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Topic: Brain Death
January 30, 2014 | Posted By Marleen Eijkholt, PhD

When people asked my ethical opinion about Marlise Munoz’s case, the brain dead woman who was kept on support for her fetus, I believe they expected a quick answer: this is wrong. Clinical or medical ethicists are often called for a quick answer: this is right or this is wrong. However, answers about why X is right or why X is wrong do not come quickly. Often there are many rights and many wrongs in a story. My answer why it is unethical to keep Mrs Munoz on support is the result of a sum of rights and wrongs. In my opinion the ‘rights’ are less weighty than the ‘wrongs’, and I will set my arguments out below.

Marlise Munoz was 14 weeks pregnant when her husband found her unconscious and brought her to the hospital. The hospital found that she fulfilled the criteria of brain-death, but did not declare her brain death yet (according to the latest reports) . They kept her on ventilator and nutritional support and argued this was required under Texas law, suggesting that it was not allowed to withhold or withdraw life-sustaining treatment from a pregnant patient.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

January 16, 2014 | Posted By Jane Jankowski, LMSW, MS

Our society is once again grappling with the challenges presented when medical technology (e.g. mechanical ventilation) is used to sustain physiological function in the absence of brain function. How we should define death, and who should be allowed to decide, is part of a very public debate in the wake of the Jahi McMath case out of Oakland, California and the Munoz case in Texas (NY Times). Though this is hardly a new issue for bioethics, the reality is that there is a clearly a chasm between the acceptance of brain death criteria as a sufficient definition of death.

The acceptance of brain death criteria in the 1980s as a legally and medically sanctioned definition of death was established in response to the controversy surrounding the obligation to sustain a patient’s respiratory function despite the absence of any brain function. When this irreversible loss of brain function occurred it was widely agreed there was no benefit to any further medical intervention and machines could be turned off, organs harvested, and the loved ones could move forward with processing the traumatic loss.  If a patient was brain dead, this was dead enough to qualify as no longer living. What drives the resistance to this definition? That the life function of circulation of blood and a beating heart continues indeed suggests the body is still alive.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

January 10, 2014 | Posted By Wayne Shelton, PhD

The case of the 13 year-old California girl, Jahi McMath, declared brain dead following a tonsillectomy has created another media frenzy. This is truly a tragic story. Apparently Jahi underwent tonsil surgery and two other procedures on December 9, 2013 to help her better manage sleep apnea. Following the surgery she was awake but shortly thereafter went into cardiac arrest and was placed on a ventilator. By December 11, physicians made a medical determination of brain death.

From the parent’s point of view, one can only imagine the shock and disbelief they have been experiencing. Their young child went to a major medical center where highly skilled physicians were going to perform what was assumed to be relatively low risk procedures. Jahi had apparently had some worries herself about not waking up following anesthesia. Like all supportive, loving parents they assured she was in good hands and no doubt reminded her of how important it was to have these procedures done in order to deal with what could be a life threatening medical condition in sleep apnea. They fully expected she would be fine and return to normal. Instead, she is on a mechanical breathing machine, which is supporting her breathing and heartbeat, and her physicians now say she’s dead.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

January 7, 2014 | Posted By Bruce White, DO, JD

The events playing out in Children’s Hospital and Research Center Oakland as I write this blog are tragic and very sad.

On December 9, 2013, thirteen-year-old Jahi McMath underwent a complex tonsil and soft tissue surgery at Children’s Hospital. Physicians had recommended the surgery because she suffered from pediatric obstructive sleep apnea. Surgeons removed her tonsils, adenoids, uvula, soft palate, and extra sinus tissues. Her family reported that she felt fine after the surgery and even asked for a Popsicle because her throat hurt.

However a few days after the surgery, Jahi began to bleed profusely from her mouth and nose, and she subsequently suffered a cardiac arrest. She never regained consciousness after the arrest, and on December 12, 2013, her condition was such that the doctors were able to determine death by neurological criteria. When the doctors advised the family that they planned to withdraw life-sustaining medical interventions because Jahi was now dead, the family objected. At this point – as was reported by one news agency – the mother, Nailah Winkfield, said, “I just looked at the doctor to his face and I told him you better not touch her.”  

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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