November 17, 2008

"In the end, nature took its course before the judicial system ran its course."

Said the lawyer for the family of Motl Brody, who sued to keep the 12-year-old boy on life support. The doctors had declared the boy brain dead, but the parents wanted their religious faith -- Orthodox Judaism -- to provide the definition of death and bind the hospital.
Motl, the third-eldest of seven siblings, had spoken of becoming a rabbi like his father, Eluzer Brody, and often wrote Hebrew poems that he sang at family functions in his soprano voice. He was diagnosed with an aggressive brain tumor six months ago and underwent surgery and other treatments....

Motl Brody's uncle Yitzchak Halberstam said: "We are very grateful he was able to stay on life support until he died. We hope the case will sensitize the medical establishment to the importance of respecting any patient's religious beliefs regarding life and death."

27 comments:

downtownlad said...

At a certain point, when a patient is declared dead, it should be incumbent on the family to pay to keep someone on life support.

I don't want to subsidize this.

Darcy said...

I don't think people truly understand this until a loved one is on life support.

I've been there, and it's an excruciating decision, even with explicit advance directives. The last thing on my mind was what it was going to cost.

Freeman Hunt said...

If he was going to die anyway, why the rush by the hospital to hurry the process? "Oh, he's gonna die. Waste of space. Get him out of here." It's a person, not a houseplant.

downtownlad said...

The patients brain was 100% dead. It wasn't even in a vegetative state like Terry Schiavo's was. It was actually atrophying.

MadisonMan said...

It's a person

The problem with contractions. Is, or was?

Can we agree that everything that made him the loved son was gone, save for the framework? Is a religion that then says He's not really dead helpful at that point? What a horrible thing to endure for a parent.

Life really can turn on a dime.

Palladian said...

"The patients brain was 100% dead. It wasn't even in a vegetative state like Terry Schiavo's was. It was actually atrophying."

downtownlad pens an autobiographical sketch.

Freeman Hunt said...

It was actually atrophying.

So he was on his way out anyway. Is there some indication that the family wasn't footing the bill?

The use of drugs to try to sustain his blood pressure seems a bit strange given the circumstances, but then again, I'm not well-versed in end of life measures.

Palladian said...

"Is a religion that then says He's not really dead helpful at that point?"

Interesting capitalization of the pronoun, especially when asking a religious question.

ElcubanitoKC said...

dtl, you don't subsidize anything.

MadisonMan said...

`Interesting capitalization of the pronoun,

God works in mysterious ways. I'm not used to being a vessel of the Almighty.

ElcubanitoKC said...

L'chaim, MadisonMan

TMink said...

"I don't want to subsidize this."

I have heard this about other expensive treatments of diseases and syndromes that are lifestyle related.

I think those arguments are bogus too.

Of course, I bet DTL is all over universal healthcare.

Trey

Richard Dolan said...

The problem of tragic choices in the allocation of health care resources always brings out the two responses already on display here: don't subsidize such people (per dtl) and it's a person not a houseplant (per freeman hunt).

What is interesting to me in all of this is the way that putting a unique face to the problem changes everything. The logic of the macro-economic argument (don't subsidize) doesn't become any less compelling when you do that, but it still often fails to persuade at the micro level. In part this reflects the rational/emotional divide, but it also reflects the idea that changing the frame of reference from macro to micro changes how we perceive values. Making the abstract particular changes how we look at something, even though nothing about the problem changes when you do that. What is really interesting is how that failure to persuade changes as the context changes -- even as the fundamentals of the problem stay the same from context to context.

Take two examples. The first is the once-familiar scene of a mining disaster, where huge and hugely expensive) rescue efforts are undertaken to save trapped miners running out of air. Most know beforehand (but no one wants to say) that the efforts are almost certainly futile, and will result only in unearthing the bodies for a more decent burial. The second is the also once-familiar cases of shipwrecked sailors resorting to cannibalism to save the many at the expense of the few.

The means/ends and active/passive distinctions, sometimes invoked at the micro level to draw lines between the examples, don't make much sense at the macro level (decisions about resource allocations are always active, meaning that they force a choice, and the "ends" are implicit in the "means").

Some will try to get rid the problem by dismissing it on religious/secular grounds, or by invoking different definitions of death. While I don't think either of those adds anything, finding the right frame of reference to think about these problems is elusive. I'm not sure anyone has a convincing solution.

Freeman Hunt said...

I bet DTL is all over universal healthcare.

I think he's probably more into immediate, universal euthanization.

Freeman Hunt said...

Richard, please don't think I'm supporting public subsidization of health care. That's another issue. I'm only saying that if the family's paying, and the family doesn't want to remove life support, I don't see the problem.

Darcy said...

Well said, Richard Dolan.

ElcubanitoKC said...

I believe it is still much better when the families get to make this decision, than when doctors, working for the state have to make the decision. It is never easy for them either. I remember in Medical School in cuba when we had to make decisions over whom would get the scarce and rationed drugs we were assigned everyday. It was definitely those younger and with better prognoses who got them. We did a lot of "going through the motions" with over-65 and terminal patients.

