despite a mother’s plea and the money to pay for it. Instead they starve her.

Our plea is for a courageous ENT specialist physician to step forth and give this mother the choice and this child a chance. Contact the Terri Schiavo Life & Hope Network at: 484-278-4287

Meanwhile, the hospital’s lawyer has also been busy corresponding. Here is part of that 12/29/13 letter:

1. Children’s will be pleased to communicate directly with a physician at any facility that is considering accepting Jahi’s body to make sure Children’s understands the requirements set by that facility for accepting the body and to ensure that the facility understands the current condition of the dead body and what is being done to maintain it under Judge Grillo’s temporary restraining order. Of course, the family’s representatives can observe that communication.

2. Children’s needs to be assured that there is a lawful transportation plan to any facility to which transfer is proposed.

3. If the proposed facility is out-of-state, Children’s needs written assurances from the Coroner that their office will allow the transfer.

What an awful, tragic mess.

Terri Schiavo’s Family Stands With Jahi’s



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The struggle over Jahi McMath continues to grow more angry and portentous.  

Now, Terri Schiavo’s family and the Life Legal Defense Foundation–I am very close with both–and others have entered the fray. They are pulling no punches. From the Terri Schiavo Life & Hope Network press release:

Together with our team of experts, Terri’s Network believes Jahi’s case is representative of a very deep problem within the U.S. healthcare system – particularly those issues surrounding the deaths of patients within the confines of hospital corporations, which have a vested financial interest in discontinuing life.

“Families and individuals must make themselves aware of what so-called ‘brain death’ is and what it is not,” said Bobby Schindler, Executive Director with Terri’s Network. “Additionally, families and individuals must educate themselves regarding their rights as patients, the advance documentation that must be completed prior to any medical procedure as well as how to ensure best any patient’s rights.”

“Every person needs to understand that medical accidents happen every day. Families and individuals must be more aware of the issue of accountability and patient rights.”

We continue to work toward Jahi’s transfer.

I understand why the family and the LLDF would take this position. After the infamy of what happened to Terri, they are naturally going to stand shoulder-to-shoulder with any family striving to save a loved one against all hope.

But I also think it is very important to reiterate the differences between the tragic circumstances of Terri Schiavo and Jahi McMath. Terri was unquestionably alive–even though some erroneously called her brain dead as a moral denigration. For example, she breathed on her own and swallowed her saliva.

If–IF–the three doctors who examined Jahi are correct, she is deceased–not as a moral denigration but as a biological condition. But for the ventilator, she would stop breathing instantly because there would be no impulses from her brain causing the diaphragm to contract and expand and the lungs to breathe in and out. That would lead to an immediate cardiac arrest.

Some might ask, what is the harm of being extra sure? Very little since brain dead people can almost never be maintained indefinitely. 

I will say this: If Jahi was misdiagnosed as dead when she is actually alive and deeply unconscious, there will be hell to pay. Not only for Children’s Hospital but generally for the mistrust that would sow in the health care system at a time when many among the Medical Intelligentsia want the naked power to coerce compliance with their treatment decisions and moral views.  

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Jahi McMath’s Ventilator to Continue



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On one hand, we have to admire the extent to which the life of Jahi McMath matters–certainly to the family, but also to the law. And good on the family’s lawyer, Christopher B. Dolan, for going all out for his clients in a difficult and controversial case. That’s what lawyers are supposed to be about.

On the other hand, this is a terrible agony that grows more excruciating by the day. A judge has extended the time in which the ventilator support maintaining the body of Jahi is to continue. I say, “maintaining the body” because the court has ruled she is legally deadFrom the CNN story:

Doctors and a judge have declared her brain dead and said there’s no chance Jahi will come back to life. A deadline loomed Monday as a judge had said the hospital could disconnect the machines after 5 p.m. (8 p.m. ET). But shortly before Jahi could have been cut off, that same judge extended his order to 5 p.m. (8 p.m. ET) on January 7.

The girl’s family told reporters it had located a facility in New York willing to take Jahi. The Oakland hospital, however, will not allow them to move her, according to the girl’s uncle, Omari Sealey.

