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Source: (consider it)
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Thread: Brain-Dead Pregnant Woman Kept Alive Against Her and Her Family's Wishes
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PataLeBon
Shipmate
# 5452
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Posted
quote:
Originally posted by Chesterbelloc:
I admit I felt a grim shudder when reading this setion of the news report: quote:
[F]amily lawyer, Jessica King, said, "Pregnant women die every day. They die in car accidents, of heart attacks and other injuries. And when they die, their fetus dies with them. It's the way it's always been and the way it should be."
I read it as asking why the hospital was playing God. She had something fatal happen to her unexpectedly when she was 3 months pregnant.
The hospital for the last 2 months have prevented nature and what some people may believe is God's Will from taking it's course.
It goes back to the line between us taking actions that help God and taking actions against the will of God.
What happened to this woman was an act of God. What happened afterwards is of your (and the family's) own interpretation. I'm very loathe (in almost any circumstance) to go against a families religious beliefs.
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That's between you and your god. Oh, wait a minute. You are your god. That's a problem. - Jack O'Neill (Stargate SG1)
Posts: 1907 | From: Texas | Registered: Jan 2004
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Palimpsest
Shipmate
# 16772
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Posted
For those who didn't see the news, the hospital decided not to appeal the court ruling. Life Support was terminated at 11:30 Sunday and the family is now preparing the body to be laid to rest.
Posts: 2990 | From: Seattle WA. US | Registered: Nov 2011
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Jane R
Shipmate
# 331
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Posted
![[Votive]](graemlins/votive.gif)
Oh, and what L'organist and PataLeBon said.
Posts: 3958 | From: Jorvik | Registered: May 2001
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Boogie
Boogie on down!
# 13538
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Posted
quote:
Originally posted by Palimpsest:
For those who didn't see the news, the hospital decided not to appeal the court ruling. Life Support was terminated at 11:30 Sunday and the family is now preparing the body to be laid to rest.
May they both rest in peace.
I hope whoever decided to use her dead body in this way has learned their lesson ![[Frown]](frown.gif)
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Garden. Room. Walk
Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008
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Gee D
Shipmate
# 13815
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Posted
Prayers for the mother and the chid; a sad outcome.
[ 27. January 2014, 09:29: Message edited by: Gee D ]
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Not every Anglican in Sydney is Sydney Anglican
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by L'organist:
This woman DIED back in November.
She was taken to hospital by ambulance having been found unconscious at home and despite the best efforts of doctors in the Emergency Room her brain stem died.
The brain stem, among other things, controls breathing. Dead brain stem = no breathing.
So what happened is that SOMEONE in the hospital - we're not being told who - decided to put a DEAD woman onto life support.
While I think the right thing has now been done in turning off the life support, I think there's a bit more to discuss.
The stuff we call life support takes over the work of breathing, but it doesn't take over the work of pumping blood around. There has to be a beating heart.
So it isn't completely accurate to talk about ventilating a corpse, or suggesting that this case somehow relates to the deaths that occur every day which rapidly lead to a dead body with no pulse and hence no applicability of "life support".
Brain death is hard to determine and can't be done in a few minutes, and can't be done in the immediate after-math of a resuscitation.
And I have complete sympathy with the doctor that first put this unfortunate woman in intensive care.
One someone has been resuscitated such that a heart beat is present, you cannot at that moment be clear about the likelihood of brain damage or of recovery. Except that if someone isn't breathing and you don't support them you know they definitely won't recover and you won't be able to re-evaluate or change your mind.
So to be honest I think everything was defendable up until the moment when they had a clear diagnosis of brain death and of a non-viable fetus. At which point they seemed to go off the rails and start fighting the family. Often it is the other way round - the hospital wanting to accept the inevitable and the family desperate to cling to any ray of hope. Which is of course completely understandable.
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Jane R
Shipmate
# 331
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Posted
mdijon: quote:
So to be honest I think everything was defendable up until the moment when they had a clear diagnosis of brain death and of a non-viable fetus. At which point they seemed to go off the rails and start fighting the family. Often it is the other way round - the hospital wanting to accept the inevitable and the family desperate to cling to any ray of hope. Which is of course completely understandable.
Agree with all of this.
Posts: 3958 | From: Jorvik | Registered: May 2001
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Eliab
Shipmate
# 9153
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Posted
quote:
Originally posted by PataLeBon:
quote:
Originally posted by Chesterbelloc:
I admit I felt a grim shudder when reading this setion of the news report: quote:
[F]amily lawyer, Jessica King, said, "Pregnant women die every day. They die in car accidents, of heart attacks and other injuries. And when they die, their fetus dies with them. It's the way it's always been and the way it should be."
