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Author Topic: This disturbed me  (Read 8938 times)

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Offline Pumpkin Seeds

Re: This disturbed me
« Reply #350 on: January 27, 2014, 07:35:00 AM »
Two months ago the hospital believed that because she was pregnant the physicians and hospital were mandated by Texas state law to keep her on life support.  No physician in their right mind is going to declare someone dead if that declaration could have them facing criminal prosecution for double homicide.

Offline Sabby

Re: This disturbed me
« Reply #351 on: January 27, 2014, 07:38:14 AM »
I'm confused, doesn't the law say that life support can't be turned off for a pregnant woman? What does that have to do with declaring the woman dead?
« Last Edit: January 27, 2014, 07:40:57 AM by Sabby »

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #352 on: January 27, 2014, 07:44:33 AM »
If she is declared dead, then legally she cannot be a patient and cannot be given care.  Nurses and doctors do not care for dead people.

Offline Sabby

Re: This disturbed me
« Reply #353 on: January 27, 2014, 07:48:29 AM »
Okay, were the doctors in question supposed to pronounce a patient dead if they were braindead?

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #354 on: January 27, 2014, 07:49:17 AM »
The criteria allows them to do so, but if Texas law says that they cannot withdraw life support from a pregnant woman than they are not able to declare her dead because then care would have to be withdrawn.  A physician does not have to declare anyone dead.  So once more if a lawyer told the physician that by declaring this woman dead he would be in violation of Texas State Law and possible face criminal prosecution for double homicide, there isn't a doctor I can think of that would make that pronouncement. 
« Last Edit: January 27, 2014, 07:52:28 AM by Pumpkin Seeds »

Offline Sabby

Re: This disturbed me
« Reply #355 on: January 27, 2014, 08:03:54 AM »
So it's a case with two conflicting laws. What are they supposed to do in such a situation?

Online Oniya

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Re: This disturbed me
« Reply #356 on: January 27, 2014, 08:13:27 AM »
So it's a case with two conflicting laws. What are they supposed to do in such a situation?

There's a term in law called  'reversible error' - which means 'mistakes which can be undone'.  As ghoulish as the 'can't withdraw care' law made it, the hospital took the path with reversible error, rather than the path with irreversible error.  They erred by keeping her on the machine, but they could (and did) correct that error when the judge declared them in error.  If they had taken her off life support and then got taken to court (which the victim's family doesn't always have a say in), then they couldn't 'correct' that error.

Offline Sabby

Re: This disturbed me
« Reply #357 on: January 27, 2014, 08:15:40 AM »
What were they doing in the two months after their choice? Are they supposed to convene their ethics board, or were they actually waiting on a Judge to step in?

Offline vtboy

Re: This disturbed me
« Reply #358 on: January 27, 2014, 08:24:16 AM »
Two months ago the hospital believed that because she was pregnant the physicians and hospital were mandated by Texas state law to keep her on life support.  No physician in their right mind is going to declare someone dead if that declaration could have them facing criminal prosecution for double homicide.

Pumpkin, did you read the Texas death statute to which you posted a link the other day? Section 671.002 is a "safe harbor" provision which immunizes physicians who, following ordinary standards of medical practice, have declared death based on an irreversible cessation of spontaneous brain activity.

You seem to be contending, in this and in subsequent posts, that even though Ms. Munoz apparently satisfied all clinical standards for brain death, the law required, on pain of criminal prosecution for double homicide, that her physicians not acknowledge the fact, because the law would then have mandated action which would have terminated the pregnancy.

If this was the hospital's reasoning, doesn't it strike you as at least a trifle bizarre?
« Last Edit: January 27, 2014, 08:27:00 AM by vtboy »

Online Oniya

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Re: This disturbed me
« Reply #359 on: January 27, 2014, 08:24:49 AM »
What were they doing in the two months after their choice? Are they supposed to convene their ethics board, or were they actually waiting on a Judge to step in?

I think that's probably when the lawyers on both sides were wrangling over it.  Those things take longer than you'd think.

Offline consortium11

Re: This disturbed me
« Reply #360 on: January 27, 2014, 08:26:29 AM »
Why thank you.  And they all said I was wasting my Saturday afternoons watching the game and it would never be useful.  I can also name the grounds of every league team and all 23 suffixes.

In case anyone (Oniya) cares
Albion, Alexandra, Argyle, Athletic, Bournemouth, City, County, Dons, End, Forest, Hotspurs, Orient, Palace, Rangers, Redbridge, Rovers, Stanley, Town, United, Vale, Villa, Wanderers, Wednesday

Off-topic pedants note:

I'm not sure "Stanley" quite counts as a suffix; the original Accrington Stanley began their life as Stanley Villa (as they were based on Stanley Road in Accrington and took on the "Accrington Stanley" name when the first Accrington Stanley left the league in 1893. Thus Accrington Stanley is a description of where they were based rather than a suffix; it's similar to Arsenal (originally Royal/Woolwich Arsenal) having their name because they were based and formed of workers from the Royal Arsenal.