Some will say they don’t trust the hospital. I have certainly caught hospital representatives lying in publicly controversial cases involving serious brain injury. And in my law career, I was once involved in a case in which doctors covered up, very much like the one in The Verdict.

But that doesn’t seem to be the case here, or the judge would have changed his ruling about death. Rather he seems to be giving the family every possible opportunity to find another way.

There have been three separate examinations–one by a medical professor from Stanford–all determining that Jahi has no brain function.

If there is evidence to the contrary, it will come out. I did a little research, and it appears that Dr. Paul Byrne may be involved. He is a well known campaigner against the very concept of brain death. He’s not alone. Dr. Alan Shewmon, of UCLA, also doesn’t accept that brain dead is dead.

But the law certainly does. After much thought and research, I do too–assuming proper and thorough testing, not always a given. The Catholic Church also accepts the concept.

I can’t imagine this case will become a vehicle for testing that legally. But then, I am the guy who thought Mitt Romney would win the 2012 election.

People who are brain dead cannot, except in the rarest of cases, be maintained indefinitely. At some point in the near future Jahi’s body will begin to deteriorate despite medical intervention. If it doesn’t–well, that will be eyebrow raising.

As more details come out, I will keep updating.

Children’s Hospital “Brain Dead” PR Disaster



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Children’s Hospital Oakland has a very good reputation where I live in the Bay Area. But its public communication around the tragedy of Jahi McMath’s ”brain death” has been astoundingly insensitive, bordering on arrogant.

The hospital’s statements quoted in today’s San Francisco Chronicle continues the maladroit insensitivity. The hospital states it will remove the ventilator the moment that can be done legally. From the story:

Children’s Hospital Oakland officials confirmed Sunday they will turn off the machines sustaining Jahi McMath’s body as soon as a legal injunction expires at 5 p.m. Monday unless otherwise ordered by a court. “Barring any other court-order legal action by the family, the ventilator will be shut off at 5 p.m. tomorrow,” said hospital spokesman Sam Singer. “It’s tremendously sad, but that’s what’s going to occur.”

Not five minutes after five. Not sometime after five. Not one second after five. At five! I can picture a doctor looking at his watch counting down the seconds, “three, two, one…”.

Then there’s this:

“Children’s Hospital Oakland continues to support the family of Jahi McMath in this time of grief and loss over her death,” the hospital said in a statement Sunday. “We continue to do so despite their lawyer’s criticizing the very hospital that all along has been working hard to be accommodating to this grieving family.”

Gee, that’s big of you. Why have hospital spokespersons acted throughout this sad saga as if the institution is the victim?

I gave another example here the other day, noting that I heard a hospital spokesman on the radio claiming he was “gratified” the court agreed with the determination that Jahi was dead. Gratified?! They should have expresses sorrow that the hospital’s doctors had been proven right. I mean, the “victory” isn’t akin to a judge deciding that their version of a disputed contract clause was correct!

There have been other examples of awful care and handling of the grieving family–such as one doctor “compassionately” telling the family during a meeting that Jahi was, “dead, dead, dead, dead.” From the 12/21/13 Chronicle story:

The ruling comes a day after the girl’s relatives met with hospital officials and said the meeting did not go well. They said a doctor had told them that Jahi is “dead, dead, dead, dead” and that further medical care was no longer needed.

Gee, maybe the doctor could try and understand that a family seeing their beloved girl warm and breathing with a machine, might have a difficult time grasping that clinical determination. Sensitivity, please!

I have covered this story extensively here because of its importance on several levels:

  • First and foremost is the terrible personal tragedy of a 13-year-old girl going in for minor surgery and dying–illustrating that most medical treatments have potential risks.
  • On the macro level, there is issue of “brain death” being dead, rather than as some misuse the word, unconscious.
  • There is the issue of the distinction between stopping care for a dead patient and forcing the withdrawal of wanted treatment maintaining the life of a living patient because it is supposedly “futile.” (With Obamacare, expect more coercion forcing the sickest patients off of life-extending treatment–not because it isn’t working but because the patient’s life is being maintained when death is what the technocrats want.) 
  • There is the exacerbating the distrust minorities have for institutions–and their differing views from the technocracy and general community on fighting death to the bitter end.
  • The way in which hospital spokespersons discussed Jahi’s tragedy publicly also illuminates the arrogance among the technocratic class, who too often lose the forest for the trees when considering how public health policies they advocate impact real families.

