Don’t we already have that? The AMA sets guidelines for a lot of things, don’t they?
According to artemis upthread, they had multiple opinions from doctors without having to move her.
The family had found a nursing home that take Jahi, but they wanted her to have a trach and feeding tube. The hospital refused to the feeding tube procedure and trach, saying it was against their policy to perform operations on “dead” patients.
My heart really breaks for this family.
Such a policy is standard in essentially every hospital I’ve heard of; there’s no point in providing medical care to dead people, as it merely wastes resources that could be better spent on the living. If waiving the policy in this case, though, should make it possible for the parents to move their child’s body to another facility, then it might be a financially (if not medically) prudent thing for the hospital to do. (Of course, one has to wonder how the parents are going to pay for the necessary ongoing care, as most insurance companies aren’t going to be willing to expend resources on dead patients either.)
And you can drop the scare quotes. Jahi isn’t “dead,” she is dead. Total brain death IS death, folks. The process of complete bodily breakdown is underway, and even the fanciest medical interventions can only slow the process down for a bit.
It will break even more when you know more about the story. Jahi was morbidly obese, and suffering from severe sleep apnea. The surgery she underwent wasn’t a simple tonsillectomy, but a more radical procedure that also removes part of the soft palate and the adenoids as well as the tonsils in order to relieve the airway obstruction. Jahi didn’t want to undergo the surgery, but her parents insisted for the best of reasons: they wanted to safeguard their daughter’s long-term health. And the actual surgery went well: initially Jahi was actually conscious in the recovery room and speaking with her parents. But then she began to bleed, and bleed, and the doctors couldn’t stop it…
I can’t even begin to imagine the soul-crushing level of grief and guilt those poor parents must be feeling. A decision made for the very best of reasons resulting in such a horrible outcome! No wonder they are having trouble accepting what’s happened to their poor daughter. 
The parents have to be going through extreme guilt and denial, as well. That poor girl. She must have had a premonition and just “knew”.
Just a sad situation. 
I’d also mention that these staff members are human beings. How long must people who have been trained to preserve and improve life, who are often dripping with empathy and compassion, be expected to tend to a corpse? Those nurses are not doing their jobs tending to a dead body, and it cannot be good for their mental health to be forced to do it for so long.
Please, don’t think I’m saying the nurses are the most important players here, they’re not. But they are people, people who are adversely effected by keeping a brain dead patient on machines for an extended period of time. This isn’t a “victimless” decision you’re leaving up to the parents. Does the hospital have no responsibility for protecting their employees from doing a job they don’t need to be doing that may be psychologically damaging to them?
Not this dead. Neither of those stories you cited involved a person whose EEG is flat. They involve people whose heart beats stopped, or slowed so slow that they weren’t audible. Neither even mentions whether or not they were on telemetry at the time death was declared. Sloppy “calls”? Sure. But not the same situation as this. This girl is *brain *dead. Dead dead. It’s not just her heart that’s stopped.
Brain death? I’d say out of compassion to the family, that it should be on something of a case by case basis. I’d hate to have a hard line drawn at, say, 48 hours, only to run into a case where a sibling couldn’t make it to the hospital and say goodbye until the 72 hour mark. I guess if I had to write a policy, I’d try to put it at a week. But I’d want an easily exploitable loophole to allow for nursing/physician exceptions from that policy based on the needs of the family. But we’ve clearly passed the point at which the nurses and physicians involved seem to think it’s appropriate and effective grieving going on here. This is, in nurse speak and only extrapolating from the articles, because these are not my patients, Complicated Grieving, and it’s not a healthy way of being.
Not to mention seeing the corpse break down…It’s not a pretty sight…Jahi is DEAD…
When a body is brain dead it’s not just a matter of keeping a ventilator hooked up. The brain is involved in a certain amount of basic maintenance so when the brain is dead various hormones aren’t released to signal various processes, breathing shuts down (hence the need for ventilation), eventually the heart stops beating, blood pressure is badly regulated…
You can maintain someone in a coma or “persistent vegetative state” for years because some parts of the brain still function. When the person is brain dead, though, the situation will just continue to fall apart.
What is keeping the tissues from starting to break down? Is the corpse starting to bloat? There comes a point when somebody has to step up and be the Bad Guy and the judge has done it.
They’ve probably got an anal tube (like a Foley catheter, in the other hole) in as much as possible, although they tend to get leaky and fall out a lot. I honestly don’t know how long a brain dead body on “life support” will continue to produce feces, but a tube will release gas from the bacteria in her gut, which will stay alive for quite some time; if they can’t eat of digested food, they’ll eat her gut for a while. Her body is undoubtedly on Turn Every 2 Hours orders to delay the development of sores, but delay is all it will do. As long as you keep pumping oxygen and nutrients into her, some cells will stay alive and continue to work their metabolic processes without input from the brain. Think of “living cells” in a petrie dish - no brain to organize them, but some things don’t require a brain.
