Showing posts with label jahi mcmath. Show all posts
Showing posts with label jahi mcmath. Show all posts

Friday, March 28, 2014

Schiavo Family Honors Parents of Brain-Dead Girl, For Better of For Worse

Philadelphia Inquirer, Friday, March 28, 2014, Page A3, STAFF REPORTS / HEALTH:



Schiavo family honors parents of brain-dead girl

At the Union League, both families gather near a portrait of Terri Schiavo: (from left) Kristina Fiore; her fiance, Bobby Schindler, Schiavo´s brother; Mary Schindler, Schiavo´s mother; Nailah Winkfield, mother of Jahi McMath; McMath´s stepfather, Marvin Winkfield; her uncle Omari Sealey.
At the Union League, both families gather near a portrait of Terri Schiavo: (from left) Kristina Fiore; her fiance, Bobby Schindler, Schiavo's brother; Mary Schindler, Schiavo's mother; Nailah Winkfield, mother of Jahi McMath; McMath's stepfather, Marvin Winkfield; her uncle Omari Sealey. DAVID M WARREN / Staff Photographer
Story Highlights
  • The family of Jahi McMath was honored Thursday by the family of Terri Schiavo.
  • The McMath family opposed removing a ventilator after three physicians said Jahi had no brain function.
  • Jahi is physically healthy; the family is just waiting for her to “wake up.”

The family of Jahi McMath, the 13-year-old California girl whose parents refused to accept a finding of brain death, was honored for courage and perseverance Thursday night at the Union League by the family of Terri Schiavo.
The McMath family went to court in December to oppose the removal of a ventilator and feeding tube even after three physicians determined that there was no brain function and a coroner issued a death certificate.
A month later, the body of the girl - organs still working - was taken to an undisclosed medical facility, where the heart still beats. A manicure and pedicure are given every Friday.
Her mother, Nailah Winkfield, said Thursday that her daughter "is getting love, respect, and care. She is beautiful. Her skin is flawless. Physically she is healthy and stable. We are waiting for her to wake up."
It has been a decade since the case of Schiavo, who was born in Huntingdon Valley and met her husband at Bucks County Community College, embroiled Congress, President George W. Bush, and much of the nation in a family dispute over the removal of a feeding tube 10 years after she collapsed into a coma in Florida.
Her brother, Bobby Schindler of Narberth, said that he felt the McMaths' decision to fight for their daughter was about medical rights and patient autonomy, which he sees as being eroded.
Brain death diagnosis is not a settled matter, he said. "The McMath family saw signs of hope, and they should be given the opportunity to provide their daughter hope. That's the bigger picture here. Who ultimately is going to make decisions for our loved ones? Is it going to be strangers - hospitals and ethics committees? Or is it family members?"
Two medical ethicists, a neurologist and a lawyer specializing in end-of-life issues all expressed dismay at the award, saying that it ignores reality, will confuse the public, and attempts to turn back what has been accepted by every state and the Vatican - that brain death is death.
"Patient autonomy is important and so is family decision-making, but they come to an end when death comes," said Arthur Caplan, a bioethicist at New York University.
"One bright line that I don't think we can cross without causing havoc in our society is the line between life and death," he added. "And the line is set by medicine - not by families, not by lawyers, not by theologians. It's doctors who say that person is dead. They are the experts."