So sad. So many lessons to be learned.

African-Americans & Obamacare Death Panels



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The Jahi McMath ”brain death” tragedy continues to unfold from awful to awful, with the family now requesting to have breathing and feeding tubes placed in the girl’s body so that she can be transferred to a continuing care facility in Southern California. The family clearly does not trust the hospital and doctors, believing their beloved is being forced off of care when, in their view, she still lives–the law saying that brain dead is dead be damned. 

That got a friend to call me wondering about about how the African-American community–already deeply distrustful of the health care system–will react to Obamacare death panels if (when) they take hold–as so many medical technocrats desire. It’s a very good question. 

The Pew Poll (see above) shows that 61% of African-Americans want doctors to “do everything possible to save their lives” when experiencing “a disease with no hope of improvement” and “in a great deal of pain.” So do 55% of Hispanics.

But one of Obamacare’s primary purposes is cost control, which will prevent “everything possible” from being done to extend life through cost/benefit treatment guidelines, insurance regulations, health care rationing, and/or futile care impositions forcing removal of treatment. Obamacarians want the right to coerce, not just educate and persuade.

Such Obamacare death panels could well shatter African-American and Hispanic strong political support for liberal agenda items generally. Even if not, it will be very hard to retain their support for the Obamacare technocracy when members see loved ones denied care that they and their family want.  So too, I think, the broader community. That’s why the death panel charge cuts so deeply.

The question is: Will that potential shattering be enough to convince death panelists to back off?

“Miracles” Do Happen in “Futile” Cases



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A commenter to my last post–which distinguished between futile care impositions and stopping life support because a patient had been declared dead by neurological criteria–made the ludicrous declaration that there is no real difference between forcing a persistently unconscious patient off of life support and one who is “brain dead.” From the somewhat angry comment by “kevintkeith”

Your attempt to declare that cases of expensive, technologically complex, and laborious biological support of brain-dead bodies are not cases of medical futility is nonsense. What else could they be? What practical difference is there between a case of a family demanding hundreds of thousands of dollars of care and exclusive access to limited ICU beds and technology for a brain-dead body, and a family demanding exactly the same thing for a patient who has some brain-stem function but is equally incapable of awareness or recovery? What is all that care and expenditure of resources going to bring to the latter patient that it is not to the equally hopeless dead patient?

In reply, I pointed out that there are huge legal and moral differences. The former situation involves a legally dead patient and the latter, a legally alive patient. He continues to insist, no.

But doctors are often wrong about PVS diagnoses, and lately have been learning that many “unconscious” patients aren’t really unaware. Indeed, I have been personally involved (behind the scenes) with a few cases in which doctors wanted to force patients off of treatment–resisted by family–in which the “miracle recovery” occurred.  I don’t think that matters morally in terms of the value of the moral worth of the patient, but it has to be remembered when trying to prevent the medical technocracy from imposing its views on the rest of us.

And then there is this letter in today’s San Francisco Chronicle:

Miracles do happen

Six years ago my 23-year-old old daughter was living in San Francisco when she was in a motorcycle accident and sustained a severe head injury. She was in a coma and the doctors urged us to take her off life support and donate her organs. We were told if she lived she would be in a persistent vegetative state. It was the most important decision I would ever make.

Despite all the medical evidence to the contrary, I refused to pull the plug on my child. Thank God I made the right decision as she has recovered exponentially from their best prognosis and is living independently and enjoys a high quality of life. In the past six years I have met countless others who were given this decision whose stories defy all the medical opinions.