I read it as asking why the hospital was playing God. She had something fatal happen to her unexpectedly when she was 3 months pregnant.
The hospital for the last 2 months have prevented nature and what some people may believe is God's Will from taking it's course.
It goes back to the line between us taking actions that help God and taking actions against the will of God.
What happened to this woman was an act of God. What happened afterwards is of your (and the family's) own interpretation. I'm very loathe (in almost any circumstance) to go against a families religious beliefs.
It's a disturbing comment because it sets out a view which, though understandable in these unusual circumstances, could not possibly lead to a principled way of deciding them. It is not a sound moral principle that if a pregnant woman suffers a fatal illness or injury, her child "should" die with her. Imagine a case where a woman 24 weeks pregnant begs the paramedic in the ambulance to do what he can to save her baby (and, if it's thought to be a relevant consideration, the woman's family supports that), is this family lawyer really saying that the hospital "should" let it die? Of course not.
The 'playing God' argument is nonsense for the same reason. Hospitals exist to 'play God'. The whole point of building one, working in one, going to one, is that people who would otherwise have suffered and died get to be happy and live. There is not some category of illness that it is blasphemy to treat.
The relevant principle here is about who has the authority to make a choice given that the woman herself couldn't (well, there's also the 'pro-life' stance, but I'll let the pro-lifers make that case). There are different answers to that which are based on principled reasoning, arguments (both ways) about rights and authority that would still work if the circumstances had been a little different. Statements like the one quoted above could not possibly be applied as a sensible general principle, or, if they were, the implications would be unacceptable to almost all of us.
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"Perhaps there is poetic beauty in the abstract ideas of justice or fairness, but I doubt if many lawyers are moved by it"
Richard Dawkins
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art dunce
Shipmate
# 9258
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Posted
A 24 week fetus is close enough to viability to survive outside of the woman. Before viability the fetus is completely dependent on the woman and if she dies so does the fetus. I don't see what is so shocking in that. Sad, yes, but a reality of life. If the fetus is very close to viability the woman or her legal proxy could choose to try and add time but no one should be compelled. I find the notion that pregnancy involves nothing more than a woman providing wetware repellant and it devalues the entire, complex process. I do not see how the ends can justify the means when the means involve mechanically forcing a corpse to gestate. That strikes me as trying to play God.
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Ego is not your amigo.
Posts: 1283 | From: in the studio | Registered: Apr 2005
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Eliab
Shipmate
# 9153
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Posted
quote:
Originally posted by art dunce:
A 24 week fetus is close enough to viability to survive outside of the woman. Before viability the fetus is completely dependent on the woman and if she dies so does the fetus. I don't see what is so shocking in that. Sad, yes, but a reality of life.
Yes. And what happens when (not if) the human race has sufficiently advanced technology that it need no longer be a reality of life? Are you arguing that it would be wrong to save a foetus at 14 weeks gestation, if it could be done affordably and safely and if all its family agreed? Because that is what the lawyer's comment ostensibly means, and I cannot imagine that she actually intends it.
quote:
If the fetus is very close to viability the woman or her legal proxy could choose to try and add time but no one should be compelled.
What counts as "very close"? Because it seems to be that you are freaked out by the idea of a mostly-dead woman being kept in a prolonged state of artificial 'life' for the sake of her child, but not necessarily by the idea of a child being saved from the body of a mostly-dead woman, and want to distinguish the two. And for that you need some principle beyond your visceral distaste.
Also, who's talking about anyone being 'compelled'? Almost everyone who has posted here seems to agree that if we had access to the woman's own decision about her body that would be decisive. We're really only differing about who gets to say what she likely would have chosen OR what would be in her interests OR what they want to happen, given that we can't ask her.
quote:
I find the notion that pregnancy involves nothing more than a woman providing wetware repellant and it devalues the entire, complex process.
Who exactly is defending such a notion?
As it happens, I don't share your visceral distaste in this case. I think you have failed to distinguish the concept of reducing a human being to the status of incubator (what's going on in the sci-fi fantasies referenced on the last page) which is something obviously destructive to human dignity, and the act of saving what can be saved from a tragic event, which doesn't degrade or devalue anyone.