Howard Hurtig, a Pennsylvania Hospital neurologist who has diagnosed brain death in many patients, called the presentation of an award under these circumstances "obviously surreal."
Hurtig said he understood the shock and pain of grieving parents, but said that doesn't alter the facts. "Every professional in this field accepts that when brain death is defined properly by the rules, it's death," he said.
Jahi McMath - "everyone's favorite," her mother said - had her tonsils removed to alleviate sleep apnea at Children's Hospital Oakland on Dec. 9.
"There were complications after surgery," she said, tears welling in her eyes. "She bled severely and went into cardiac arrest in front of me. It was traumatic, and I will never be the same."
Two doctors at the hospital and a pediatric neurologist from Stanford University concluded there was no brain activity and she was brain-dead. The Alameda County coroner's office issued a death certificate.
The parents sued to prevent removal of life support; a judge urged the parties to work out an agreement. The hospital allowed the family to remove the body with machines still working.
"I don't feel that anybody with a heartbeat and blood flowing through their veins, being treated in a medical facility, deserves a death certificate," said Winkfield, 34, who has worked for Home Depot for 12 years. "As a mother, I have unconditional love for my daughter, and I'm going to fight for her until I have no more life left in me. My hope is that she will change how people view brain death, and ultimately that she wakes up."
She declined, as she has in the past, to say where Jahi was taken or who is paying the bills. Caplan, the bioethicist, said he was certain that no insurance company would continue to pay for medical care once a person had been declared legally dead.
The award to the McMath family was presented by the Terri Schiavo Life and Hope Network, started in 2005 by Schiavo's brother, parents and others.
Talk-show host Glenn Beck was Thursday evening's scheduled keynote speaker but canceled hours before; an event spokesman cited a family emergency.
The award recognizes families that overcome high resistance in fighting for loved ones.
The Schiavo and McMath cases are different in essential ways. Schiavo suffered a heart attack in 1990, and was left with a severe brain injury due to a lack of blood and oxygen, similar to what happened with Jahi McMath.
In Schiavo's case, however, the brain damage was not as severe, and some activity remained. Her body could breathe on its own and respond to stimuli. As Caplan put it in lay terms, "the thermostat's still on," and with nutrition and hydration, such a body can be maintained for years. Schiavo lived in such a persistent vegetative state for 15 years.
In cases of brain death, like McMath's, the brain has no function at all - no brain waves. Even with a ventilator and feeding tube, the body will break down after brain death. Neither Caplan nor Hurtig would predict how long a brain-dead body can continue to function. They said there is no precedent for it.
Thaddeus Pope, a lawyer and expert in medical futility at Hamline University in Minnesota, said brain death has been accepted by all states and medical societies for 30 to 40 years.
There is no organized effort to remove such laws or to revisit the issue of whether brain death is death, Pope said, though he noted that a small minority of bioethicists and physicians question the rules by which brain death is determined and whether those rules should be changed.