Beautiful people who would not be alive today had they complied with the prevailing medical advice. My thoughts and prayers go out to Jahi McMath and her mother. I am praying for this family and ask everyone who reads this letter to do the same. Miracles do happen, despite the odds. Rebecca Vickers, Portsmouth, R.I.

Indeed. I have met them.

I believe that the courts properly walked the extra mile in the Jahi McMath tragedy. But three different doctors have now concluded she has no brain function at all and that the condition her situation is irreversible. That is brain dead.

Cutting off living patients against their will–for example, stated in an advance directive–or over their family’s objections, is to prevent efficacious treatment to a living patient based on strangers’ views of his or her moral value and quality of life.

Nope. That shouldn’t be allowed except in extraordinary cases, and then only after a full and open court proceeding.

“Brain Dead” Girl Not a “Futile Care” Case



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What a mess.

The family of Jahi McMath, the teenager who was declared dead by neurological criteria in three separate examinations after a tonsillectomy, wants her moved to a different care facility so life support can continue. The hospital is resisting. From the San Francisco Chronicle story:

The family of a 13-year-old girl who has been declared brain-dead has found a nursing home that will keep her on a breathing machine while relatives pray for a miracle, the family’s lawyer said Thursday. However, Children’s Hospital Oakland, where Jahi McMath underwent tonsil-removal surgery Dec. 9 and then suffered cardiac arrest, objected to the transfer and said it was not authorized by the judge who ordered the girl kept on a ventilator.

After hospital physicians’ finding of brain death was confirmed by a court-appointed doctor, Alameda County Superior Court Judge Evelio Grillo ruled Tuesday that the girl was legally deceased and that the hospital could discontinue medical care. But he extended until next Monday a restraining order requiring connection of the breathing apparatus. Jahi’s family contends she is still alive and spent Christmas at her bedside. Their lawyer, Christopher Dolan, said Thursday that a nursing home has agreed to take her, and he is negotiating with Children’s Hospital and insurance companies to insert breathing and feeding tubes that would allow her to be moved…

The hospital said it “does not believe that performing surgical procedures on the body of a deceased person is an appropriate medical practice.”

This raises very important legal and bioethical issues and distinctions that I think we need to explore.

This is not futile care case. Medical futility disputes generally arise between a family that wants life supporting treatment to continue and hospital doctors/bioethicists that want it terminated.

Futile care cases involve unquestionably living patients. The dispute concerns whether the cost of care and the quality of life for the patient justifies maintaining his or her life and vetoing patient or family decisions to continue treatment. In other words, it involves a form of health care rationing.

In contrast, Jahi’s case involves whether–and please excuse me for seeming insensitive here–a cadaver should be maintained indefinitely on life support. In other words, as a matter of respecting the dead and properly managing scarce medical resources, can the family force the hospital, doctors, nurses, and whatever entity is funding the application of medical technology, to keep Jahi’s body going? Under California law, the clear answer is no.

Can the insuring entity and a nursing home agree voluntarily to continue the application of medical technology? I don’t see why not. 

But the judge will be under great pressure to say no. Why? Doing so will sow great confusion in the general community by sending the false message that Jahi is alive. And eventually, Jahi’s body will begin to deteriorate, as happens in all but the rarest “brain dead” cases.

But. If the medical maintenance is terminated by force–when there is agreement to allow it to continue–that coercion will sow greater distrust in the community about the health care system–already badly eroded. And in this particular case, I worry that some will consider such a move to be racially motivated. 

Like I said: What a mess. 

My opinion? I think properly diagnosed brain death is dead. If it were my loved one, I’d let her go.

“Personhood Pincer” Threatens Human Rights



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Over at First Things I have a piece describing how utilitarian bioethics and animal rights are working as a pincer to destroy human exceptionalism. They are doing this by, on one hand, trying to elevate some animals (later, others) to legal personhood (animal rights), while on the other working to depersonalize some humans(bioethics.). From, “The Personhood Pincer:”

Unlikely as it may seem, utilitarian bioethics is the counterpart to animal rights in the war on human exceptionalism. Rather than seeking to elevate some animals to the level of humans, utilitarian bioethics advocates would reduce some humans to the status of animals—with the concept of “person” again serving as the point of the spear.

