Update on the Taran Francis case
Yesterday, I discussed the very sad case of Taran Francis, the 13-year-old boy who suffered meningitis from an untreated dental abscess that progressed to meningitis and brain death and the motion filed by the family's lawyer to prevent life support from being removed. (I've also seen it spelled "Teron Francis" and am not sure which spelling is correct.)
Although the thought of what the family is going through is heart-rending, my first take on the issue was that the legal action was ill-advised, because brain dead is dead. Keeping the boy's body alive when his brain is dead is a very expensive exercise in utter futility. Also, my guess was that this was probably a matter of poor communication between hospital personnel and the family. My second take (in the Addendum I posted) confirmed this impression, when I found out more information in an account that revealed that hospital officials might have been insensitive in dealing with the family, telling them that they would only have 24 hours to come to terms with Taran's death and implying that the only reason they were keeping Taran's body alive is because the family might want to donate his organs. Whether that is how the hospital actually presented the situation to the family or not is impossible to say from the news reports. Having had a little experience with such situations during the trauma rotations I took during my residency, I know that, on occasion, no matter how sensitive the hospital staff is in relaying the tragic news, the family still doesn't hear. (On the other hand, the story that the family relayed of a member of the staff telling them that the only reason they were keeping Taran's body alive was in case they wanted to donate his organs rings truer than I would like to admit.) Given that additional information, however, I could understand why, if the family had gotten the impression that the hospital was eager to pull the plug (whether correctly or mistakenly), they might have felt compelled to sue, even though I still think the legal action was very misguided and ultimately self-defeating.
Now, I've found out that the Judge Douglass McKeon ruled (and here and here) today that the boy could not be taken off life support without his family's permission. This is a bad ruling. It's bad because it in essence invalidates the law in this particular case, and it's bad medicine. No, I am not saying that the hospital should pull the plug right away, given that they had already come to an agreement not to before the ruling. It is highly unlikely that, in the face of the negative publicity it has received, the hospital would do so anyway. The ruling is also bad medicine, in that it leaves the impression that brain death is not the same thing as death, when such is not the case. Given the timidity of the ruling, I have to wonder if Judge McKeon was afraid of a Terry Schiavo-like controversy, were he to reverse his restraining order. Even worse, he doesn't seem entirely objective, given that he brought his wife to Taran's bedside, where she prayed for him.
But, as I said before, this case is not the same as the Terry Schiavo case. Terry Schiavo was in a persistent vegetative state; she was not brain dead. Terry Schiavo could have lived indefinitely in her persistent vegetative state if her feeding tube had been maintained; without the brain, Taran's body will deteriorate and die regardless of what anyone does. Maintaining his shell "until his heart stops" (as his mother put it) does Taran no good, nor does it do the family any good, prolonging as it does the agony of the family's ordeal. Personally, I had a fair amount of ambivalence about whether letting Terry Schiavo die was the right thing to do before I formed my opinion on that case; I have no ambivalence in my conclusion that disconnecting the respirator from Taran would be the right thing to do, assuming the diagnosis of brain death is accurate.
Unfortunately, some of the same groups that rallied to Terry Schiavo's cause have taken on Taran's cause (see also here and here), even though the two cases are not analogous. They do so based on a flawed understanding of the significance of brain death:
Although the thought of what the family is going through is heart-rending, my first take on the issue was that the legal action was ill-advised, because brain dead is dead. Keeping the boy's body alive when his brain is dead is a very expensive exercise in utter futility. Also, my guess was that this was probably a matter of poor communication between hospital personnel and the family. My second take (in the Addendum I posted) confirmed this impression, when I found out more information in an account that revealed that hospital officials might have been insensitive in dealing with the family, telling them that they would only have 24 hours to come to terms with Taran's death and implying that the only reason they were keeping Taran's body alive is because the family might want to donate his organs. Whether that is how the hospital actually presented the situation to the family or not is impossible to say from the news reports. Having had a little experience with such situations during the trauma rotations I took during my residency, I know that, on occasion, no matter how sensitive the hospital staff is in relaying the tragic news, the family still doesn't hear. (On the other hand, the story that the family relayed of a member of the staff telling them that the only reason they were keeping Taran's body alive was in case they wanted to donate his organs rings truer than I would like to admit.) Given that additional information, however, I could understand why, if the family had gotten the impression that the hospital was eager to pull the plug (whether correctly or mistakenly), they might have felt compelled to sue, even though I still think the legal action was very misguided and ultimately self-defeating.
Now, I've found out that the Judge Douglass McKeon ruled (and here and here) today that the boy could not be taken off life support without his family's permission. This is a bad ruling. It's bad because it in essence invalidates the law in this particular case, and it's bad medicine. No, I am not saying that the hospital should pull the plug right away, given that they had already come to an agreement not to before the ruling. It is highly unlikely that, in the face of the negative publicity it has received, the hospital would do so anyway. The ruling is also bad medicine, in that it leaves the impression that brain death is not the same thing as death, when such is not the case. Given the timidity of the ruling, I have to wonder if Judge McKeon was afraid of a Terry Schiavo-like controversy, were he to reverse his restraining order. Even worse, he doesn't seem entirely objective, given that he brought his wife to Taran's bedside, where she prayed for him.
But, as I said before, this case is not the same as the Terry Schiavo case. Terry Schiavo was in a persistent vegetative state; she was not brain dead. Terry Schiavo could have lived indefinitely in her persistent vegetative state if her feeding tube had been maintained; without the brain, Taran's body will deteriorate and die regardless of what anyone does. Maintaining his shell "until his heart stops" (as his mother put it) does Taran no good, nor does it do the family any good, prolonging as it does the agony of the family's ordeal. Personally, I had a fair amount of ambivalence about whether letting Terry Schiavo die was the right thing to do before I formed my opinion on that case; I have no ambivalence in my conclusion that disconnecting the respirator from Taran would be the right thing to do, assuming the diagnosis of brain death is accurate.
Unfortunately, some of the same groups that rallied to Terry Schiavo's cause have taken on Taran's cause (see also here and here), even though the two cases are not analogous. They do so based on a flawed understanding of the significance of brain death:
Nor should any one have to meet some arbitrary standard of recovery to justify his life. It is sufficient to survive. Finally, if Taran were truly dead, he would have suffered rigor mortis by now. Would they bury a breathing boy with a beating heart in the ground? Then why murder him?I'm sorry, but sadly Taran has not "survived." He has already passed on. Unfortunately, his shell remains with the appearance of life, but it is not life. It is not "murder" to accept that the boy's brain has died and withdraw artificial means of supporting the remaining shell of a boy from whom life has already fled (and whose body will not survive for long, even on a ventilator). I think that the family will eventually come to this realization, too. I'm just profoundly sorry that an apparent lack of communication between the hospital and the family allowed an already tragic situation to escalate to such depths of ugliness, regardless of whether the misunderstanding was due to the hospital's insensitivity or the family's inability or unwillingness to let go. Going to court over this served no good purpose and muddied the issue of how brain death is dealt with in New York.
Ugh. What a terrible situation. And how irresponsible of these groups to distort information and exacerbate the issue.
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