Jahi McMath, Brain Death, and the Lies of the Medical Establishment

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After post-tonsillectomy bleeding, Jahi McMath suffered a cardiac arrest that damaged her brain. She was declared brain dead. The hospital wants to remove her ventilator, but the family is opposed. While there have been extensions granted by judges, the hospital, the medical establishment, the State of California, and the bioethics establishment have ganged up to force Ms. McMath’s ventilator to be removed. The hospital refuses to do a needed tracheotomy since “we can’t operate on a dead person” (this in spite of the fact that the hospital would support removing the organs of a person declared “brain dead” even though that is surgery as well). The hospital refuses to authorize transport, and under California law, the coroner “has to release the body.” This is an example of declaring a person dead by fiat and is a logical consequence of the acceptance of “brain death” criteria beginning in 1968.

Henry K. Beecher was the chairman of the Harvard committee on brain death. In an article in the 1968 JAMA, he argued that brain death should be considered death in part because organs could then be harvested from the patient while they are still perfused with oxygenated blood. In later articles he was more explicit in saying that death was redefined in the interests of organ transplantation. The 1981 Uniform Determination of Death Act (UDDA) or a compatible law has been passed in all fifty states. The law says death can either be declared after cardiopulmonary arrest or when the “whole brain” is dead. The President’s Commission report claimed that once the brain is dead, the body’s organic unity is gone.

Brain death criteria are not well-supported by evidence. Cicero Coimbra, a neurologist in Brazil, has noted that one of the tests to determine brain death, the apnea test, which involves removing the ventilator from a patient suspected of being brain dead for three minutes to check for spontaneous respiration. Dr. Coimbra points out that this test can itself cause brain death in patients who are not initially brain dead. He also argues that there is hope for some of these patients–hypothermia and other treatments to preserve brain cells may have good results. There have been cases in which a person was about to have organs removed for transplantation–and the person fully recovered. It is possible that removing a ventilator from Ms. McMath might take the life of a person who might not otherwise die from her head injury.

The entire brain is not dead in most cases of brain death–studies have found EEG activity in the majority of so-called “brain-dead” patients tested. For organs to be removed, body temperature has to be close to normal, and body temperature is mediated by the hypothalamus, which is part of the brain (along with the pituitary gland, part of the endocrine system). Supporters of brain death claim that these parts of the brain do not count–one wonders what else they would say would not count if further evidence of continuing brain activity is found.

As the recent President’s Council report points out, brain dead people are organic unities. Their blood circulates, and oxygen/carbon dioxide exchange continue. While the ventilator provides oxygenated air, machine dependence is not equivalent to death. Some conscious people are ventilator-dependent, and no sane person would consider them dead. The President’s Council identified death with loss of respiratory function combined with permanent loss of consciousness. Why, then, does ventilation count for life and not the heartbeat? Also, given that our knowledge is limited concerning the generation of consciousness in the brain, claims of permanent unconsciousness are arrogant at best.

I respect Arthur Caplan as a significant scholar in bioethics. What I cannot respect is his ignoring opponents of brain death in his public statements as if there is no current debate on the topic in academia. It reveals a lack of respect for opponents of brain death criteria, some of whom are physicians (Dr. Coimbra and Dr. Alan Shewmon as well as the late Richard Nilges practice or practiced neurology). Professor Caplan is surely aware that just because a law says death occurs at a certain point does not imply that the law is correct. Many bad laws have been passed–the UDDA may be another example of bad law.

Current bioethicists tend to think that patient autonomy is fine when the patient (or the patient’s family in the case of an incompetent patient) refuses care. But if a patient or patient’s family wants continued care, then there are appeals to “futility,” as if “futility” is not a value-laden term. “Death” is also a value-laden term and can be used for utilitarian ends such as justifying organ harvesting from heart-beating donors or to save money by removing a ventilator from a little girl. The hypocrisy of many doctors, hospital administrators, and “bioethicists” is sickening. The trashing of the value of Ms. McMath’s life is ethically monstrous. Given the history of movements such as the eugenics movement and experiments such as the Tuskegee Syphilis Experiment, I wonder what motivations are really in the minds of some of those most eager to remove Ms. McMath’s ventilator. Utilitarianism now trumps the value of human life, and medicine is corrupted to the point that I wonder whether some doctors are really practicing medicine any more.

If it were determined that Ms. McMath could not recover, the family’s wishes should be honored, even if the care Ms. McMath receives is “extraordinary care.” The family would also have the moral right to ask that the ventilator be turned off — but autonomy goes both ways and not only in the direction that cynical “bioethicists” desire.

