Respectful Insolence

Yesterday, I wrote about the sad case of Motl Brody, a 12-year-old Orthodox Jew whose brain tumor had rendered him brain dead and whose parents are fighting the efforts of the hospital to disconnect him from the ventilator and to stop all the powerful cardiac drugs that are keeping his heart beating and his blood pressure high enough because their religion tells them that death is defined by cessation of heartbeat and breathing. They do not accept the concept of brain death, even though they do accept that their child will never recover.

Yale neurologist and all-around skeptical guru Steve Novella has weighed in. Definitely worth a read.

Comments

  1. #1 I am so wise
    November 13, 2008

    This is going to sound harsh, even crass, but just pull the plug already.

  2. #2 tincture
    November 13, 2008

    Doesn’t sound harsh to me. The poor kid is dead and taking up resources that could be better used for those who have a chance.

    It’s harsh for the family to tell others to get fucked because their invisible beard in the sky doesn’t think their son is technically dead.

  3. #3 provokateur
    November 13, 2008

    For all their claims to higher spirituality and morality, many religious fanatics place a hell of a lot of importance on the flesh.

    It’s just a bit of throbbing meat at this stage– nothing soulful and redolent of what made the person special in the first place is animating it. I mean, how superficial and insulting to the memory of the person to ascribe humanness to a lump of synthesised/machine pumped ‘aliveness’—disgusting!

    Deal with your grief with time not waste and insult.

  4. #4 eddie
    November 14, 2008

    Probly just waiting for the next big thunderstorm.

  5. #5 marilove
    November 14, 2008

    His brain is decomposing. He is dead. The poor nurses that have to take care of a dead child. Ugh.

    I feel for the parents, really, but he’s dead and the hospital shouldn’t be made to care for DEAD people.

  6. #6 Danimal
    November 14, 2008

    A simple solution would be to transfer his heart to someone who needs it, thus the boy could potentially live much, much, longer.

  7. #7 Donna B.
    November 14, 2008

    The flip side of when life begins.

  8. #8 Samantha Vimes
    November 15, 2008

    Ugh. They are keeping a tumor on life support.

    Also, I’d complain about them using electrical equipment on him on the Sabbath, but all rules are suspended to save a human life. But what they are keeping alive is the tumor that’s killed their son. I may have a nightmare about that.

  9. #9 Graculus
    November 15, 2008

    I am given to understand that the parents are fully cognizant of the fact that their child is dead, but that their dogma requires this course of action. Which makes this doubly stupid.

  10. #10 Danimal
    November 16, 2008

    Remembering the death of your dog. One of my best friends died last night. JeffW 09-12-1961 until 11-15-2008. RIP.

  11. #11 Gingerbaker
    November 16, 2008

    I’ll be contrarian. And rather brusque, I apologize.

    Allowing patients to have control over their medical destinies is a good thing, although that sometimes means that bad decisions will be made.

    Here a bad decision is being made because of religious reasons. As much as I dislike religion and the bad decisions it inspires, if we are going to allow religious freedom in this country, we must respect the family’s choice.

    The article by Mr Novella states that the patient is effectively dead for all medical purposes. He also makes the point that the longer the patient stays on the floor consuming resources, the less money is available for the next patient.

    OK, here is my point. The poor patient is medically dead. That his body is consuming health care dollars at an alarming pace is a hospital record keeping problem. Really, the machines sustaining his corpse are consuming electricity. The hospital should not be charging ICU rates to power some machines. There are no longer any critical medical issues with this patient.

    The corpse should be moved out of the ICU, absolutely minimal nursing care should be assigned to the case, and the hospital should stop billing the insurance company as if an actual patient was being treated.

  12. #12 JonnyMo
    November 16, 2008

    According to the Yeshiva World News, Motl Brody has died.

    http://www.theyeshivaworld.com/article.php?s=motl+brody

  13. #13 AnnR
    November 16, 2008

    That article is interesting, an earlier posts ask followers to stop with the email/phone campaign as it might result in “Chillul HaShem” Looking that up it’s dishonor to God’s name.