I wouldn't mind if someone wanted to cut up my corpse for an anatomy lesson to help a would-be surgeon to improve their skills. I would strongly object to being killed for such a purpose. See the difference?
quote:
I do not see how the ends can justify the means when the means involve mechanically forcing a corpse to gestate.
Are you saying that the means (assuming, for the moment, that the means might actually be effective as it appears they were not in the real-world case) are inherently wrong? That mechanically causing a corpse to gestate is unjustifiable even if the previous occupant of that corpse positively wanted and chose to be preserved so as to save her child?
Or is 'forced' in your sentence there to mean 'against the known wishes of the dead person'? Very few people are arguing that we should act against her wishes.
quote:
That strikes me as trying to play God.
So? Why's that wrong.
I've got a mechanical aortic valve. The one God gave me was fucked. A surgeon opened up my chest, cut it out, and replaced it. More than sixty years ago that would have been impossible, and I'd have died a lot sooner than I currently hope to. That's completely unnatural, directly opposed to the way God made my body. I'm cool with that.
There's nothing wrong with sustaining a human body mechanically to some good purpose. It's a good thing for hospitals to play God.
There isn't a principled reason why medical procedures that happen to freak you out are 'playing God' and wrong, and others that you don't mind so much aren't. It's all intervention in the natural world. It's all artificial manipulation of human bodies. It's all playing God, or none of it is. The principled reasons to make moral distinctions lie in questions of consent and authority and acting in the best interests of patients. The key question for this particular case is really "In what circumstances should one person decide what happens to another person's body if that body is brain-dead and pregnant?"
That some people have a strong emotional preference for one or other option is beside the point: there are plenty of people whose natural instinct would be to fight for the child's life and who feel that quite as much as you are repulsed by the idea of a dead person being artificially sustained as an incubator. The moral question is not about which set of people are right (that's unanswerable in a free society), it's about whose views we listen to in any given case. That question demands a principled answer, not a visceral one.
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"Perhaps there is poetic beauty in the abstract ideas of justice or fairness, but I doubt if many lawyers are moved by it"
Richard Dawkins
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mousethief
Ship's Thieving Rodent
# 953
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Posted
Taking a viable baby from a dead woman by section, and keeping a woman's body "alive" to act as a macabre human incubator for a non-viable baby are two quite different things.
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This is the last sig I'll ever write for you...
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mdijon
Shipmate
# 8520
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Posted
It is macabre. And applying such measures to preserve a non-viable fetus is stupid as well as macabre.
But I don't think a "this is macabre" is a very trustworthy moral compass.
Many people find it macabre to open up a man's abdomen, retract back the fat, guddle around among the bowels and giblets until you find an appendix and then suture and snip off said appendix. Of course it is life-saving in certain circumstances and we think it is normal now. (Although possibly without witnessing the event).
It is pretty macabre to open up a dead body and remove the kidneys to transplant into someone else. Especially if you had to ventilate a brain-dead road traffic victim for a bit longer in order to get the organ retrieval team in.
But I say all these things, with appropriate consent, are ethically sound. Medical teams do things that look or feel macabre every day, and can't use that as a guide to ethics.
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mousethief
Ship's Thieving Rodent
# 953
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Posted
I hope you'll forgive me for saying this, but I never said or implied otherwise.
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This is the last sig I'll ever write for you...
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mdijon
Shipmate
# 8520
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Posted
I most certainly do forgive you, even though you are well within your rights to point it out.
And perhaps you'll forgive me for leaping on the word macabre in that way. In medical ethics that is a particular button for me. Same with accusations of "playing God". It is simply a label for actions that the speaker doesn't approve of rather than a consistently applicable category, as Eliab describes in detail above.
[ 29. January 2014, 05:38: Message edited by: mdijon ]
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Posts: 12277 | From: UK | Registered: Sep 2004
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Jane R
Shipmate
# 331
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Posted
Eliab: quote:
Also, who's talking about anyone being 'compelled'? Almost everyone who has posted here seems to agree that if we had access to the woman's own decision about her body that would be decisive. We're really only differing about who gets to say what she likely would have chosen OR what would be in her interests OR what they want to happen, given that we can't ask her.
This entire thread is about the family of the dead woman being compelled. The woman in question had made her wishes about end-of-life care very clear. Her family asked for these to be respected.
The hospital refused to do this.
As Doublethink pointed out earlier, NHS guidelines don't say explicitly what to do in this situation (possibly because it's so rare) but extrapolating from the guidelines on what to do with an organ donor who happens to be pregnant suggests that if the foetus was close to viability they would try to deliver a live baby, which might involve keeping the (brain-dead) mother hooked up to life support for a short time and might even involve overriding the wishes of the next of kin. That isn't comparable to this situation, though; when Ms Munoz died she was still in the first trimester and not even close to viability.
