Difficult Decisions

August 9, 2014

Saturday, August 9, 2014

Good morning again:

I write to recommend two important articles that offer considerable food for thought and discussion.

The first is an article in Slate titled, White People Are Fine With Laws That Harm Blacks. The author, Jamelle Bouie, discusses a new study

When I want to emphasize a point on criminal justice reform, I lead with the data. There are huge racial gaps in arrests, convictions, and sentences. I’m shocked by the statistics and assume that’s also true of readers.

But according to a new study from Stanford University psychologists Rebecca C. Hetey and Jennifer L. Eberhardt, the stats-first approach to issues of race and incarceration isn’t effective—in fact, it’s potentially counterproductive.

Yes, indeed, that’s what the researchers discovered. Their findings show that racial bias gets worse when whites see evidence of racism.

The second article is by Andrew Pollack in today’s New York Times: Ebola Drug Could Save a Few Lives. But Whose?

This article discusses the ethical issues involved in deciding who should receive dosages of new drugs developed to treat Ebola. Only a few dosages of two new drugs are available and the drugs have not been approved for use in treating Ebola. Whether they will prove to be effective is unknown. The two Americans recently transported to Emory University Hospital have received dosages and appear to be improving, which may or may not be due to the drug, and the decision to treat the Americans rather than Africans has been criticised.

Some of the difficult questions are:

Are the drugs safe to take?

Do they work?

Given the extremely limited supply, who should get the drugs”

Americans or Africans?

Health care providers or patients?

Newly infected or patients in advanced stages of the disease?

Young or old?

Warning: Due to a series of recent events we will be moving to a new community, which as yet is undetermined. We will continue to post articles as time permits, but we definitely will not be able to post daily. We will do the best we can, even if it’s only a drive-by to post an open thread.

Thank you for your patience.


Unplug Marlise Munoz from corpse support immediately

January 16, 2014

Thursday, January 16, 2014

Good afternoon:

I cannot stop pondering the ethical dilemma created by doctors keeping Marlise Munoz’s decomposing corpse on a ventilator so that the fetus in her womb can reach full term and be birthed into this world.

Since the beginning of our species approximately 200,000 years ago, pregnant women have died and will continue to die. That reality is not going to change, although the percentage of pregnant women who die probably will decline over time. Until relatively recently, the fetus perished with the mother, unless someone removed it with forceps or cut it out of the dead or dying mother’s body and it had developed sufficiently to survive on its own.

Our technology has created an ethical dilemma.

We used to define death as the cessation of a beating heart. We declared a person dead, if they had no pulse and we could not restart their heart.

If we could restart their heart, we could keep them “alive” pursuant to that definition, even if they did not regain consciousness, such as might be the case with someone in a coma.

We have changed our definition of death because our technology has rendered it obsolete.

We have intravenous lines to provide plasma and feeding tubes to provide nourishment.

Liquid waste can be removed with catheters.

Nurses and their aides can clean-up solid waste and re-position a patient to prevent bed sores and skin ulcers.

Ventilators can oxygenate the blood and eliminate carbon dioxide from it by inflating and deflating the lungs with air and a beating heart will circulate the oxygenated blood.

We can do all of these things to keep someone alive, pursuant to that definition, even if they never regain consciousness.

However, in what sense is a person alive, if he or she is unconscious and brain dead, an irreversible condition in which there is no detectable brain activity and no possibility of regaining consciousness?

Rene Descartes answered the question in his Principles of Philosophy, published in 1644:

Cogito ergo sum: I think, therefore, I am.

We have redefined death as the cessation of brain activity. Indeed, without the assistance of a ventilator, a brain-dead person’s heart would soon stop beating and they would be declared dead pursuant to the old definition. For that reason, doctors have decided that it’s unethical to keep a brain-dead body on a ventilator. Expressed another way, it’s unethical to keep a corpse attached to life support equipment.

The ethical question is whether we should make an exception to that rule when a pregnant woman dies?

I propose two simple rules:

(1) Always disconnect a corpse from life support equipment; and

(2) Remove the fetus from the corpse, if it is reasonably capable of surviving outside the womb, given the state of medical technology. (I am thinking of premature births and hospital nurseries)

I would disconnect Marlise Munoz from life support immediately and I would not remove the fetus from her womb because it is not reasonably capable of surviving outside the womb, given the state of medical technology.

Marlise Munoz is a corpse, not a person.

A corpse cannot be a patient.

Her unborn child is a fetus, not a person, it has no cognizable right to life, and it certainly cannot viably survive outside the womb. See Roe v. Wade, 410 U.S. 113 (1973).

The Texas statute upon which the hospital relies in refusing to disconnect her suffers from the same infirmity as the Texas statute criminalizing abortion that the United States Supreme Court struck down in Roe v. Wade because it prohibits the hospital from disconnecting any pregnant woman from life saving equipment, regardless of the viability of the fetus to survive on its own outside the womb. The statute also impermissibly requires a doctor to violate an ethical rule of the medical profession, which is much better suited to establish its own ethical rules than the Texas Legislature, which has no business criminalizing ethical medical conduct.

Since Marlise Munoz is brain dead, we can infer that the fetus was deprived of oxygenated blood for at least 6 minutes. I don’t know how that might have affected a 14-week old fetus. Just because its heart is beating normally, however, does not mean it’s okay and it certainly cannot viably survive outside the womb, a principle concern in Roe v. Wade.