    I’m kind of impressed. I feel like that indicates a certain tolerance in a group I wouldn’t have chalked any tolerance to. Is it indicative that although the group is fundamentalist that they accept others feel differently or just a sort of paranoid feeling that too much protest will have bad results?

  14. #14 DuWayne
    November 16, 2008

    Just read your first post on this and commented, have a follow up after reading Steve Novella’s post on it.

    I really appreciate his take on it, as I think it would be very helpful for those trying to let go. Taking the decision out of their hands, would make the whole process much easier to handle. Sure, there are certainly going to be folks who will have a conniption about it, not sure that I wouldn’t were it one of mine being disconnected. But ultimately it brings the closure without putting parents through the agony of saying, “all right, shut it off.” As rational as I like to think I am, I am not sure I could ever utter those words.

    Gingerbaker -

    In all honesty, I am all about getting rid of a lot of religious exemptions. And if you read Orac’s post and Steve’s, plus the comments, it is clear that removing him from the ICU isn’t an effective solution. It would effectively be removing him from the lifesupport that is sustaining him.

    …and the hospital should stop billing the insurance company as if an actual patient was being treated.

    Even given the possibility of removing him from ICU, why the hell should the hospital do anything more for free? Not seeing the logic there. While I can see the insurance company having a case for raising holy hell about the billing, that should be between the insurance company, hospital billing and the family. Hospitals don’t generally provide care for free, excepting for indigent patients. Even then, they generally bill a fund that is set aside for providing such care.

  15. #15 Gingerbaker
    November 17, 2008

    “Even given the possibility of removing him from ICU, why the hell should the hospital do anything more for free? Not seeing the logic there”

    I’m not saying the hospital should treat him for free, but an ICU bed can cost $20K a day, and the hospitals true cost at this point is pennies a day for electricity.

    If we can stop $20K a day worth of unnecessary charges going to the insurance company, the argument of Novella that this life should be preempted by the hospital because of monetary reasons goes away.

    I also have a real problem with any doctor making the argument that the hospital has a right to end life-sustaining treatment of a patient due to downstream economic considerations, given that the AMA, IIRC, opposes single payer government health care which would basically cut per patient costs in half.

  16. #16 Scott
    November 17, 2008

    Gingerbaker, you should read more about what kind of care is involved here. It’s not just the electricity to run the machines. (Wear and tear maintenance issues are an obvious additional cost along those lines, but even that isn’t the big one.) He (was) on a bunch of drugs, being monitored full-time by highly trained personnel, and quite a few more things I can’t immediately recall.

    It’s an exceptionally expensive proposition. (And single-payer health care is no magic bullet; it’s not like it would instantly cut costs in half with no work. There’s FAR more to it than that.)

  17. #17 Gingerbaker
    November 17, 2008

    Scott

    I am sure you are right about various costs involved with the patient. I am not a doctor I can make no informed evaluations about the costs.

    It just seemed to me that if the patient is dead, as defined by the hospital, there would be no need to charge ICU prices.

    The issue here, it seems to me, is not about religious exceptionalism, it is the ethics of terminating life based upon an assumption that funding is so limited that the hospital has a moral right to contravene bad patient DNR decisions.

    I have real questions about the ethical premises of this assumption.

    I do not agree that there is a finite amount of health care money available in the U.S. I am really quite sick and tired of seeing hospital personnel (and yes, I mean especially doctors) acting as insurance company representatives, doing their mighty best to quell costs, even if that means terminating patients against their family’s wishes.

    Doctors should be advocates for their patients, not for insurance companies. The concept that docs must be responsible gatekeepers, because there only is only “so much money to go around” to pay for the medical care of patients is IMO…. bullshit.

    Yes, I can hear the keyboards rattling away now – such an idea is not informed upon the realities of today’s marketplace. Still I say bullshit.