Utilitarian bioethicists agree with animal rights activists that it is “speciesist”—unjust discrimination against animals—to treat humans as possessing an intrinsically higher value than animals. As in the chimpanzee cases, moral status is seen as something earned by possessing “relevant characteristics, such as being self-aware.”

Since all human beings are not so capable—some because of immaturity, others due to illness or injury—under bioethics theory, they are not “persons,” and hence, have less moral value than humans (or animals) capable of higher functioning.

If either of these movements prevail, we can kiss universal human rights goodbye, since our intrinsic liberties are based on the unique and objective importance of each of our individual lives. In contrast, personhood is a subjective concept which we can possess one day and not the next:

This is the pincer that seeks to grasp us. One claw is represented by animal rights advocacy to personalize some animals based on their supposed human-like capacities. The other, by bioethicists seeking to depersonalize some people based on their lack of capacities.

If either view prevails, our equal rights would become ephemeral, based on subjective personhood rather than intrinsic humanity. Our value would depend on the moment of measuring, leaving us ever vulnerable to depersonalization and perhaps even the concomitant loss of what today are called universal human rights.

Both animal rights and bioethics are implacable foes of human exceptionalism. Both aim to destroy Judeo/Christian moral philosophy–distinct from religion–upon which Western Civilization is based.

“Brain Dead” Teen’s Life Support to End



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Jahi McMath is dead, a judge has ruled after an independent medical examiner agreed with previous determinations that she has lost all brain function. Under the law, that is the necessary ruling. Under the law, life support is not required to maintain the body of a late patient.

The judge gave the family, still fighting the determination, until Monday to appeal or adjust to the tragic reality. From the San Francisco Chronicle story:

An Alameda County judge declined Tuesday to force Children’s Hospital Oakland to continue providing medical care to a 13-year-old girl whom physicians declared brain-dead nearly two weeks ago after tonsil-removal surgery. But Jahi McMath will remain on a breathing machine for the time being, as Judge Evelio Grillo kept in place a restraining order until 5 p.m. Monday, giving the girl’s family an opportunity to take its case to a higher court.

The judge ruled after a court-appointed doctor – Paul Fisher, chief of neurology at Lucile Packard Children’s Hospital at Stanford – examined Jahi and testified that she is legally brain-dead and cannot recover any brain function.

I hope the family spends the remaining time loving Jahi and making preparations, as there is zero chance in my view that the court’s ruling will be overturned on appeal. If a miracle is to happen, it will have to be when the breathing assistance is removed. People who are brain dead have no ability to breathe on their own.

It’s also a shame the hospital has handled the tragedy so maladroitly. I was speaking about this to a former pediatric nurse who used to work in Children’s Hospital Oakland’s ICU. She said the facility has a real calling to serving the African-American community, and this has hurt trust. That’s why I was upset to hear a hospital spokesman say he was “gratified” that the court validated the hospital’s diagnosis.

No, the proper and decent thing would have been to say that they were sorry the original diagnosis was affirmed. Good grief.

For the differences between brain dead–actually death declared by neurological criteria–and a diagnosis of living in an unconscious state (often misdiagnosed), see here.

Texas Law Right to Keep Pregnant Woman Alive



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A Texas woman named Marlise Munoz collapsed and has apparently permanently lost consciousness. She had told her family that she wouldn’t want to be kept alive in such circumstances. Normally, if the family decided to withdraw life support, that would be that.

But Marlise was 14 weeks pregnant. Texas law prohibits removing pregnant women from life support. From the Politix story:

Marlise made her wishes clear to her family after her brother died in an accident. She told her husband and her mother, Lynne Machado, that she did not ever want to be kept alive on a life support machine. But Texas law overrides women’s wishes when they are pregnant: “Section 166.049 Pregnant Patients. A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”

I normally believe that decisions about wanting or not wanting life support should be followed–assuming clear and convincing proof. But no “right” is absolute. There is a second life here. And that matters.