Likewise Dagenham & Redbridge have their name because they're the amalgamation of Dagenham FC and Redbridge Forrest. Redbridge Forrest were based in Redbridge and so if we include them then all clubs with double barrel names indicating places are now suffixes; thus "Hove Albion" rather than simply "Albion" would be the suffix for the team in Brighton.

Even more pedantically, I'm not sure "Vale" counts as a suffix (at least for Port Vale). To take the original story the club sticks to, it's name comes from the fact it was formed at "Port Vale house" and even if it doesn't, as "port" isn't a geographical place, the "vale" isn't really a suffix as it doesn't alter the previous word; it's simply their name.

Going even deeper into pedantry, "Bournmouth" may not count; "AFC Bournmouth" is a trade name, with the club being registered as Bournemouth and Boscombe Athletic Football Club.

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Re: This disturbed me
« Reply #361 on: January 27, 2014, 08:35:23 AM »
[OT stuff]

First thing that came to my mind was that I didn't see the Lilywhites on there.  (The only team whose flags I remember seeing when Mr. Oniya and I toured the UK on our honeymoon in 1998.  Yes, I know they're Irish.)

Offline vtboy

Re: This disturbed me
« Reply #362 on: January 27, 2014, 08:46:34 AM »
I think that's probably when the lawyers on both sides were wrangling over it.  Those things take longer than you'd think.

I can understand the hospital's reasons for not taking Ms. Munoz off life support. But, that does not excuse its gamesmanship with respect to her death.

I would have respected the hospital, though disagreed with it, if it had said, in effect, "The law is not entirely clear as to whether we may shut off life support to a pregnant but brain dead body, so we are going to keep Ms. Munoz's lungs breathing and her heart pumping until her fetus either is delivered or dies."

But, that is not what the hospital said. Instead, it refused to acknowledge Ms. Munoz's death, a matter which would have been entirely uncontroversial but for her pregnancy. And, it did this precisely because it apparently understood that, being dead, Ms. Munoz would no longer be a "patient" within the ambit of the AD's prohibition against cutting off life support to pregnant "patients".

Tampering with the facts like this goes well beyond legal prudence and good bioethics. What the hospital did here was truly shameful. If its directors and staff think the AD's prohibition should be broadened to include dead, pregnant bodies, they should petition the Legislature to change it. I am sure it would not prove difficult to find many like minds among Texas's lawmakers.   

Offline consortium11

Re: This disturbed me
« Reply #363 on: January 27, 2014, 09:03:52 AM »
[OT stuff]

First thing that came to my mind was that I didn't see the Lilywhites on there.  (The only team whose flags I remember seeing when Mr. Oniya and I toured the UK on our honeymoon in 1998.  Yes, I know they're Irish.)

Yet more Off-Topic chat
Lilywhites as in Dundalk F.C (the only Irish team I'm aware of with that name)? As far as I know that's a nickname rather than a suffix... I can think of probably just under a dozen football teams with that as at least one of their nicknames.

If you're willing to look at non-league then a whole bunch of others rear up; Spartans, Celtic (as in Farsley), Motors... although that runs into the issue with Port Vale... Harriers, Victoria and I'm sure a bunch of others as well.

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #364 on: January 27, 2014, 12:18:56 PM »
The hospital did not ignore her condition.  According to the family the hospital did acknowledge her brain death, but once again a hospital cannot declare someone deceased and then continue to provide care.  The physician has declared the patient brain dead, but has not announced death because the patient is on life support.  Once the physician declares the patient dead then she must be removed from life support, leading to death of the fetus.  A physician is not going to make that declaration if he is at risk for criminal prosecution.  The hospital did not ignore her condition, they simply did not proceed with a change in her status from living to deceased.  This is how any hospital proceeds with a patient on life support because this is how they must proceed, otherwise the hospital has to remove care.  Removal of care means the patient is no longer a patient.  Someone that is not a patient does not receive medical treatment (i.e. life support), does not receive nursing care to monitor treatment and care for their physical needs and does not even receive a room.  The hospital is not ignoring her condition, but is simply not proceeding with the next step which would, as Oniya pointed out, lead to an irreversible condition of death.

