Tag: determination of death

Bioethics Blogs

California Attack on Brain Death Law (Israel Stinson)

The Israel Stinson case now looks a lot like the Jahi McMath case.  

In a recently filed amended complaint against the State of California the family alleges:

“26. Ms. Fonseca has knowledge of other patients who had been diagnosed as brain dead, using the same criteria as in her son’s case. In some of those cases, where the decision makers were encouraged to consent to the withdrawal of life support, the patients emerged from legal brain death to where they had cognitive ability and some even fully recovering. Such cases are fully medically documented.”

“38.  Despite an official determination that Israel Stinson is dead, the child has shown movement in direct response to the voice and touch of his mother.”

“39.  Since the issuance of the Certificate of Death, three physicians, independent of Kaiser and UC Davis, have given their medical judgment that this child is in fact alive.”

“45. As of the filing of this Second Amended Complaint the child is increasingly having more purposeful movements. In addition to the prior movements that he had at Kaiser in April, he now moves his arms, hands, legs and toes. Further, these movements are not random. They occur primarily in response to voices and music. A song that the child knows was played. He begins to move at the sound of the music.”

“49. Plaintiff is informed and believes and thereon alleges that the definition of death is fallacious. In essence, the presupposition is that the cessation of all functions of the entire brain – including the brain stem – is per se irreversible. However, Plaintiff is informed and believes and thereon alleges that brain waves return in rare cases after having disappeared.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Legal Standards for Brain Death under Attack

My new article, “Legal Standards for Brain Death” was just published in the Journal of Bioethical Inquiry, 13(2), 173-178 (2016).

A major appellate court decision from  the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by neurological criteria. There may be a mismatch between legal and medical standards for  brain death, requiring the amendment of either or both.

The Digital Object Identifier (DOI) is 10.1007/s11673-016-9718-0.  The URL is http://link.springer.com/article/10.1007/s11673-016-9718-0.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Jahi McMath – Amicus Brief from 4 Medical Associations

The Jahi McMath state medical malpractice action remains on appeal.  The medical defendants want the Court of Appeals to reverse the trial court’s denial of their demurrers to the first amended complaint.  They do not want the McMath family to have even the opportunity to prove that Jahi is now alive. 


Last month, an amicus brief was filed on behalf of the California Medical Association, California Dental Association, California Hospital Association, and the American Medical Association.  They argue that they have:

“a strong interest in correcting the Superior Court’s decision allowing collateral attack of a determination of brain death, because it undermines the determination of death and brain death
that is accepted within the medical community, incorporated into the law, and routinely relied on by healthcare professionals.

“The determination of brain death must be conclusive, at least as to providers and facilities involved in McMath’s care, and the family certainly should not be permitted to attack that adjudicated fact under the auspices of a personal injury lawsuit. Everyone involved must be afforded finality and confidence that, years later, they can rely on a final court order and judgment determining that McMath’s brain ceased to function in December 2013.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

US District Court Rejects Attack on Brain Death

US District Judge Kimberly J. Mueller

On Friday, the US District Court for the Eastern District of California issued a clearly written and cogent decision in Fonseca v. Kaiser, upholding the California Uniform Determination of Death Act.

The court “recognized the unease with which some regard brain death.”  But, on balance, the court found that “a professional doubt surrounding brain death as death, legally or medically, represents a minority position.”

Three times, Israel Stinson was diagnosed as dead.  Consequently, Kaiser clinicians want to stop physiological support.  Various court orders have already delayed them for nearly a month.  But time is now running out.

The court found that the family’s claims lacked sufficient merit to grant a preliminary injunction.  The court stayed its decision for a week.  And the family will probably get another few weeks as they appeal to (and probably ultimately lose before) the US Court of Appeals for the Ninth Circuit.

The court determined that the family’s constitutional substantive and procedural due process claims were unlikely to succeed.  The CUDDA is a rational law supported by lots of valid policy objectives.  Moreover, such claims are not properly stated against Kaiser and its physician in any case, since they are not “state actors.”

The court also determined that the sole statutory claim (that could be asserted against Kaiser) lacked merit, since EMTALA does not apply to inpatients.  

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In The Journals – April Part II by Michelle Pentecost

Another set of great papers from the journals in April. Enjoy!