Besides, from the story we don’t know what Marlise would “want” if she knew that removing life support would also cause her unborn baby to die. That could well have been a huge factor in her thinking about what she would have wanted under these terrible circumstances. 

In this case, the question involves a benefit of the doubt. I think Texas law made the right decision as a matter of policy by giving that benefit to saving the lives of unborn babies. After birth, the family should be free to decide.

What if the fetus–now 18 weeks along–was permanently injured?

My view: If he or she continues to develop toward viability, I think it would be discriminatory to make potential disability a factor in applying the law.  

Two-Demensional Criticism of Me--Again



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Again and again two-dimensional thinkers fail to engage my actual arguments in favor of human exceptionalism–and/or against nature rights, animal rights, euthanasia, etc.–preferring instead to invent my motives and purposes. For example there was that time when I was accused of seeing biology “as a tool of Lucifer.” Ha!

Latest example, by way of Andrew Sullivan, comes Reason’s A. Barton Hinkle, claiming I opposed granting human-type rights to chimps because of my supposed fear that it would undermine the Bible. From his piece:

Like evolution, the recognition of animal rights has the potential to undermine biblical literalism. So it is not particularly surprising that the Institute treats even limited recognition of some rights for chimpanzees as the first step on a slippery slope.

In his fervent imagination. I don’t get into religion one way or the other in my human exceptionalism work, and have been criticized precisely for that reason. Indeed, in my book criticizing animal rights, A Rat is a Pig is a Dog is a Boy, I don’t make any religious arguments in 267 pages.

Hinkle also claims I am “wrong” about the goal of the animal rights movement:

The ultimate goal, Smith writes, is “to prohibit all domestication of animals” and “destroy human exceptionalism.” Wrong. The panic over the possibility of safeguarding not merely animal welfare, but legal animal rights, fails to recognize that we already do just that. Humans, after all, are animals too.

That’s too cute by half. Of course, we are biological animals. But using the word “humans” for us and “animals” for, well, animals helps identify the moral distinction between us. Some use the terms animal and “nonhuman animal,” which I think is intended to blur those lines, but there you have it.

And, of course the goal of animal rights is to destroy human exceptionalism. That’s why they label the belief in unique human dignity or higher intrinsic value “speciesist,” e.g., discrimination against animals.

His apparent ignorance about those goals doesn’t mean I am incorrect. For example, leading animal rights advocate, Gary Francione, argues that animals have a “right not to be property:”

If we were to recognize such a right (initially as a moral/social matter and later protected by law), we would stop bringing domestic animals into existence altogether

Similarly, PETA believes that the instrumental use of animals is, by definition, abuse. Hence, it’s slogan:

Animals are not ours to eat, wear, experiment on, use for entertainment, or abuse in any way.

So, to sum up, Hinkle is just engaging in the typical two-dimensional stereotyping and factually challenged assertions seen too often in public discourse these days.

I would say, “Nice try but no cigar,” except that it wasn’t a nice try.

Judge Orders Life Support for “Brain Dead” Girl



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This is the right decision. 

Most of you have probably heard of Jahi McMath, the girl who had catastrophic complications from a tonsillectomy and was later declared “brain dead.” The family wanted an independent medical assessment before considering termination of life support–and unbelievable to me–Children’s Hospital Oakland (which has a good reputation) resisted.

Surprise! That led to litigation. Now, a judge has ordered life support continued pending an exam by a doctor from outside the hospital. From the San Francisco Chronicle story:

An Oakland girl declared dead by Children’s Hospital Oakland must be kept on a ventilator until an independent neurologist can examine her to determine if her brain is showing signs of activity, an Alameda County judge ruled Friday in a case stemming from a tonsillectomy that ended in tragedy…”The statute says there’s a right to have this reviewed by the independent physician,”

So rather than doing what the law required anyway, the hospital made the family sue. Good grief.

Here’s another reason the family might not trust the hospital: Administrators had refused to show them their own daughter’s medical records:

The hospital, which had been withholding Jahi’s medical records from the family, informed the family Friday that it will turn over those documents.

