Doctors at a hospital in the District of Columbia have determined that a 12 year old boy, Motl Brody, has no upper or lower brain activity. He was declared dead by legal criteria November 4. Here's the Washington Post article on the case.
By legal and medical criteria, the boy died last week.
The dilemma is that he was placed on a ventilator and receiving drugs to stimulate his heart beat before the determination that he met the criteria for legal death in the District. His parents are Hasidic, Orthodox Jews and have legally objected to turning off the ventilator or stopping the medications, saying that their religion does not recognize anything other than cessation of breathing as "death." The case is now in court.
Perhaps the parents would consider discontinuing the addition of new doses of medications when the current ones run out? In this way, there is no intentional act of stopping the heart, and there would be no intervention if the heart continued to beat.
One way to look at the case is that it's never ethical to force doctors to act against their medical judgment as to what is in the patient's best interest. However, this patient is now dead. What do we owe the parents of a dead child?
The child's doctors have said, '"Ethically, there is no appropriate treatment except removal of the ventilator and of the drugs."'
However, it is considered ethical to continue cardiopulmonary support in order to preserve organs for harvest and transport. So, the organ support itself is not unethical. Is support for the body ethical in order to meet the religious requirements of the deceased patient's family?
Finally, who is responsible for carrying out acts that the doctor believes is not in the medical best interest of the patient? And for how long?
Wednesday, November 12, 2008
Another end of life dispute (Motl Brody)
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3 comments:
More than 20 years ago, I recall hearing a noted neurologist state, rather emphatically, "If that's how they feel, let them ventilate him in their living room, but not in my ICU."
If the patient is dead in the legal definition of the word, can the physician just certify that and sign the death certificate and the hospital staff do what they do when a person expires in terms of transferring the corpse to the morgue, etc.? Does declaring death require parental permission?
"Does declaring death require parental permission?"
When the parents have a willingness to take legal action? That's one can of worms the hospital would like to remain tightly sealed. Espicially when religion is involved. The corpse could be so rotten the bones are showing, and the parents might still remain in their strangely religious state of denial.
The boy's heart stopped and he died on Saturday, November 15.
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