    Doctors have been brainwashed into being the walking, talking automatons for the insurance industry. Every decision they make is under the penumbra of “responsible” stewardship of finances, their “duty” is to reduce the costs of health care by careful,sage outcomes-based analyses. And on it goes. They have lost their way, but it is understandable.

    They must fight for every penny of compensation they receive – just as if there actually IS a finite amount of health care funding available. They must fight for the right for their patients to receive needed tests and therapies – just as if there actually IS a finite amount of health care funding available.

    More than a decade of this instruction at the hands of the insurance industry has taught them something very perverted: That it is in everyone’s best interest if doctors restrict medical treatment of their patients to save (the insurance industry’s) money.

    And yet, the AMA is against single-payer!

    A recent report showed that of the $1.2 trillion we spend on health care in the U.S., half of it is money misspent. And the lions share of that misspent money is because we do not have single-payer. $400 billion in administrative savings will pay for all the Motl Brodys and quite a bit more. Not enough money to pay for health care indeed!

    The health care budget of this country is what we decide it is, not what the insurance industry says it is, or what the military-industrial complex demands it can NOT be.

    How can we even suffer the mere pretext that a discussion about the right of a hospital to prematurely terminate a patient’s care is an ETHICAL act when the AMA is against single-payer and when hospital administrators and some surgeons earn millions?

  18. #18 dlnevins
    November 17, 2008

    Gingerbaker, reducing expenses by minimizing administrative costs is only one of the ways single-payer health care systems keep costs under control. The other way is by rationing care based on its medical effectiveness (rather than by the way we do it, based on patients’ ability to pay). The whole Motl Brady situation simply wouldn’t arise in any other country’s single-payer system precisely because the patient’s family would never be offered the opportunity to select such futile care. In a single-payer system, patients don’t get to demand medically unnecessary things unless they can pay for those things by themselves – and high-tech care for a corpse is about as medically unnecessary as it gets.

  19. #19 DuWayne
    November 17, 2008

    Gingerbaker -

    I also have a real problem with any doctor making the argument that the hospital has a right to end life-sustaining treatment of a patient due to downstream economic considerations…

    What life sustaining measures? The kid was already dead. What exactly is the point of spending anything to keep his corpse breathing?

    And the AMA’s position on single payer is irrelevant. Honestly, there is little reason to assume that single payer is going to cut costs for care in half. Don’t get me wrong, I am a huge advocate for UHC, I just see way too many problems with single payer.

    And as a strong advocate for UHC, I would much prefer to see this kind of bullshit end. This is a part of why our health care costs so much and should never fly under taxpayer funded health care

  20. #20 Gingerbaker
    November 20, 2008

    dlnevins said:

    “The whole Motl Brady situation simply wouldn’t arise in any other country’s single-payer system precisely because the patient’s family would never be offered the opportunity to select such futile care”

    That’s a good point, if it is true.

    This is a very unusual and rare case.

    One usually does not see an argument on whether a medical definition of death supercedes a religious one, and I doubt that any hospital would care to explore that in court under any payment scheme.

  21. #21 Gingerbaker
    November 20, 2008

    DuWayne said:

    “What exactly is the point of spending anything to keep his corpse breathing?”

    Medically – nothing. As I said, it is a bad DNR decision. But…

    If we are going to still allow patients the autonomy to direct their own medical care, then we sometimes have to allow them to make bad decisions.

    Also, I do not think anyone wants the State to have the power to prematurely terminate the life of anyone without the family’s permission. And in most cases, by simply refusing to pay for such life-sustaining care, the State would effectively be ending the patient’s life.

    This case is very unusual and rare. Plus, the actual costs needed to sustain the poor boy’s corpse is much less than the hospital billing department was charging – accommodations could have been made.

    My point here is the vicissitudes of this case should not be framed as balancing the family’s needs vs the economic needs of society. The U.S. can afford to pay for cases like this, and could afford even more if we went single payer.

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