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Saturday, May 14, 2011, 12:04 PM
Wesley J. Smith

An Australian “brain dead” woman (clearly a misnomer, about which more below) was ordered removed from life support only a few weeks after suffering brain injury.  But thanks to the efforts of her family, she is now recovering.  From the story:

A TERRITORIAN has woken from the dead. Gloria Cruz was diagnosed as being “brain dead” by a team of doctors after suffering a massive stroke. But her distraught husband Tani begged them not to switch off her ventilator. “I’m a Catholic – I believe in miracles,” he told them…

Ms Cruz had a stroke in her sleep on March 7 and was rushed to Royal Darwin Hospital. After a CAT scan, a doctor said she probably had a brain tumour. Mr Cruz, 51, who works as a forecaster at the Darwin Met Bureau, said: “The doctor didn’t elaborate. He just said I should prepare myself.” His wife underwent brain surgery immediately…Doctors said the case was “hopeless” and she would probably die within 48 hours.

When a doctor recommended that the ventilator be removed and Mrs Cruz be allowed to die, her husband told them: “A miracle could still happen. I told him that God knows how much I love her – that I don’t want her to suffer but I don’t want her to leave us.” Mr Cruz asked for a 48-hour respite. A doctor, social worker and patient advocate later rang him and again asked him to agree to have the ventilator turned off. After two weeks, a breathing tube was inserted in Mrs Cruz’s mouth and the ventilator was turn off. Hospital staff were stunned when she woke from her coma three days later.

This story illustrates many of the problems we see in medicine today:
1. There is a tendency to give up way too early on patients who have serious brain trauma.  I think that is in part to the bioethical meme that rejects human exceptionalism, accepts the so-called “quality of life” ethic that presumes people with catastrophic cognitive traumas have lower moral worth, and indeed as some hold, are mere human “non persons.”
2. “Brain death” is a badly misused term. If Cruz breathed on her own after the ventilator was turned off, by definition, she wasn’t dead, but in a coma, as the story stated later.  Media and medical communicators have to watch their lexicon.  An unconscious patient is a living patient.
3. Diagnosis of persistent consciousness can’t usually be done reliably in days, or even weeks.  It takes months, and even then, there is a 40% misdiagnosis rate.  It would appear that a hasty prognosis might have been made in this case that could have had tragic results.  What if the family hadn’t fought for her life?  She might not have recovered to the point that she was able to breathe unassisted.
4. Doctors should not have the unchecked power to unilaterally “pull the plug.” Decisions that wanted further treatment is “futile” should not be made by the doctors or hospital bioethicists or social workers.  Rather, they require strong checks and balances and decision by rule of law.  If the wanted treatment is clearly so burdensome to the patient (not the medical team or hospital finances) that it should be stopped, that is a decision to be made in open courts with rights of cross examination and appeal.
5. Occasionally, “miracles” do happen.

This part of the story raised my eyebrow:

A doctor was so amazed, he said: “It’s a miracle.” And then he turned to Mr Cruz and said: “I am happy that my prognosis was wrong.”

Well, that’s nice.  But I hope the doctor learned something from this experience.  Sometimes prognoses are wrong.  The one in one hundred chance comes up one in one hundred times.  Hope should not be too quickly abandoned.

HT: Bioedge

10 Comments

    Foxfier
    May 14th, 2011 | 12:43 pm

    Link’s broken.

    Wesley J. Smith Reply:

    I’ll fix. Thanks.

    Bret Lythgoe
    May 14th, 2011 | 1:28 pm

    The human brain is a profound, enchanted mystery. Even though neuroscientists have made considerable progress in eliciting its properties, they’re not even close, to being close, to deciphering its essence!

    Case in point, is its plasticity. This notion, forty years ago, would have perhaps been placed in the same intellectual category, as, say, alchemy. But we clearly know that, with sufficient stimulation, the synapses, or tiny, megamicroscopic spaces between neurons, actually increase in number, as a consequence.

    Therefore, it would be profoundly premature, to say the absolute least, to “pull the plug” on profoundly brain damaged people.

    The dangers of rushing to end treatment « Ladies for Life
    May 14th, 2011 | 2:51 pm

    [...] Wesley J. Smith looks at the problem of doctors who give up before the patient does. [...]

    James
    May 14th, 2011 | 8:47 pm

    You failed to mention that this lady will almost certainly be stuck in the high support wing of a nursing home for the rest of her life. She will probably never walk, or speak again. Doctors make calls based on probability of getting positive outcomes. It’s how we make sure our health dollars don’t go to waste. If you want to sit and pray for a “miraculous” recovery where your loved one comes back as a demented, drooling mess that’s your right. But YOU should pay for it. Not the tax payer.

    Wesley J. Smith Reply:

    See, it is crass,bigoted comments like this that prove my points.

    HistoryWriter Reply:

    @Wesley J. Smith,

    “See, it is crass,bigoted comments like this that prove my points.

    Not really. If anything it proves that people have strong opinions on the subject. Some refuse to consider quality of life as part of the equation; others make it the entire equation. The truth obviously lies somewhere between, and most cases are arguably too complex to be reduced to over-simplified slogans and ten-second sound bites.

    Stop patting yourself on the back. James hasn’t “proved” anything for you.

    HW

    bonnie snaith
    May 16th, 2011 | 6:43 pm

    James, these are human beings we are talking about not demented drooling messes. Maybe you should get to know a few people that have suffered brain injury . If given the opportunity ,proper treatment ,rehab and love they can have meaningful lives. There is no way to know how much a person can recover if given the chance. Human beings are exceptional and are worthy of our time ,care, money and love. There is no greater place to focus our attention and resources than in each other.

    Blake
    May 16th, 2011 | 9:09 pm

    There is no way to know how much a person can recover if given the chance.

    Just imagine: if our culture falls into the habit of just killing everyone who becomes a liability to the medical “deciders”, how much we will not learn.

    bonnie snaith
    May 16th, 2011 | 11:06 pm

    Thanks for that Blake. You are so right. Today is the 4th anniversary of my son’s accident. He wasn’t supposed to ever wake up. His recovery in the last 8 months since he has moved home in a loving environment where he has been challenged daily has been incredible. The human spirit is amazing and when people are given hope instead of despair(or death) the possibilities are endless. When we give up on our fellow humans all we have are unanswered questions of what might have been. I personally am not willing to live with those unanswered questions.

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