Her body may even occasionally make movements, as calcium ions move into and out of muscle cells. If you took the vent out, she might make sounds, as escaping air moved past the vocal folds, or caused the mucus membranes in the throat and mouth to vibrate like violin strings. These things often make family members, and even medical professionals, hold on to the illusion of life where no meaningful use of the phrase can be said to exist.
A really interesting blog article written by an ICU nurse. Doesn’t address brain death specifically, but gives you some idea of the technologies involved in ICU care.
Not necessarily. Being worried that you won’t wake up is a fairly common fear for anyone who’s been properly informed about what can happen as a result of surgery or even just going under general anesthesia, as the doctors are supposed to specifically warn you that this can very rarely happen even if everything goes right. I had a strong fear that I wouldn’t wake up or that I would lose my memory (both potential but vanishingly small risks) when I went under general for a laparoscopy, but it worked out just fine.
So, will tissue actually die or can they keep the body going indefinitely?
I think you’re being rather generous.
In theory, indefinitely, but reality is much more complicated than theory. Eventually, you’re giving them so many blood pressure medications to keep their blood pressure up, artificial hormones to keep their kidneys functional and warming blankets and warm IV fluids to keep their body temperature up that someone makes a wrong step and things crash and the heart won’t beat anymore despite the vent sending oxygen to the automatic cells that keep the heart beating (and you hope like hell that there isn’t a pacemaker keeping the heart going as well). Or infection sets in and things at the ends of the body don’t get enough blood from the low blood pressure and they get infected and start to rot and fall off while you try to prevent the infection from becoming sepsis.
With just a ventilator and not all the other interventions, the kidneys and GI tract will keep going for about a week.
So, very expensive and intensive care is needed just to keep the body going, then?
Yes, with the round-the-clock full time attention of at least one Registered Nurse with a specialty in Critical Care (not a Licensed Practical/Professional Nurse or a Certified Nursing Assistant.)
Exactly. A body without a brain is like a car without a driver. You don’t know for sure exactly what will happen next (will it crash into another car, will it drift out of the lane and off the road, or will it just gradually slow down and stop?), but you DO know it can’t just keep smoothly going down the highway. However the end comes, it’s inevitable once the driver’s gone.
A brain-dead body’s the very opposite of a vegetable: you can’t just push it into a corner and water it every now and then. It requires constant intensive monitoring and intervention to keep the body’s increasingly-deranged metabolism and physiology from crashing, and finally the day comes when all the intervention in the world can’t keep things stable enough for the body’s peripheral tissues to keep on functioning. Death is inevitable once the entire brain (including the brainstem) is dead. So exactly what is spending $10,00 a day on Intensive Care really accomplishing here?
Sooner or later, these parents are going to HAVE to grieve the death of their daughter. The longer they refuse to come to grips with the reality of the situation, the harder it’s going to be when the inevitable moment of cardiovascular collapse finally comes. It’s really better for everyone (including them) if that moment of grief can start now. in the end, denial’s a very poor coping mechanism.
I’ve been following this, and it is a mess on both sides. The parents are suffering from guilt for pushing for the operation, and there is a religious angle also. The girl is dead, and rationally they should admit it.
But the hospital has been acting like the stereotype of doctors playing god. The girl died under their care, but they have been acting like the most important factor for them is to get this corpse off our hands. The refusal to allow the tracheotomy to be done so she could be moved is yet another example of this.
One reason some people oppose doctor assisted euthanasia is a suspicion that hospitals will push people to die to save money. This situation isn’t helping to counteract it.
When the lawsuit comes around, I feel for the lawyer who has to defend the hospital.
The situation is certainly a tragedy. The child is legally and medically dead, by the Uniform Determination of Death Act (UDDA). Jahi has no cortical brain function, nor brain stem function, unlike Terri Schiavo or any of the cases Rachellelogram cited. Jahi’s parents are not hoping for a recovery, but a resurrection.
Hospitals (all typically have ethics boards that oversee these issues) should absolutely be compassionate and accommodating in the face of these types of tragedies, but after the third physician’s opinion of Jahi’s state? IMO, this matter should have been settled in a week tops with the family referred to grief counselors or social workers best equipped to assist them. At this point, the line has certainly been crossed from compassionate and accommodating into enabling the irrational. I certainly hope whatever facility that is taking Jahi in is not being paid by the public.
There are no more medical decisions to be made at this point, unless the parents wished to donate Jahi’s organs. Medical professionals do not continue to perform medical procedures on people who are legally and medically dead. It is outside of best practices, unethical and opens the door to a slew of liability.
The child is being harmed by having her body slowly decompose in what can only be characterized as a gruesome and protracted funeral. The public is being harmed by being forced to cater to the parents irrational beliefs at the cost of ~$10k a day for the most expensive, technical and resource intensive medical care available, none of which will improve Jahi’s quality of life in any way (as she is dead) or change her prognosis.
Please read this:
Excellent read, pretty much encompasses my views on how I want my end of life care and death to be treated. Thanks for sharing.
I know a tracheotomy is a fairly mundane procedure (the feeding tube is less-so) but isn’t a policy of operating on dead people a waste of resources?