Roger J. said...

I suspect these kinds of tragic decisions are made every day in every hospital in the country. The situations tend to get highlighted by cases such as this, Terry Schaivo, and in the Katrina situation. My personal opinion is that government intervention in these types of decisions on either side is totally inapproriate. Others, of course, may differ.

Zeb Quinn said...

Except for the truly wealthy, healthcare is always rationed care, de facto under our present system and de jure under single-payer (socialized) systems, the former tending to be more fluid and forgiving in where it draws the lines.

ElcubanitoKC said...
This comment has been removed by the author.
ElcubanitoKC said...

Zeb Quinn, do you have any first-hand experiences that justify your assertion that socialized healthcare is more forgiving on this respect?

Even in socialized anything, if you have money, or products, or services, or sex, you get better care. Bribing is actually more common in socialized systems of any kind than on private ones.

ElcubanitoKC said...

Sorry, Zeb, I read that before lunch. LOL

I gotcha now...

Cedarford said...

The problem with end of life decisions and suicidal "corpse retrieval missions" is that without society imposing rules and standards, the emotional heat of the moment will cost lives or cost medical resources that could save lives elsewhere in the system.

So society does have a part. It cannot be just "entrepreneurs" of the hospital vs. "consumer" patients hashing things out in private. Naturally there will be disputes. Naturally, society is expected to resolve those disputes with laws or with courts.

Doing "whatever the victim families want" costs lives. It could be lives of accident victims who lost an ER surgeon staff slot because the hospital had to pay 350,000 in care of a brain-dead welfare momma because her kids and their "biologicals" didn't want the plug pulled. Or, of foolhardy rescuers who feel morally backmailed into undertaking extremely dangerous "rescue" missions to get the "remains" helpful for "emotional closure" of the "families". 3 men got killed in a failed "rescue" attempt in Utah coal mine when they rationally should have known that 5 air samples showed lethal monoxide levels at the cave-in - simply because hysterical victims families had called for "heroes" to do "rescue at all costs".

Society does have an interest in NOT leaving it to just victims families and owners (of hospital, coal mine, etc). And societal rules and laws better safeguard the health and safety of other members of society by reducing the power of emotional blackmail (victim's families) and the profit motive over life (certain owners and investors).

downtownlad said...
The patients brain was 100% dead. It wasn't even in a vegetative state like Terry Schiavo's was. It was actually atrophying.


Just some clarification on the Schiavo husk. The autopsy proved what was expected. The Schiavo husk existed only because small portions of what remained of the brain did not rot and atrophy away with the rest. Most of the brain was long gone.

She was an "it", basically dead with no cognitive functions left on initial arrival at the hospital ER.

Somehow the brainstem had been left enough oxygen to survive when the "higher order" brain tissue died off. Her husband and parents won a million-dollar lawsuit to keep the body alive, which the autopsy also showed was wrongly decided. Finally unplugged, the Schiavo case may be considered historic in being the point where the US public decided the Right-to-Life fanatics and Republican theocrats had gone too far, and needed to be stopped. The Schiavo Fiasco also marked the "inflection point" of the Bush Presidency, it was all downhill from there for Dubya.

ElcubanitoKC said...

Dr Goebbels, stop eating, that food can be used somewhere else by someone else.

And for the record, I, like most of my family has already done, will have a DNR order filed.

Nichevo said...

C4, I have been told that you are a missileman in the USAF, you rode a silo in ND or somewhere for a few years. Is this true?

Assuming it is, naturally you would never had to deal with anything resembling actual combat as it has been known on this planet since the waters descended. You would not necessarily know from combat mindset or warrior ethos; there would be no reason to inculcate in you credos such as "Leave No Man Behind."

I suppose there would then be no reason for you to see analogues of such values in literally "pro-life" episodes as - well, tearjerker stuff like mine rescues, Kill Bill coma recoveries, etc.

But these efforts may have a social value - morale, etc. whether on the battlefield or in the homeland - in excess of their actuarial optimization. If you like slippery slope arguments, it is another notch on the social ratchet away from Soylent Green, to know that our civilization lavishes such resources on such forlorn hopes.

We are emphatically NOT a utilitarian society. (Such a one would not want to reduce smoking in a population that collects more from the government the longer it lives.)

And you should give praise for that, because if most people are an "it" to you, what are you to them, the light of their lives?

Besides, in a true meritocracy, the Jews would take over and you'd really be screwed, Ceef ;>

Nichevo said...

I think you also don't consider, Cedarford, that increased demand for medical resources tends to increase the supply. The more lawsuit-crazed MDs giving you MRIs for every headache, the more MRIs are built, the more MRIs are available, the price goes down, the technology advances. One day, as there are now X-ray machines in most doctors' offices, there will be MR suites.

John Lynch said...

Doctors should work for patients. If we've created a system where that's not true, we did something wrong.