That should have been done on the first request. Otherwise, it looks like something is being hidden.

If the independent physician also finds that the girl is dead, she will undoubtedly be removed from life support as there is no duty to maintain the body of a dead patient. At that point, with more trust in the finding, I wouldn’t be surprised if the family agreed. (See here for details on the proper meaning of ”brain dead.”) 

If any part of her brain is working as a brain, I assume life support will be ordered continued since the girl would legally be alive.

That might not end the matter, however. The hospital could next try to have treatment removed based on medical futility. Now there would be a brouhaha, given that the death declaration would have previously been found mistaken!

I also want to make a larger point beyond this personal tragedy. I believe that Obamacare and Futile Care Theory are sowing great distrust in the medical system. Technocrats are seizing crucial treatment decisions in dire cases away from patients and families. And they can often be very crass and arrogant about such matters.

Moreover, people are figuring out that these kick-the-patient-off-of-treatment decisions are, at least in part, often about cost of care rather than efficacy. In fact, the efficacy of the care is seen as the problem! People are becoming less willing to bow to the “quality of life” death panel mentality that policy makers and bioethicists seek to impose on society.

Plus, mistakes can be made–as in the Haleigh Poutre fiasco in Massachusetts.

There will be pushback from society if this trend continues. Big time.

Bear Euthanasia Leads to Death Threats



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A dangerous bear was euthanized near Reno, and those who reported the problem are being threatened with death by furious bear lovers. From the USA Today story:

The issue arose after the Nevada Department of Wildlife trapped a 263-pound male black bear outside the Evanses’ Incline Village home early Thursday morning. The bear, which had been tranquilized by the Department of Wildlife once and captured and released again as recently as October, was euthanized as a threat to public safety later in the day, said department spokesman Chris Healy.

The bear had attempted to break into Adrienne Evans’ car twice in recent weeks and on Tuesday night succeeded, causing extensive damage to the vehicle’s interior, the couple said. She denied having food inside the vehicle, as alleged by critics. The bear had also walked into an enclosed entryway at the couple’s upstairs condominium on several occasions, the couple said.

I’ll speak slowly: If a bear is a danger to human life, the bear has to be put down. Why? Protecting human life is more important than preserving bear life. 

That should be elementary. These days, for too many anti-humanists, it is incomprehensible.

Euthanasia Infection Grows More Virulent



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I have a piece out today about how virulent the euthanasia pathogen has become–and how pervasively it is infecting Western society. From, “The Suicide Juggernaut:”

Advocates of assisted suicide tell two—no, three—lies that act as the honey to help the hemlock go down. The first is that assisted suicide/euthanasia is a strictly medical act. Second, they falsely assure us that medicalized killing is only for the terminally ill. Finally, they promise that strict guidelines will be rigorously enforced to protect against abuse.

I then prove the thesis, getting into–among other horrors–the proposed professional ”suicide facilitators” in Scotland, the Belgian leap off the moral cliff, Quebec’s plan to require all doctors to be complicit in euthanasia, and how Vermont will run assisted suicide on the honor system.

As I ask rhetorically at the end: What could go wrong?

“Brain Dead” Term Too Loosely Used



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I have been following the tragic case of Jahi McMath, who went to Oakland Children’s Hospital for a tonsillectomy and suffered a catastrophic complication, resulting in cardiac arrest. According to the media, her doctors later declared her “brain dead” and told the parents she would be removed from life support. After a lawyer’s letter, Jahi’s life support continues.

“Brain dead” is a popular term, not a medical one–and it is too loosely used. Some use it to denigrate the moral value of profoundly disabled patients such as Terri Schiavo, who we now know may be aware and able to recognize familySlinging “brain dead” as an epithet justifies dehydrating them to death or castigating family members, like the Schindlers, who fight to keep such patients alive–which they legally and biologically are.

In Jahi’s case, brain dead actually means a declaration of “death by neurological criteria,” one of the two legal methods for declaring the bona fide death of a human being. To be declared dead by neurological criteria does not mean there are no brain cells remaining alive. Rather, it means that medical tests, observation of the patient post injury, and history of the case demonstrate that the patient’s brain and each of its constituent parts have irreversibly ceased to function as a brain. As one doctor told me, it is as if the patient was functionally decapitated.