This is essentially what the hospital would do if the patient family wanted to keep her on life support.  Had the family stated wanting to keep her on life support, nothing medical changed.  Yet in that instance the hospital is not “gaming” the system.  There is no difference, medically speaking, in either instance.  Declaring death is a legal step, there is nothing medical or biological in what the physician would have to do in this instance.  The physician is reviewing the current law on declaring death, reviewing medical reports and information to match the criteria for death with his findings and making a declaration for death so that the patient becomes “legally” deceased.  Once the patient is legally deceased the hospital can remove care.

As for a safe harbor provision, there is no such thing in this regard.  If the family stated wanting her on life support, but the physician went ahead and declared her dead so that the hospital had to remove care.  Also if Texas has a law on the books stating that removing life support is illegal and the physician made a move to do so leading in death to the patient and fetus, then he is liable.  The criteria is simply being established in that law, not being used to shield the physician.  There is not much safe harbor in death.
« Last Edit: January 27, 2014, 12:22:35 PM by Pumpkin Seeds »

Offline Sabby

Re: This disturbed me
« Reply #365 on: January 27, 2014, 12:24:36 PM »
So, they would have pronounced her dead, just not this time, because of the fetus. How is that not manipulation?

Is there any reason they couldn't have said "Okay, patient is dead, however, unusual circumstances must be taken into consideration, so the body shall remain on life support until a course of action is decided on"

That sounds much less shady then "Well, we SHOULD pronounce her dead, but... see, the thing is..."

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #366 on: January 27, 2014, 12:30:15 PM »
That is essentially what they were doing Sabby.  They just didn't sign the paperwork to declare her legally dead, because by declaring her legally dead they would have to stop giving care.  As people have pointed out, a dead person cannot be a patient.  The physician said she is brain dead, they even said she meets the criteria for death but until this is resolved life support must be maintained so no declaration of death can be made.

Declaration of death = No Care.  No Care = Death of Fetus.  Death of Fetus = Illegal in Texas.  Therefore Declaration of Death = Illegal.

a = b and b = c then a = c.

Offline Sabby

Re: This disturbed me
« Reply #367 on: January 27, 2014, 12:35:51 PM »
I still fail to see the reason for not declaring her dead. You seem to be under the impression that a declaration of death leads unavoidably to the removal of life support, despite the fact that they have acknowledged the uniqueness of the situation and have put standard procedure aside for now.

Why can they change every rule except this one?

Offline Kythia

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Re: This disturbed me
« Reply #368 on: January 27, 2014, 12:37:11 PM »
OT ramblings
Shrug.  That's the one my local pub quiz uses and hence the one that gains me free beer.  I'm'a stick with it.

And yeah.  To me "Lilywhites" is Tottenham, but to my brother they're Preston North End.  Fulham use it as well, IIRC

Back on topic, yeah I think its a stretch calling it gaming the system.  Assuming good faith on the part of the hospital - which they've done nothing to rule out - they had a patient that, to the best of their understanding, they were obliged to provide care for.  As such, they took no steps that would prevent them providing care.


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Re: This disturbed me
« Reply #369 on: January 27, 2014, 12:55:29 PM »
*nods*  In essence, it's easier to disconnect life support if you've left it on erroneously than it is to hook it back up if you've disconnected it erroneously.

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #370 on: January 27, 2014, 01:24:35 PM »
I am under this impression because I have experienced this first hand.  Once a patient is dead there is no more nursing care, care is removed.  The hospital was also following the rules.  In fact the hospital is essentially in trouble here over following what they thought was a rule that applied to them.  They were not setting aside any rules or protocols, they were following Texas law so far as their lawyers interpreted. 

Offline Sabby

Re: This disturbed me
« Reply #371 on: January 27, 2014, 01:27:31 PM »
Once again, why must this given rule apply to a situation that they have acknowledged as unusual enough to need legal intervention?

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #372 on: January 27, 2014, 01:29:47 PM »
Sabby, they didn't ignore any laws.  Why would they ignore a law while also trying to follow one.

Offline Kythia

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Re: This disturbed me
« Reply #373 on: January 27, 2014, 01:31:38 PM »
Once again, why must this given rule apply to a situation that they have acknowledged as unusual enough to need legal intervention?

You've answered your own question there.  Legal intervention would be happening, the hospital knew its actions would be scrutinised by the courts so, rather than just saying "Fuck it, this seems like the best thing to do" they followed the law.  So that when that intervention happened, they wouldn't be found liable of breaking any.

Offline Sabby

Re: This disturbed me
« Reply #374 on: January 27, 2014, 01:38:18 PM »
Sabby, they didn't ignore any laws.  Why would they ignore a law while also trying to follow one.

I know they didn't ignore the laws, and I'm at a loss as to how you keep thinking I'm suggesting they have.

I have asked simply why they adhere to standard procedure for a case they recognize as unusual. I'm not going to run circles when I'm using as simple wording as I can, so If you cannot answer me simply and directly, I'm done with this discussion.