 

 Social Science & Medicine

‘I knew before I was told’: Breaches, cues and clues in the diagnostic assemblage

 Louise Locock, Sarah Nettleton, Susan Kirkpatrick, Sara Ryan and Sue Ziebland

Diagnosis can be both a ‘diagnostic moment’, but also a process over time. This paper uses secondary analysis of narrative interviews on ovarian cancer, antenatal screening and motor neurone disease to explore how people relate assembling procedural, spatial and interactional evidence before the formal diagnostic moment. We offer the idea of a diagnostic assemblage to capture the ways in which individuals connect to and re-order signs and events that come to be associated with their bodies. Building on the empirical work of Poole and Lyne (2000) in the field of breast cancer diagnosis, we identify how patients describe being alerted to their diagnosis, either through ‘clues’ they report picking up (often inadvertently) or through ‘cues’, perceived as a more intentional prompt given by a health professional, or an organisational process. For patients, these clues frequently represent a breach in the expected order of their encounter with healthcare. Even seemingly mundane episodes or behaviours take on meanings which health professionals may not themselves anticipate. Our findings speak to an emergent body of work demonstrating that experiences of formal healthcare during the lead-up to diagnosis shape patients’ expectations, degree of trust in professionals, and even health outcomes.

 

Socio-economic divergence in public opinions about preventive obesity regulations: Is the purpose to ‘make some things cheaper, more affordable’ or to ‘help them get over their own ignorance’?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Brain Death Case – Kaiser Continues to “Treat” Israel Stinson

The U.S. District Court for the Eastern District of California has extended the
TRO mandating Kaiser to “treat” Israel Stinson until May 11.  That is the day scheduled for a hearing on the preliminary injunction.


Dr. Chris Palkowski, chief of staff at Kaiser Permanente Roseville Medical Center, issued the following statement on Monday’s court hearing.  (HT Fox40)


“Our hearts go out to this family as they cope with the irreversible brain death of their son, and we continue to offer our support and compassion to them. We will continue to comply with orders issued by the Federal court.”


“Last week, the California Superior Court ruled that Kaiser Permanente Roseville complied with all state requirements (under California Health and Safety Code 7180 and 7181) that specify what steps physicians and hospitals must take to determine brain death. Israel’s parents asked the California Superior Court to rule that Kaiser Permanente’s procedures for determining brain death did not comply with the law. The Court ruled that Kaiser Permanente fully complied with the state law. The Court also ruled that Kaiser Permanente fully satisfied the law’s requirement that a hospital provide a reasonable amount of time after determining brain death, to allow the family to come together.”


“California’s law is modeled on one that has been adopted in nearly all the states in the nation. It’s called the Uniform Determination of Death Act and applies to all, regardless of religion. At Monday’s hearing, the family asked the Federal Court to challenge this California law, and rule that federal law provides an exception in the case of a religious belief that brain death does not exist.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Bioquark Questions Irreversibility of Brain Death

Bioquark claims that death may not be irreversible.

The mission of the ReAnima Project is to focus on clinical research in subjects who have recently met the Uniform Determination of Death Act criteria, but who are still on cardio-pulmonary support.

The project has an “ultimate goal of inducing epimorphic, intercalary, regenerative and remodeling events that can begin to restore central nervous system form and function.”  (Daily Mail)

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

(New) Legal Standards for Brain Death

My latest article on brain death is now available from Journal of Bioethical Inquiry.

A major appellate court decision from the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by ne…

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Everybody’s a winner when euthanasia combines with organ donation, say doctors

Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance.

The authors stress that euthanasia is not a cure-all for the organ shortage. Most euthanasia patients suffer from cancer, which is a contraindication for organ transplantation. However, 25 to 30% of them do not, so there is obviously a real possibility of expanding the supply.

Furthermore, the authors say, public perception of this formerly abhorrent practice is increasingly positive:

“transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.”

Ethically, the procedure is basically uncontroversial as long as the patient is not pressured to donate, they contend.

“In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient’s wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The History of Bioethics Series – National Bioethics Commissions

This is the first post in our “History of Bioethics” series in which we will examine some of the seminal events that shaped the landscape of bioethics and its practice in the world today. This first blog will focus on the creation of the national bioethics advisory bodies in the United States and their different iterations throughout the years.

 
The current advisory group, the Presidential Commission for the Study of Bioethical Issues, established by a 2009 Executive Order from President Barack Obama, continues the more than 40-year history of bodies established by the President or Congress to provide expert advice on topics related to bioethics. These groups have differed in their composition, methods, and areas of focus, yet they all have shared share a common goal – to promote the careful examination and analysis of ethical considerations that underlie our nation’s activities in science, medicine, and technology.
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-78) is generally viewed as the first national bioethics commission. Established as part of the 1974 National Research Act, the National Commission is best known for the development of the Belmont Report, a document that laid out the ethical principles and guidelines for research involving human subjects. This document has been used as a basis for further federal regulations in the area of human subjects protections.

 
The Presidential Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1978-83), also established by Congress, produced reports on foregoing life-sustaining treatment and access to health care, among other topics.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.