This ghoulish situation reminds me of horror plots such as Mary Shelley’s Frankenstein, George Romero’s Night of the Living Dead, Ira Levin’s Rosemary’s Baby, Stephen King’s Pet Cemetery and their various progeny.

Our technology has outdistanced our wisdom.

A baby coming into existence by feeding on its mother’s corpse makes me shudder with revulsion.

Some things are not meant to be.


This is our 855th post in 26 months. We work hard to support our readers with informative and well written articles on a variety of subjects, some legal and some not.

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Ethics of keeping brain-dead pregnant woman on life support

January 15, 2014

Wednesday, January 15, 2014

Good afternoon:

How can it be unethical to keep a brain-dead woman on life support but unlawful to disconnect a brain-dead pregnant woman from life support when both women are medically dead?

Erick Munoz filed a lawsuit yesterday against the John Peter Smith Hospital in Tarrant County, TX (Fort Worth) seeking an order directing the hospital to disconnect his brain-dead wife, Marlise Munoz, from life support. Under ordinary circumstances, he would not have had to file the lawsuit because the hospital would have disconnected her. These are not ordinary circumstances, however, because she was 14 weeks pregnant when she died and the hospital is claiming that it is prohibited by law from disconnecting her.

Section 166.049 of the Texas Health and Safety Code provides in pertinent part:

A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.

Marjorie Owens, WFFA-TV, Dallas-Fort Worth has the story:

On the morning of Nov. 26, Munoz found his wife unconscious on the floor of the couple’s kitchen. Munoz said later that day he was told by doctors at John Peter Smith Hospital that his wife — who was 14 weeks pregnant with the couple’s second child — was brain dead.

Doctors told her family they suspect she suffered a pulmonary embolism.

Since then, Munoz has been in a battle with the hospital to remove his wife from life support. While tests on his wife’s fetus show a normal heartbeat, Munoz said it was against his wife’s wishes to be kept alive by a machine.

Doctors cannot determine the medical condition of the fetus until it reaches 24 weeks (it’s now at 18 weeks).

He argues that she is not a “pregnant patient” because she is clinically dead and he fears the health of the fetus was compromised by her death.

I agree.

Keeping a clinically dead woman’s lungs functioning on a ventilator so that a fetus can be brought to term in a decomposing body is too ghoulish to consider, except in Texas apparently, which ironically takes pride in executing people sentenced to death, including at least one wrongfully convicted innocent person.

This case reminds me of Jahi McMath, the 13-year-old brain-dead girl who died following surgery to correct sleep apnea by removing her tonsils, adenoids and other sinus tissue obstructing her airway. McMath was not pregnant, of course, and the hospital insisted on disconnecting her from life support over the strenuous objections of her mother, who went to court and obtained a temporary order that stopped the hospital long enough for the mother to find a place that would care for her daughter.

The hospital took the position that absence of brain activity constitutes “death” because there is no conscious awareness and the condition is irreversible. Therefore, the medical staff was ethically required to disconnect her from life support. Although the hospital initially objected to the transfer on ethical grounds, it relented and withdrew its objection conditioned on the coroner issuing a death certificate and serving as a paper middleman accepting possession of the body from the hospital and immediately transferring it to the mother who signed a document accepting full responsibility for whatever happened thereafter.

Meanwhile, Jahi’s brain is liquefying and her body is slowly decomposing on a life support machine at an undisclosed location.

These two tragic cases illustrate the importance of giving some careful thought to our own eventual death while we are “of sound mind and body.” I am referring to preparing a written “living will” that expresses our intent with regard to what we want or do not want done to us while we are alive, but unconscious and unable to communicate. For example, do we want to be resuscitated? A DNR order is an order saying do not resuscitate me.

I am not going to advise anyone about what to put in a living will. That’s for you to figure out. There may be legal requirements that have to be satisfied in your jurisdiction to have a valid living will, so you should consult a lawyer before you make one.

No discussion of end-of-life issues is complete without discussing assisted suicide.

Three states (Vermont, Oregon and Washington) have passed laws permitting physician assisted suicide. One state (Montana) has legalized physician assisted suicide by a court decision. Physician assisted suicide is unlawful in the rest of the states and the District of Columbia.

I believe every person has an inherent right as a conscious organic life form to a humane means of assisted suicide.

The issue that inevitably arises is how should we deal with the eligibility issue?

Should we ignore it?

Must a person be at least a certain age before they are eligible?

How about mental competence? Must they be competent to make the decision? Who decides? According to what standard?

Can someone else, such as a husband or a wife or a family member, make the decision for an incompetent person? For example, someone on life support or someone suffering from dementia or Alzheimer’s?

Should a change-your-mind minimum period for reflection be mandatory?

What about seeing a counselor?

If counseling is required, what qualifications must a person have to become certified as an assisted-suicide counselor?

Should religious counseling be part of the process?

What about the process itself? Big party first? Should hallucinogens be a part of the process? What about choosing among a number options? Cost?

What about starting a business that specializes in helping people plan their demise and the ethics of creating legally enforceable contracts with monetary damages for changing your mind?

And so on.

What do you think?

For more information on assisted suicide and euthanasia, go here.


This is our 853rd post in 26 months. Yesterday, we had 650 visitors, over 1500 page views and only one donation.


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