Posts: 3958 | From: Jorvik | Registered: May 2001
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JoannaP
Shipmate
# 4493
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Posted
quote:
Originally posted by Eliab:
The relevant principle here is about who has the authority to make a choice given that the woman herself couldn't (well, there's also the 'pro-life' stance, but I'll let the pro-lifers make that case). There are different answers to that which are based on principled reasoning, arguments (both ways) about rights and authority that would still work if the circumstances had been a little different. Statements like the one quoted above could not possibly be applied as a sensible general principle, or, if they were, the implications would be unacceptable to almost all of us.
Surely, one of the relevant principles here is the definition of "patient". The hospital insisted that Mrs Munoz was a patient, despite being brain dead, and therefore covered by the law whereas her family believed that corpses can't be patients.
[typo]
[ 29. January 2014, 11:55: Message edited by: JoannaP ]
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"Freedom for the pike is death for the minnow." R. H. Tawney (quoted by Isaiah Berlin)
"Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety." Benjamin Franklin
Posts: 1877 | From: England | Registered: May 2003
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mdijon
Shipmate
# 8520
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Posted
The duty of care to a patient doesn't end after death. Confidentiality, dignity, respect of previously expressed wishes are the typical focus of the duty of care, rather than trying to bring a fetus to term, but in certain circumstances (not this case) I think a hospital could have a duty of care that included delivering a fetus.
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Posts: 12277 | From: UK | Registered: Sep 2004
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North East Quine
Curious beastie
# 13049
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Posted
Originally posted by Eliab:
quote:
Yes. And what happens when (not if) the human race has sufficiently advanced technology that it need no longer be a reality of life? Are you arguing that it would be wrong to save a foetus at 14 weeks gestation, if it could be done affordably and safely and if all its family agreed? Because that is what the lawyer's comment ostensibly means, and I cannot imagine that she actually intends it.
We are a long, long way from being able to save a foetus of 14 weeks gestation, let alone affordably and safely. What happens when we can, can be decided then. This experiment to try to save a 14 week foetus produced a baby which, at 22 weeks, had heart malformation, undeveloped sexual organs, hydrocephaly and deformed limbs, and was not viable.
Posts: 6414 | From: North East Scotland | Registered: Oct 2007
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mdijon
Shipmate
# 8520
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Posted
We don't know if that is an inevitable consequence of a fetus with abnormal gestational support (i.e. a brain-dead woman on a ventilator) or a consequence of the lack of oxygen when she suffered her cardiac/respiratory arrest.
Either way I don't think it was predictable.
Also this isn't really an experiment in the sense of being done as a bit of research - i.e. "let's see what happens if...".
It may have been misguided and wrong, but I think it is likely the doctors and nurses involved really thought they were doing the best for their patient, rather than just capriciously "seeing what would happen". It may seem like an experiment in the sense that no-one could be really sure what would happen, but that is very often the case in medical treatment. One is always generalizing from published or personal experience and making leaps of faith that these generalizations are justified.
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Posts: 12277 | From: UK | Registered: Sep 2004
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
I think it more likely that the hospital's attorneys thought there was a greater risk in a politically-minded district attorney bringing criminal charges if they removed life support than in the family bringing suit, which could only result in an order to remove it. Once they had a judge backing up the family it became safe to do what they knew all along they should have done.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
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mdijon
Shipmate
# 8520
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Posted
That seems rather uncharitable. There are people on the thread who argue from their own moral point of view that the hospital ought to have done everything it could to preserve the fetus. I don't agree with them, but I don't impugn their motives.
Likewise as I describe above the decision to start ventilation was likely to be the right one in my view. When to stop is always tricky. To use the phrase "knew all along" seems a stretch.
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Posts: 12277 | From: UK | Registered: Sep 2004
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orfeo
Ship's Musical Counterpoint
# 13878
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Posted
But it's not about whether they morally 'knew all along', it's about whether they legally 'knew all along'. The whole thing was not couched in whether they ought, morally/ethically, to comply with the husband's wishes, it was a claim that they COULDN'T.
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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.
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mdijon
Shipmate
# 8520
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Posted
I would hope there were some people worrying about the morality as well as the legality. No argument from me that what the eventually did was stupid, but I can certainly see how they doctors might arrive in a situation with a brain-dead pregnant woman on a ventilator through operating in good faith.
