Sunday, November 09, 2008

Wasting precious healthcare resources to increase the duration of an act of death

Fundamentalist Christians and Über devout Catholics aren't the only ones who challenge death by prolonging the act of dying, Hasidic Jews do the same and, sometimes, they do so for even less logical reasons than the so-called "pro-lifers" do. The latter often have an unrealistic expectation of divine intervention to bring their loved one back to life or a belief that that G-d wants their loved one to live otherwise he'd let them die of naturally. The latter, illogical, belief is similar to a current case in which the family of a 12-year old, brain-dead, cancer patient is fighting a hospital to prevent a hospital from withdrawing the invasive means of life support that keeps the boy "alive".

Though Motl Brody was declared dead earlier this week, his family is fighting discontinuation of mechanical ventilation and other medical treatment because, according to the strictest interpretation of Jewish law, death does not occur until the heart stops beating and the lungs stop breathing. It is clear the boy is clinically dead with no signs of even the most rudimentary of reflexes in response to noxious stimuli, no electrical activity in his brain and brain necrosis has started. Brody's family understands the boy will never come back to them and that his heart and lungs will cease to function but feel it is their religious obligation to use medical intervention to continue activity of these organs. According to a filing by the family's attorney, Motl
"is alive, and his family has a religious obligation to secure all necessary and appropriate medical treatment to keep him alive," MSNBC
Here's where, without being a Talmudic scholar, I can point out the Hasidic family's attempt to follow halacha is misguided at best. In this I am not questioning their understanding of halacha, I'm pointing out that they very clearly do not understand the medical intervention that continues on their dying son and how it pertains to halacha. In a nutshell, Motl's lungs have already failed and he is not breathing on his own; if there is any brainstem function to produce even minimal respiratory functioning (and that's a big if), the family should allow that brainstem function to support whatever degree of spontaneous respiration it can as well as whatever cardiac function is ongoing. As the brainstem function continues to deteriorate and/or the heart and lung cease to function without artificial means to perform the actions the organs themselves are supposed to do, the boy will die of natural causes. In refusing to withdraw the support of mechanical ventilation, the family is not helping the lungs to function, the family is using the ventilator to force air in and out of the lungs. Based on their current argument the family could, theoretically, mandate mechanical ventilation to continue even after the heart stops beating as well - the machine will continue to cause the lungs to rise and fall with inspiration and expiration until there is sufficient barotrauma that the lungs just don't move. One could use the same argument to demand hospital staff perform a sternotomy to perform manual cardiac compressions when the heart muscle is no longer able to beat on its own.

The ultra-Orthodox movements do not believe in withdrawal of life support for any reason (even a DNR is, technically, verboten). As such, if they are not willing to cease artificial life support when it is functioning to replace the organs instead of supporting the organs funtioning, they should not be permitted to use it (if man can not hasten death by any means as it is imposing his will on G-d's, I don't understand why that man would impose his will on G-d's by using artificial means to prolong life?). In this case, there is an extreme response that isn't just mandating wasteful and invasive measures to attempt to prolong life, it's mandating use of these measures to prolong the appearance of life. The idea is ridiculous as it is based on the belief that one must intervene to artificially perform the functions of the heart and/or lungs keep to mimic life because those organs are not functioning on their own. Not only is this activity inconsistent with life, it is not action consistent with halacha. It takes a willful and fearful misunderstanding of religious doctrine to mandate the battery of a patient under the auspices of keeping him alive. The family and their attorneys aren't preventing Motl's death, they're not even prolonging the time until the organs cease to function on their own - they allowing a machine create an illusion of life and calling it medical intervention to avoid letting the boy's heart come to a natural rest of its own volition.

UPDATE: As expected, Motl Brody died prior to the hearing on his case.

Tags: ; ;; ;

Sphere: Related Content

No comments: