Monday, April 30, 2018

Brain death in the news 2

The mother of a 14-year-old boy who is currently on life support at a children’s hospital in Pennsylvania is seeking to have her son transferred back to a facility in New Jersey, where the law determining if a patient is brain-dead is not limited to neurological criteria.

Areen Chakrabarti, who has autism, has been on life support at Children’s Hospital of Philadelphia (CHOP) since a tragic house fire broke out at the family’s New Jersey home earlier this month.

He was initially taken to Capital Health in New Jersey, but was transferred to CHOP’s intensive care unit on April 15.

There, he was declared brain-dead and doctors wanted to remove him from life support. Rumpa Banerjee, the child’s mother, took the hospital to court to prevent them from doing so. On Friday, a judge granted Banerjee’s request for a temporary restraining order that prevents the hospital from removing support, granting her time to find a facility willing to take her son.

“They were about to take the life support away,” Barnerjee previously told Fox 29. “I cannot let it happen. It’s a murder. It’s a murder in my faith.”

Banerjee told Fox News that she has already faced several rejections from hospitals in Pennsylvania and New Jersey because of Areen’s critical condition. She said that while she understands that her son is trying to communicate with her, his movements are not considered “meaningful” by doctors.

She also said that initially doctors indicated that his prognosis could change as the swelling on his brain went down, but that they have since changed their stance.

“A doctor’s prediction is a doctor’s prediction — they are not his mom,” the boy’s mother told Fox News.

In Pennsylvania, a patient who is considered brain-dead can be declared legally dead, but in New Jersey, brain-dead and death can be legally separated, the family’s attorney, Christopher Bagnato, told Fox News.

New Jersey law also prohibits doctors from removing brain-dead patients from ventilators over families’ religious objections. 

Additionally, Bagnato argues that when the hospital placed the boy on life support, they acknowledged that there is some form of life to support. He said that while the boy is relying on support to breathe, his heart is still pumping, and there is blood flow, meaning he is partly alive.

He said CHOP should help facilitate a transfer to another facility.

1 comment:

  1. Take Jahi McMath first. Brain death cases are just one type or subset of medical futility dispute. Focusing just on that one type of case. In the past five years, pediatric brain death cases going to court in the United States include at least these eight cases:

    1. Jahi McMath
    2. Israel Stinson
    3. Allen Callaway
    4. Aden Hailu
    5. Isaac Lopez
    6. Mirranda Lawson
    7. Alex Pierce
    8. Areen Chakrabarti

    There are more cases if you count both young adults and adults. Furthermore, several published reports from Cleveland Clinic, San Francisco General, and other hospitals shows there are more conflicts than in the past, even if they do not escalate to court.

    Are there more cases like Alfie Evans in the United States? Yes, there have been dozens that have escalated to court, plus many more mediated through intramural mechanisms. Still, very few involve the hospital going to court for permission to withhold or withdraw life-sustaining treatment.

    First, in California, Texas, and Virginia the burden is flipped: the families must go to court to stop the clinicians. Moreover, that is a widely recommended approach at the institutional level: announce the plan and give the family time to challenge, but do not seek permission from the court.

    The consequence of the “ask for forgiveness not permission” approach is that most of the U.S. cases are unlike the UK cases. U.S. clinicians rarely seek ex ante permission. Instead, U.S. cases usually have a different posture. Either (a) families are suing for money damages after the death, or (b) families are seeking to enjoin clinicians from stopping after such a plan has already been announced. When hospitals do get ex ante consent for withholding/withdrawal they usually get consent from a guardian instead of from the parents.

    But I make these observations with a small sample size of cases. There appear to be few pediatric futility cases in U.S. courts. Why is that? I am not sure how much is (1) because clinicians are good at avoiding conflict, (2) because ethics consultants are good at resolving conflicts, (3) because clinicians cave in against their judgment, or (4) because a local county court guardianship proceeding is rarely visible or reported.