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Posts: 12277 | From: UK | Registered: Sep 2004
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Eliab
Shipmate
# 9153
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Posted
quote:
Originally posted by Jane R:
The woman in question had made her wishes about end-of-life care very clear.
I'm not saying you're wrong, but that isn't at all apparent from the articles linked to. If, in fact, she had clearly made a choice about what should happen to her body in these circumstances I think that decides the matter. I'm pro-choice, and it's her body, not the hospital's, not the court's and not her family's.
What I think it is unsafe to do is infer from a general preference (which many people have) not to be kept artificially and pointlessly metabolising after one's brain has died, with a decision to terminate a (wanted?) pregnancy after one's brain has died when there is a chance of a healthy birth. That isn't a pro choice position. It involves taking the answer to one question and treating it as if it were a decision about a fundamentally different situation.
In this case, it seems that there was no real chance of a surviving child, so yes, once that's known the hospital did have a good indication of what the woman wanted, and should have acted on it. The moral question we were arguing about at the start of this thread no longer applied to this particular case. I still think it worth having a principled answer to that question.
quote:
Originally posted by JoannaP:
Surely, one of the relevant principles here is the definition of "patient". The hospital insisted that Mrs Munoz was a patient, despite being brain dead, and therefore covered by the law whereas her family believed that corpses can't be patients.
"Is she a patient?" seems to have been a question created by the way that the Texas directive was worded, more than a question of moral principle, but yes, I agree that the issue of what rights a dead person has, and what duties are owed to them, is an important principle here.
And it seems to me that those who are arguing for their preferred option by insisting that the woman was dead, and therefore has no continuing interests to be considered, are making an unprincipled* argument. Because, in general, we do think that a dead person's wishes about what should happen to their body are important and should be respected. Many people try to honour their deceased family member's preferences about the use of bodies for organ donation or scientific purposes, and method of disposal, even when their own personal preferences are different, and even when they are under no legal obligation. It's the decent thing to do. I think few of us would be happy to accept a general principle that the wishes of the dead can be disregarded.
It seems to me that the decision to terminate a pregnancy is one of even greater moral and personal significance than those decisions which we in general regard ourselves as morally obliged to respect. Therefore I think that whether the woman is considered legally dead, or not, or legally a patient, or not, her choice matters more than anyone else's. The question for me is what happens if she can't make or communicate a choice. Put bluntly, the question is "In what circumstances do I get do decide whether you should have an abortion?"
(*in the technical, rather than the pejorative, sense of 'unprincipled')
[ 30. January 2014, 08:44: Message edited by: Eliab ]
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"Perhaps there is poetic beauty in the abstract ideas of justice or fairness, but I doubt if many lawyers are moved by it"
Richard Dawkins
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orfeo
Ship's Musical Counterpoint
# 13878
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Posted
quote:
Originally posted by mdijon:
I would hope there were some people worrying about the morality as well as the legality.
Why?
The main point of the law here is that it's the patient's morality that gets followed, not the hospital's. As is the case with most medical law.
That's the problem with worrying about 'the morality'. Most people can only worry about their morality, and aren't very good about worrying about other people's morality on the other person's behalf.
Worrying about the legality is a lot more straightforward because there is only one law.
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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by orfeo:
Most people can only worry about their morality, and aren't very good about worrying about other people's morality on the other person's behalf.
What you're articulating is the principle of autonomy. It is, I believe, morality that makes us value that.
The problem with "just follow the patient's morality" is that we can't always ask them, as in this case. Where we can I agree, people should never have interventions forced on them that they don't want except in very rare cases of public health imperative.
However sometimes what they want to know might be in conflict with someone else's confidentiality, or an intervention they request might not be consistent with good medical practice.
What the family report of their wishes may not be completely coherent, and we may not be able to verify it.
I wish it were simple.
[ 30. January 2014, 09:19: Message edited by: mdijon ]
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Posts: 12277 | From: UK | Registered: Sep 2004
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Jane R
Shipmate
# 331
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Posted
Eliab: quote:
In this case, it seems that there was no real chance of a surviving child, so yes, once that's known the hospital did have a good indication of what the woman wanted, and should have acted on it. The moral question we were arguing about at the start of this thread no longer applied to this particular case. I still think it worth having a principled answer to that question.
I think we are basically in agreement, then. I am generally pro-choice, but if there had been a realistic chance of delivering a live child I would agree that the hospital should have tried to do that; in those circumstances I think you could argue that the hospital has a duty of care to the (potential) child as well as to the mother.