Death by neurological criteria is controversial. Some pro lifers see it as an excuse to harvest organs from living patients, and oppose its use as a clinical method of determining death.

Many bioethicists–of the type who once assured a wary public that brain dead was truly dead–agree (now) that brain dead isn’t dead. But not because they want to stop procuring organs from such people. Rather, they want to expand the pool of donors by obtaining access to the organs of patients with clearly working brains, such as a patient diagnosed as unconscious but who can breathe without medical assistance. In other words, they want to allow killing for organs and they believe that undermining the public’s belief in “brain death” can help them achieve that end.

Under the law, brain dead is “dead” when it connotes death by neurological criteria. In such circumstances, if accurately determined, there is no legal right to continue life support of what is, essentially, a cadaver. This isn’t true–yet–of patients thought to be permanently unconscious. But that may be coming, my pretties. That may be coming. 

A huge problem in this field is that there are no uniform criteria for declaring death by neurological criteria, with testing requirements varying from state to state, and in some instances, hospital to hospital. That needs to change.

My wife, the San Francisco Chronicle columnist Debra J. Saunders, weighs in on the case here.

Bioethicist Pushes Death Panels



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I think the bioethics left has a bit of an identity crisis going on. On one hand, they decry those who warn against death panels. On the other, they often turn around and say we need death panels.

Thaddeus Pope, a law professor and believer in medical futility, has a post on bioethics.net describing where we already have and don’t (yet) suffer from death panels. I basically agree with his analysis (although Hawaii has not legalized assisted suicide and the state of Montana law is a muddle).

The main difference between us is that he approves of death panels and wants more of them, while I am implacably opposed.

But at least he honestly describes the future planned for us by the Medical and Bioethics Intelligentsia. From, “Top 10 North American Death Panels:”

Many policymakers and commentators decry use of the term “death panel.” In contrast, I welcome broader and more frequent use of the term. Tragic choices must be made. And all sorts of tribunals are making life-and-death decisions not just every day, but even every hour of every day. Americans are being denied access to interventions that might prolong their lives. It is true. It is unavoidable. Recognizing the regularity and necessity for death panels will make discussions over when and how to use them more productive.

Hell no, we won’t go! The more we expose death panel agendas to the light of public scrutiny, the harder they will be to implement. We should never surrender our lives to those who would impose their “choices” on the rest of us.

Pain Control Breakthrough Due to Animal Testing



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Animal rights organizations continue to peddle the lie that animal research leads to zero human benefit. But every major medical breakthrough in the last fifty years involved animal research, whether in obtaining basic biological knowledge or testing potential treatments for efficacy and safety before human trials.

Now, a potentially very important breakthrough on treating pain may have arrived thanks to research in mice. From the News.com.au story:

A group of enzymes that become active in animals suffering ongoing pain has been discovered by Monash University scientists…

Prof Nigel Bunnett, from Monash’s Institute of Pharmaceutical Sciences, discovered the proteases becoming active in the cerebrospinal fluid of mice when they were experiencing chronic pain. By illuminating the switched-on proteases with fluorescent tags, he has also been able to identify the nerve endings responsible for sending their messages to the brain, known as proteases-activated receptors..

That is an example of basic research, the knowledge of which can lead to treatments.

Time now for human trials!

Doctors at The Alfred will soon begin taking spinal fluid samples from up to 90 surgery patients suffering pre-existing pain to determine if the proteins, called proteases, are also responsible for pain in humans. Monash scientists will also use the samples to refine drugs to block the pain process, which they have already used effectively in their mouse trials. 

So, animal rights believers: Should this research have not been conducted? Should the potential for the tremendous alleviation of long-term human suffering still remain unknown? Because without the sacrifice and pain of these mice, this important biological information would remain unknown. 

This is why I call animal research a “grim good:” Because of animal research, the amount of human suffering that has been alleviated cannot be measured.

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