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.