What concerns me is the attempt to keep the body on life-support for such a long time in the hope that the pregnancy would continue normally, despite the fact that Ms Munoz had suffered brain death. Pregnancy is a very complicated symbiotic relationship. We know quite a lot about it, but we don't know enough about how the normal development of the foetus is affected by things that happen to the mother.
Posts: 3958 | From: Jorvik | Registered: May 2001
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orfeo
Ship's Musical Counterpoint
# 13878
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Posted
quote:
Originally posted by mdijon:
quote:
Originally posted by orfeo:
Most people can only worry about their morality, and aren't very good about worrying about other people's morality on the other person's behalf.
What you're articulating is the principle of autonomy. It is, I believe, morality that makes us value that.
The problem with "just follow the patient's morality" is that we can't always ask them, as in this case. Where we can I agree, people should never have interventions forced on them that they don't want except in very rare cases of public health imperative.
However sometimes what they want to know might be in conflict with someone else's confidentiality, or an intervention they request might not be consistent with good medical practice.
What the family report of their wishes may not be completely coherent, and we may not be able to verify it.
I wish it were simple.
I recognise all those complications, but the law does too, and has ways of dealing with them.
And I think the hospital understood all the general principles as well. The only reason they didn't follow them was because of a particular interpretation of a single provision. An interpretation that didn't last very long at all in court.
Which is why we get into the 'did they know all along' territory. Because it seems that what was preventing them from disconnecting the machines WASN'T any kind of ethical concerns or worry that they couldn't ascertain this woman's intentions or anything of that kind. Their stated position the whole time had absolutely nothing to do with those kinds of legitimate difficulties. Their stated position hinged entirely on labelling a brain-dead woman as a pregnant patient, and ignoring the bits of Texas law that said brain-dead means you're legally dead.
Almost every article that anyone linked to on this thread had quotes from legal experts, including ones that helped draft the law in the first place, saying that the hospital was misreading the law. It seems terribly strange that either the hospital didn't seek legal advice, or that the hospital's lawyers managed to come to the opposite conclusion to every other lawyer around.
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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.
Posts: 18173 | From: Under | Registered: Jul 2008
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orfeo
Ship's Musical Counterpoint
# 13878
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Posted
To put it succinctly, not once did the hospital's position rely on the difficulties in ascertaining FACTS: what did this woman want? Had she thought about this situation? Could the baby make it?
No, the hospital's position consistently relied on a view of the LAW. It's not difficult to read a law. Yes, it might be difficult to ascertain whether particular facts exist that the law uses to determine the outcome, but that's not this case. Everyone knew the exact same facts - the husband knew them despite the hospital's strange attempts to not actually confirm that his wife was braindead.
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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.
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mdijon
Shipmate
# 8520
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Posted
I don't think the law covers every situation. In fact one might argue this is an area where it doesn't.
We establish now that the law does not mandate keeping the ventilator on. The law does not, as far as I know, therefore instruct the switching off of the ventilator in this situation.
That leaves the doctors to talk to the family and agree on what should be done, based on common sense, their beliefs about what the patient would want, and what I call morality.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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orfeo
Ship's Musical Counterpoint
# 13878
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Posted
quote:
Originally posted by mdijon:
We establish now that the law does not mandate keeping the ventilator on. The law does not, as far as I know, therefore instruct the switching off of the ventilator in this situation.
It instructs following the instructions in a lawfully executed 'living will'. And if we're not satisfied that we have such a thing covering this situation, it instructs following the wishes of the next of kin. Which, as I pointed out a couple of pages ago, pointed in the same direction so there was no possible conflict between those two options.
Even when you say 'the doctors should talk to the family', you're expressing a principle of law even if you don't recognise it as such.
[ 30. January 2014, 12:47: Message edited by: orfeo ]
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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.
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mdijon
Shipmate
# 8520
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Posted
Actually I'm not sure there's any directive in law to follow the wishes of the next of kin. At least certainly not in the UK, Texas appears to have some weird medical laws.
And that is kind of inevitable really. Why should my next of kin have such power of my medical management? We may have argued last week and vowed never to talk again. They may not be very sensible. I might need protecting from their wishes.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
The press reports state that husband and wife had talked about things, and views were known in the family - but there was no extant living will or advance directive.
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Organ Builder
Shipmate
# 12478
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Posted
quote:
Originally posted by Eliab:
I'm pro-choice, and it's her body, not the hospital's, not the court's and not her family's.
