January 6, 2014

Family Over Hospital, Parents Over Government

Two interesting medical/ethical stories are playing out now, one getting a lot of attention and the other less so.

The one you've probably heard more about is the very sad case of Jahi McMath, the California teenager who was declared brain dead on December 12, 2013 after suffering complications following surgical procedures to help relieve her sleep apnea. The determination of brain death has been confirmed not only by doctors at the hospital but also by some who examined her on behalf of her family, and others who were called in on behalf of the courts, according to multiple reports. 

Jahi’s family, not accepting that she’s deceased, has succeeded in obtaining a court order extending 'life support', if that's the proper term, until January 7th and have been looking for a facility that can take the the girl, keep her comfortable and/or provide some kind of innovative treatment, in hopes that she might recover. A brain trauma center in New York is supposedly willing to take her, although there have been some questions on how to transport her, what level of care would be needed during the relocation, and (somewhat indelicately, I know) how any care would be paid for. 

Much of this is playing out in court, with the hospital on one side and, I would say not surprisingly, the Terri Schiavo Life and Hope Network and the family on the other side. A decision was announced this past Friday that Jahi can be moved from her current location, Children's Hospital Oakland; the logistics of that, and how or if life support will be maintained at that time, still seems to be up in the air. 

It was reported today that Jahi has been released from Children's Hospital and sent to an undisclosed facility (in part for security reasons), according to the family attorney Chris Dolan. He also noted that
She's where she's going to be for a while. She needs to be medically stabilized, medically treated. 
I'm sure that last statement will be examined by experts from many fields for some time. 

The other case you’ve probably heard much less about is an equally sad situation in Texas.

Marlise Munoz, a mother in her 30's and an EMT, was found unresponsive by her husband Erick, who's also an EMT. He did what he could to try and revive her, as did folks at the hospital, but ultimately the were unsuccessful and Marlise has been on life support since November 26th, after suffering what doctors believe was a pulmonary embolism. She's being kept alive mechanically, even though her husband has indicated that he and his wife had specifically discussed not wanting to be kept alive on machines; her parents agree. 

And yet, there she lies, brainwaves flat, machine-supported. 

Why? Because Mrs. Munoz was pregnant – 14 weeks at the time of her collapse, now nineteen weeks or so - and under Texas law, life support cannot be withdrawn from a pregnant person. 

There are some who think that the hospital is misinterpreting the statute and could end the family's nightmare, but the facility, John Peter Smith Hospital in Ft. Worth, is holding firm, noting that it was not a difficult decision for them to uphold the law and refuse to end the mechanical means of support. And, the doctors have been able to detect a fetal heartbeat, and they check regularly for it.  

What they don't know, and won't know for several more weeks, is what amount of damage may have occurred during the time Marlise was not breathing, had no pulse, and underwent the all-too-familiar efforts we regularly see on TV when actors playing doctors try and resuscitate someone. Was the fetus also oxygen-deprived during that time? Did the drugs pass through the mom to the baby? What are the effects from the repeated electric shocks?  Is the baby healthy, beyond just having a heartbeat?  Erick Munoz, the devastated husband and now single parent to the couple's first child, expressed hopes that if nothing else, this case will educate others, and perhaps lead to the law being changed.

So. Two cases one where the hospital says no, we won't continue life support even when the family wants us to; the other hospital continuing life support even when the family does not want it. Needless to say, folks from all sides have been chiming in on these cases, including Mike Huckabee, a minister, former Arkansas politician, and political commentator. He has made his opinion on the Jahi McMath case very well known, speaking about it on his Fox TV show this past Saturday and posting similar comments on his Facebook page as well. Here's what he said:
Every life has value and worth. There is no such person who is disposable, one whose live has been deemed by others to be less than others and therefore expendable, I can't share that.
He added 
The road that starts that way in deciding that some lives have less value and are unworthy of protection, that leads to a culture that tolerates the undeserved killing of over 55 million unborn children in this country. It leads to China's birth policy that limits the number of children for a family and enforces forced abortion if they deviate from the state-determined ideal. 
And finally, he noted:
It's also that culture that allowed the Nazis to hideously justify the savage slaughter of millions of Jews, disabled people, old people and those with mental illness. Let's hope and pray that the courts continue to do what every court should do, respect parents over government, family over hospitals, and above all, protect Jahi from them all. 
Let's hope and pray that the courts can continue to do what every court should do, respect parents over government, family over hospitals.... above all, protect Jahi from them all. 

Should the Munoz family be allowed to put the name of their beloved Marlise in that statement above, in place of Jahi McMath's name, and be allowed to make their own decisions, family over hospital, parents over government? 

I think yes.