Brain dead? Moi?

cross posted from my main blog.

Stories like this one will give you a clue why the pro lifers got so hysterical against the UK doctors in the Alfie case awhile back:

from the BBC (video at link).

more here from WFSA:

MOBILE COUNTY, AL (CNN/RNN) – A boy was left brain dead after an accident while playing at a friend's house. After his parents accepted his condition and made the decision to donate his organs, the boy woke up. Trenton McKinley, 13, suffered severe brain trauma two months ago from a dune buggy accident. "I hit the concrete, and the trailer landed on top of my head. After that, I don't remember anything," Trenton told FOX10 News.

For the next several days, Trenton was brain dead and barely breathing, according to reports. "Five kids needed organs that matched him,” said his mother, Jennifer Reindl. “It was unfair to keep bringing him back because it was just damaging his organs even more."

Reindl said Trenton was dead for 15 minutes, and doctors said he would be a vegetable if he survived. Then a day before doctors were scheduled to remove him from life support, Trenton began to show signs of cognition.

Trenton said he believes he was in heaven while he was unconscious. "I was in an open field walking straight,” he said. "There's no other explanation but God. There's no other way. Even doctors said it."

several medical problems with this: was he just in a deep coma, or brain dead? The family understood he was brain dead, but then they say the doctors said he had no chance of recovery so they wanted to pull the plug: which is not the same as being brain dead.

Removing the respirator as "extraordinary" treatment is ethically permitted by the Catholic church, but he was not brain dead.

And if he wasn't brain dead, how could they remove his organs?

The dirty little secret: doctors are now allowed to do "living" donations of organs from the dying who don't meet the criteria for brain death. It is called "non brain dead" organ donation, and that is what seemed to be happening here.

The problem? the lay public doesn't know the difference, so that as more of these cases hit the news, the story of people awakening while their organs are being removed will go from an "urban legend" to reality.

Sigh.

In brain death, the entire brain is dead, including the brain stem. Remove the machines and you die.

in "Higher brain death" that is not true. You have someone who breathes on their own and sometimes even can eat if you carefully feed them.

But in this case (and in Alfie's case), there was no brain death: either the family misunderstood, or the doctors were just trying to remove the extraordinary treatment of a respirator because

a) it's expensive,
b) the family will suffer
c)even if the patient recovers he will be handicapped (aka a "vegetable")

ah, but then you have
d) look at all those wonderful organs that can save the lives of other folks.

and I left out the "but he's dying" argument, which is what these bozos argue: Sorry guys: No, he wasn't dying, but he was in danger of living and that is what the newfangled masters of the universe hate: all those with a poor quality of life becoming a burden on society.

For the elderly, there is a good argument that their many medical problems and low chance of recovery might cause them and the family not to push extraordinary care, but that is not the same as calling someone brain dead so you can harvest their organs:

In effect, this will make people less likely to not sign an organ donor card.

(and the powers that be will then change the law to mandate organ donation if you didn't have a paper saying no).

Many years ago, when bioethicist Arthur Caplan moved from Mn to PA, and he signed up for a local driver's license, he was going to check the "organ donor" box, but the clerk warned him not to do it "because then they'll let you die".

And every move to increase organ donations by moving the criteria to include more people will just make more people suspicious of doctors. (The bioethicists now want to move the diagnosis of brain dead to include "higher brain dead", i.e. you can breathe on your own and live a long time but they can declare you dead because after all you don't meet the criteria for personhood, and if they take your organs, hey, a lot of strong healthy people will live.)

I support organ donation, but because of this last trend I never had an organ donation card on my driver's license.

But since I live in the Philippines, no problem: They often have to pull the respirator after a few days because the families can't afford the bill, but they don't do "body runs" to take the patient to Manila to get the organs out.

and don't give me that argument about "but with modern medicine, many of these people who would have died now live and fill up nursing homes".

Uh no: that argument goes back to the time of Plato, guys, and many of those who thanks to modern medicine nowadays are able to hold jobs in the past would have been kept in a back room and cared for by family (or dropped off at the local monastery).

--------------------
addendum: BMJ article on the controversy, "Does it matter if the patient is not dead"and if you dig into the article you find the usual suspects pushing the criteria for taking organs and making the patient dead:

Truog and Robinson acknowledge that many patients currently diagnosed “brain dead” do not, in fact, meet the American legal requirements governing that practice. They note that many retain demonstrable brain function—and that this knowledge, which should be a challenge to those certifying death on the basis that there is no such activity—is set aside as not “significant”.1

so they are arguing against removing the organs of those meeting the criteria too?

No, actually they are arguing that since some of those who are used to donate the organs weren't really brain dead (due to misdiagnosis) so why not just move the line and just take the organs from non dead people.

. Truog and Robinson, like others before them,propose the abandonment of all obfuscation where requests for transplantable organs are concerned. They accept that “brain dead” individuals are alive. The issue then becomes: “Given that brain dead individuals are not dead, is it morally acceptable to remove their organs for transplantation?” Truog and Robinson answer “yes,” and “propose that the ethics of organ donation be based on the ethical principles of non-maleficence and respect for persons rather than on brain death and the dead donor rule”. They “propose that sometimes the harm of dying is sufficiently small that patients should be allowed to voluntarily accept that harm if it makes organ donation possible”.

italics mine.

It would be permissible to use as donors at least two classes of patients who had given prior consent: the “permanently unconscious” and the “imminently dying”.1 Ultimately, it would be up to “society” to determine the minimal threshold of lively existence below which donation would be permitted.

They suggest that organ donation from the “permanently unconscious” be limited to patients declared “brain dead” by current standards, because of uncertainty about the “capacity for consciousness” in patients in a persistent vegetative state or in anencephalic newborns.

actually, the reason is because in the early 1990s, the AMA and others put forth an argument to use anencephalic babies as organ donors, and there was a huge public outcry against it.

The time has not yet come, but give them time.

the authors of this BMJ article oppose these two bozos, and argue:

Truog and Robinson’s proposals that unpaired vital organs be removed from “brain dead” and other classes of patients can be seen as the endorsement of killing people for their organs. One difficulty with this is that once utilitarian considerations are used to justify killing ventilator dependent patients who are dying, those same considerations could also be used to justify killing non-ventilator/dependent patients or patients who are not dying.

Another major problem with doctors being involved in killing patients is that such a practice by medical professionals fundamentally distorts the nature of medicine itself.

Edmund Pellegrino and David Thomasma have developed the idea that medicine is primarily a relationship between a sick or injured person needing help and the physician or other health care provider who is trained to provide such help...

The fundamental moral problem with killing patients (as opposed to allowing them to die) is that such a practice distorts the very nature of the doctor/patient relationship, since it involves a dangerous use of medical power.

but expect a lot more pro euthanasia propaganda in the press who is eagerly pushing it, while lamenting that those dang "christians" lack compasssion (and wondering why minorities who remember Tuskegee don't sign "do not resusitate" orders or donate organs).