In most US states (maybe all, but I'm not qualified to say), once the patient is dead (as this woman was determined to be) the body belongs to the estate, with the executor having full rights over it. In the absence of a will that person would have been her husband; if they had a will it is still likely he would have been her executor.
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How desperately difficult it is to be honest with oneself. It is much easier to be honest with other people.--E.F. Benson
Posts: 3337 | From: ...somewhere in between 40 and death... | Registered: Mar 2007
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by mdijon:
And that is kind of inevitable really. Why should my next of kin have such power of my medical management? We may have argued last week and vowed never to talk again. They may not be very sensible. I might need protecting from their wishes.
But that's true of anyone to whom you might assign power of attorney for your medical care. It proves too much, as they say. SOMEbody has to make those decisions, and in the absence of any advance directive, next-of-kin makes more sense than anybody else.
[ 30. January 2014, 16:50: Message edited by: mousethief ]
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by Organ Builder:
quote:
Originally posted by Eliab:
I'm pro-choice, and it's her body, not the hospital's, not the court's and not her family's.
In most US states (maybe all, but I'm not qualified to say), once the patient is dead (as this woman was determined to be) the body belongs to the estate, with the executor having full rights over it. In the absence of a will that person would have been her husband; if they had a will it is still likely he would have been her executor.
Same in Britain (and the very different legal system of France). If you are dead your body now belongs to your heirs. (And if you are alive the hospitals first line should be to keep you alive). And you can't leave your body in our will because you do not own your body, you are your body. A live human is not the sort of thing that can be property. So until your are dead your body is not property, not anyone's property, including your own.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Jane R
Shipmate
# 331
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Posted
Not sure 'belongs' is the right word exactly... perhaps it would be more accurate to say that your heirs have responsibility for (disposing of) your body. Otherwise how is it possible for people to donate their bodies for medical research? According to Ken's analysis, when you're alive you can't do it because you still need the body yourself; when you're dead you no longer have rights over it.
Posts: 3958 | From: Jorvik | Registered: May 2001
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by Jane R:
when you're dead you no longer have rights over it.
Not sure if that's entirely true. Dead people do have rights, for instance to determine how their wealth is distributed, if provision therefor is made before they die.
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This is the last sig I'll ever write for you...
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Organ Builder
Shipmate
# 12478
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Posted
quote:
Originally posted by Jane R:
Not sure 'belongs' is the right word exactly... perhaps it would be more accurate to say that your heirs have responsibility for (disposing of) your body. Otherwise how is it possible for people to donate their bodies for medical research?
In the US, "belongs" is legally the right word--because once you die, the law considers your body "property" just as a nice vase or a table would be property. I believe that regardless of what has been done in advance, the institution has to wait on an executor to release the body (unless the institution has been made executor). Many institutions won't insist on taking a body unless the family agrees, anyway. That's one reason why it is really important to do the paperwork and choose your executor carefully.
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How desperately difficult it is to be honest with oneself. It is much easier to be honest with other people.--E.F. Benson
Posts: 3337 | From: ...somewhere in between 40 and death... | Registered: Mar 2007
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by mousethief:
quote:
Originally posted by Jane R:
when you're dead you no longer have rights over it.
Not sure if that's entirely true. Dead people do have rights, for instance to determine how their wealth is distributed, if provision therefor is made before they die.
I think a more accurate way of expressing this is that living people have rights to plan for the distribution of their wealth upon their death, but the right (and ability) to make such plans expires when they die.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by mdijon:
And that is kind of inevitable really. Why should my next of kin have such power of my medical management? We may have argued last week and vowed never to talk again. They may not be very sensible. I might need protecting from their wishes.
quote:
Originally posted by mousethief:
But that's true of anyone to whom you might assign power of attorney for your medical care. It proves too much, as they say. SOMEbody has to make those decisions, and in the absence of any advance directive, next-of-kin makes more sense than anybody else.
Indeed, if you have assigned power of attorney you have accepted a certain risk but made a judgement based on someone's character and trust them. If you haven't it certainly dose make sense to talk to the next-of-kin (however defined - there's no precise legal definition and several different parties may have a similar claim and say different things), but it doesn't make sense to have them make the decision.