mvitez@phillynews.com
215-313-3518 @michaelvitez

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Monday, January 27, 2014

Brain-Death Battles: Coming Here to Philadelphia?

Philadelphia Inquirer, Wednesday, January 22, 2014, Page A3-STAFF REPORTS / HEALTH:



States vary on brain-death laws

FILE - This undated file photo provided by the McMath family and Omari Sealey shows Jahi McMath. McMath remains on life support at Children´s Hospital Oakland after doctors declared her brain dead, following a supposedly routine tonsillectomy. (AP Photo / Courtesy of McMath Family and Omari Sealey, File)
FILE - This undated file photo provided by the McMath family and Omari Sealey shows Jahi McMath. McMath remains on life support at Children's Hospital Oakland after doctors declared her brain dead, following a supposedly routine tonsillectomy. (AP Photo / Courtesy of McMath Family and Omari Sealey, File)
FILE - This undated file photo provided by the McMath family and Omari Sealey shows Jahi McMath. McMath remains on life support at Children´s Hospital Oakland after doctors declared her brain dead, following a supposedly routine tonsillectomy. (AP Photo / Courtesy of McMath Family and Omari Sealey, File)GALLERY: States vary on brain-death laws

Could headline-grabbing scenarios like those in Texas and California involving brain-dead patients happen here?
Yes, experts say.
First, Texas: Marlise Munoz, 33, was found by her husband, Erick, at 2 a.m. Nov. 26 on their 2-year-old son's bedroom floor. Her heart had stopped for perhaps an hour after a pulmonary embolism. Her husband began CPR, called 911.
She was 14 weeks pregnant.
Her family stated from the beginning - only confirmed by the hospital last week - that Munoz was brain-dead.
Her husband told doctors in November to withdraw life support. The hospital refused. It cited a 1977 law, the Texas Health and Safety Code, stating: "A person may not withdraw or withhold life-sustaining treatment . . . from a pregnant patient."
Thirteen states have similar laws - absolute and inflexible, according to Katherine A. Taylor, a lawyer and ethicist who teaches at Drexel University College of Nursing and Health Professions.
Eighteen states, including Pennsylvania, have pregnancy restrictions like Texas', she said, but are less rigid: The fetus must be considered viable.
A 2006 Pennsylvania law, Act 169, that addresses living wills and health-care decision-making, she said, requires that a pregnant patient be kept on life support "unless, with a reasonable degree of medical certainty, the fetus cannot develop to live birth."
In five states, including New Jersey, laws allow the woman or her proxy to direct what she would want if she is pregnant. "What's also important about these states," Taylor said, "is that they give notice in their living will form that she should think about this possibility and decide what she would want."
In 14 states, the law is silent on the subject.
"This statute in Texas should not apply to this patient because she is dead," Taylor said. "But if she weren't dead, these statues are bad law, bad public policy, bad ethics.
"I think every family should make their own decision about that," she added. "In Texas, the state lawmakers have stepped in and made it for them, decided this woman should be kept alive before viability. That is so unjust."
One argument by Marlise Munoz's attorney, fighting to force the hospital to withdraw life support, is that the Texas law violates her constitutional rights to equal protection under the 14th Amendment. It denies pregnant women and their proxies decision-making authority, a right afforded to everyone else.
Even though the hospital acknowledges Munoz is dead, it appears to be waiting for a court ruling.
"You're clearly trying to balance the potential life of the fetus with what the family and deceased would have wanted," said Arthur Caplan, a former University of Pennsylvania bioethicist now at New York University.
"It's not a matter of being pro-life or pro-choice to me," he said. "It's more nuanced. I'm not denying there's a fetus to think about. But there are so many uncertainties. I'm willing to think the family and husband should decide what's best, and not the Texas legislature."
John M. Haas, president of the National Catholic Bioethics Center in Philadelphia, says Texas law no longer applies, since Munoz is dead. He says the family should make the decision now, and a big consideration is the viability of the fetus.
"The people think the Catholic Church is black and white on these things, and we're not," he said. "We accept judgment of physicians. . . . It seems to me that if it were highly likely that the child could survive if the corpse was kept functioning for another week, there would be a strong presumption of doing that."
But if there were little chance the fetus would be viable, he said, the opposite would be true.
"If the child was deprived of oxygenated blood," he said, "do you have to use extraordinary means to keep the child alive? The answer would be, no, you don't."
The second case is in California, where Jahi McMath, 13, had tonsil surgery Dec. 9. She ended up brain-dead. When the hospital tried to remove the ventilator, her parents went to court, which granted a temporary stay.
After a coroner issued a death certificate, the family wheeled the corpse, lungs still functioning with a machine, out of the hospital. The family's lawyer said the body is now on a feeding tube and ventilator at an undisclosed hospital.
"I don't think I've ever had a case where a family says, 'I'm sorry, I can't accept that. You have to keep her going,' " said Howard I. Hurtig, a neurologist at Pennsylvania Hospital. "There is no law that requires you to keep her going. This was settled 40 years ago."
Families often refuse to withdraw life support when doctors and nurses feel care is futile - but not after a patient has died.
Hurtig said what's likely going on in California is a failure in communication.
Clearly, he said, the family was heartbroken. Perhaps doctors didn't show enough compassion. Maybe there were previous episodes when the family felt disrespected or was denied care.
"My own experience is, if you explain things carefully and compassionately, . . . a lot of times people come to their senses," Hurtig said.
Taylor said New York and New Jersey laws allow families of brain-dead patients to ask that death be declared based on the absence of a heartbeat.
"It's my understanding it was passed primarily to accommodate the Jewish Orthodox community," she said. The New York statute, for instance, makes it clear the accommodation is temporary and urges hospitals to write polices providing "guidance on limits to the duration of the accommodation."
Taylor said she has been on the ethics committee of a Princeton hospital for six years and the issue has not come up.

mvitez@phillynews.com
215-854-5639
@michaelvitez

Read more at http://www.philly.com/philly/health/20140122_States_vary_on_brain-death_laws.html#AugPhKZ6pcz943oy.99