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Belgium: The Return of “Useless Eaters”

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English: Skull and crossbones

English: Skull and crossbones (Photo credit: Wikipedia)

At http://www.france24.com/en/20121218-belgium-looks-euthanasia-minors-alzheimers-sufferers is an article on a proposal that will most likely pass Belgium’s legislature that allows euthanasia for minors and for Alzheimer’s patients. Increasingly secular, godless Europe is finally passing laws that reflect the decline of the remnants of Christian ethics that held on for a while after the decline of religious belief. The phrase “useless eaters” was coined by a Nazi doctor who was discussing Nazi Germany’s euthanasia program. It had no problem killing minors and people with senility of whatever cause. With no clear cut behavioral diagnostic difference between Alzheimer’s Disease and senile dementia in general, the new law, when passed, could de facto be applied to some non-Alzheimer’s senile patients.

What are the limits on the age of minors? Apparently none–any minor deemed “too sick to live” by a doctor and by parents or guardians could be killed. The slippery slope that supporters of euthanasia claimed would not happen is already fact. Next door in The Netherlands, voluntary euthanasia quickly led to involuntary euthanasia, and there was, for a time, a proposal on the table to have a “quality of life threshold” below which a person would no longer have the right to live. It may just be a matter of time before the severely mentally retarded will join the list of “useless eaters” and euthanized. A godless society only gives life a utilitarian value. Although Kant tried to set up a secular system that allowed for intrinsic human dignity, his dream died, at least in some European countries, and the remnants of the Christianity that still influenced Kant died away. Now there is no bar to making decisions regarding euthanasia not based on alleged “mercy,” but on a person’s ability to “contribute” to society. The fittest survive; those considered unfit will be eliminated. The most frightening instances of murder are those murders that use mercy to justify them. The only “mercy” involved may be for the family to get a burden off their back and the state to save on medical bills due to fewer patients requiring long-term care.

The United States, for now, has enough residual Christian belief to avoid Europe’s direction for now. However, given the responses of most of my medical ethics students to questions regarding the moral rightness or wrongness of physician assisted suicide, it seems that those supporting PAS will win in the long run. If they do, it will be no surprise if PAS leads the way into voluntary active euthanasia and eventually to involuntary active euthanasia. Society will be at last be in part of a eugenics movement that will make the earlier movement in the first decades of the twentieth century seem like child’s play. God help us all if that happens–and it will happen in Western Europe (and probably in Canada) before it happens in the United States. But with 30% of young people in the U.S. classifying themselves as “irreligious,” the road toward Europe may be wider than one might think.

Atheists forget, when they catalog the crimes of religion, that the mass murderous regimes of the twentieth century were atheistic: Nazi Germany, the Stalinist Soviet Union, Maoist Communist China, North Korea, and Cambodia when it was under the rule of Pol Pot. The sanctity of human life does not make sense in an atheistic framework; the value of human life must be instrumental and not intrinsic in a consistent atheistic system. It is no surprise, then, that Belgium and the Netherlands are going the route toward allowing more and more classes of people to potentially be subject to euthanasia. The Nazi world of alleged “useless eaters,” a world Europe once claimed to eschew for good, is coming back to haunt a godless society. The price paid for such folly will be very high.

The First Therapeutic Use of Embryonic Stem Cells

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Embryonic Stem Cells. (A) shows hESCs. (B) sho...

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GERON Corporation is carrying out research injecting embryonic stem cells into the spinal cord of a man with spinal cord injuries. The hope is that new nerve tissue will grow and repair the spinal cord. The company’s stock rose over five dollars a share today, which is no surprise given the revolutionary nature of this research.

However revolutionary such research is, embryonic stem cells are removed from human embryos in a process that kills the embryo. This is, as I have argued in another post, the taking of innocent human life–and human personhood cannot be separated from the human organism. Now a utilitarian in ethics who focuses on “the greatest good for the greatest number of people” (or “for the greatest number of sentient beings,” depending on the utilitarian) most likely would support this research if in fact it leads to helping patients with spinal cord injuries. Such patients might be able to recover from paralysis and walk again. Many Americans, who tend to think in both utilitarian and pragmatic terms, will support embryonic stem cell research if it leads to therapeutically useful results. Should this procedure work, parents of paralyzed children will demand its use. Some of these parents may be those who previously opposed embryonic stem cell research. Supporters of the research will ask, “What if your wife or husband, mother, father, or child couldn’t walk? Wouldn’t you want this treatment for them?” As with another morally problematic procedure, solid organ donation from “brain dead” individuals, the majority of people in pro-life circles may change their tune and support embryonic stem cell research. There will be a few hold-outs who, like me, believe that goodness is not dependent on consequences, but I predict they will be very few. I hope that if embryonic stem cell therapy turns out to be successful that I am wrong about the pro-life community surrendering to utilitarianism. But given their past performance on the issue of brain death, I am not optimistic.