If the next of kin in this case asked for the woman to be kept alive then I don't think the hospital would do right to simply follow their instructions. The hospitals job in that case would be to talk them out of it so that a futile few months were not spent on a ventilator before the inevitable loss of the fetus. If they couldn't talk the family out of it then the hospital might have to go to court to establish their right to switch the ventilator off.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by Jane R:
Otherwise how is it possible for people to donate their bodies for medical research? According to Ken's analysis, when you're alive you can't do it because you still need the body yourself; when you're dead you no longer have rights over it.
In practice the family have the right to override your expressed wishes in life. In order for the body to be used for medical research, or the organs for organ donation, the family have to respect the wishes you expressed. Many families want to respect their loved one's wishes, but some don't and then they win. If the family can't agree then it gets legal and complicated.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Jane R
Shipmate
# 331
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Posted
So... applying that principle to this situation, once brain death was clearly established and the family asked for the ventilator to be turned off, the hospital should have done it even if it wasn't what Ms Munoz had said she wanted?
Interesting.
Posts: 3958 | From: Jorvik | Registered: May 2001
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mdijon
Shipmate
# 8520
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Posted
Yes. Sounds counter-intuitive, I know, but the point is that patients aren't entitled to demand treatments which are not going to help.
People with inoperable lung-cancer aren't entitled to demand surgeons heroically attempt to operate and people with colds aren't entitled to demand antibiotic prescriptions.
Likewise patients who cannot possibly make a recovery do not have the right to be ventilated indefinitely in the vain hope that they might, and their families don't have the right to demand it either.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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mdijon
Shipmate
# 8520
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Posted
My assumption in the above was that the fetus has been determined to be non-viable.
If the fetus was viable, the mother brain-dead, but had clearly expressed previous wishes that made us think she would want her child to be born at all costs then that is much more tricky. If the family were against it then I think they probably should be the deciding factor, since we don't have much basis for guessing at the outcomes of an early-stage fetus.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Palimpsest
Shipmate
# 16772
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Posted
Many years ago when I was doing AIDS counseling in Boston, I was given a lecture on legal issues by a lawyer who had dealt with a lot of gay couples in those days before civil partnerships and same sex marriages.
One common problem is that the person making the will would want to be buried with their partner. Their estranged family would want to drag the body back to the family plot and pretend the partner didn't exist. The will then could not over-ride the family rights to decide where the body would be buried. One technique the lawyer used was to leave a bequest of money to the family conditional on them allowing the body to be buried where the person wanted. It felt like a strange form of ransom.
Posts: 2990 | From: Seattle WA. US | Registered: Nov 2011
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by Crœsos:
I think a more accurate way of expressing this is that living people have rights to plan for the distribution of their wealth upon their death, but the right (and ability) to make such plans expires when they die.
But not the right to have them carried out.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Erroneous Monk
Shipmate
# 10858
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Posted
quote:
Originally posted by mdijon:
If the fetus was viable, the mother brain-dead, but had clearly expressed previous wishes that made us think she would want her child to be born at all costs then that is much more tricky.
Are you saying that in a hypothetical scenario where the fetus were viable (say 30 weeks) that the next of kin should be allowed to refuse consent for a caesarian? Or that a woman should be allowed to leave a living will refusing consent to a caesarian in such a scenario (however unlikely it would seem to be in reality than any woman pregnant with a wanted child would do that)?
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And I shot a man in Tesco, just to watch him die.
Posts: 2950 | From: I cannot tell you, for you are not a friar | Registered: Jan 2006
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John Holding
Coffee and Cognac
# 158
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Posted
There's currently a case in Vancouver where the mother essentially dropped dead of a massive brain seizure. Her fetus was then at (I think) 25 weeks. The father is hoping the baby will reach 30 weeks, at which point the doctors will do a c-section and deliver the baby, and the mother will be taken off life support. Obviously a very different case, as the mother had not contemplated dying, the father desperately wants the child (while agonizing over the fact that as the child is born, his wife will be dying) and the fetus was in good health, so far as anyone can tell, and will probably be able to grow to a point where a c-section can take place.
John
Posts: 5929 | From: Ottawa, Canada | Registered: May 2001
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Chesterbelloc
Tremendous trifler
# 3128
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Posted
That's great news, John. And it's precisely why when the lawyer in the original case justified the turning off of the mother's machine by saying: quote:
Pregnant women die every day. They die in car accidents, of heart attacks and other injuries. And when they die, their fetus dies with them. It's the way it's always been and the way it should be.
I shook my head so emphatically.
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"[A] moral, intellectual, and social step below Mudfrog."
Posts: 4199 | From: Athens Borealis | Registered: Aug 2002
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