Killing a Patient to Save His Life
nytimes.com
nytimes.com
Which, according to the article, has the effect of stopping the heart as well as brain activity. This seems pretty close to "death." If someone decided to stop the operation halfway through without replacing the saline solution or reviving the patient, it would make sense to me to claim that the "time of death" was the time at which brain activity ceased.
It is about conserving information. As long as your brain can be turned back on you're still alive.
Edit: Looking at wikipedia a bit, it looks like "brain death" is currently defined as including a dead brain stem. Kind of seems like an ethical gray area when the cerebrum really is dead (non-recoverable), not merely suspended. Still, I'm not convinced that general anesthesia fully suspends the cerebrum. I believe at least some forms merely suspend the ability to form memories.
Furthermore, while necessary, the brainstem is not sufficient to sustain consciousness.
Third, phenobarbital at a sufficient dose completely wipes electric brain activity (metabloism goes on, at a lower pace).
Fourth, even if you suspend someone using the procedure described in the article, there is still residual biologic activity in the cells. Chemical reactions are slowed down, but not stopped.
As far as I can tell, that statement is correct. The headline is drawing attention to the evolving nature of just what constitutes "death" and how this particular procedure is pushing it out even further.
It hasn't been a synonym for "death" for a few decades.
"Brain death" is a total and irreversible loss of brain function.
Seriously though, with these new types of procedures I feel like we need another checkbox next to the organ donor one that says: "Try risky medical procedures if the attending doctor honestly thinks it gives me a better chance of living with no permanent brain damage when compared to conventional treatment." Or probably something a little more succinct.
With current thinking you don't even need to do mouth to mouth disease transmission is a vary low risk.
I am curious how much organ they could still harvest after performing such procedure though.
Personally I'd want to take the 1/10 chance, but I'm sure there are a lot of people who would want to live even if it meant diminished mental capacity.
There are enough cases known to science where cold has done wonders. And the technology seems viable. I say go for it. At worst we will be getting valuable knowledge.
If your odds are already very low taking a risk for better odds seems like a good deal to me.
You're most likely dead anyway why not try something new to give you a better chance.
Did they actually do dry runs of the surgery from shooting to triage to finish? I wonder whose job it was to shoot the dog with a .45
My understanding is that they only use this procedure if your chances of otherwise surviving without this are very slim, per the article the injuries are the kind where "Less than 1 in 10 survive". As for the opt-out/opt-in, you cannot really opt-in to any procedure if you're undergoing cardiac arrest, so perhaps we should let anyone in this scenario die since they cannot truly consent?
Rephrased with some exaggeration: "Our patient will die anyway, so let's run the experiments. Maybe one of our experiments is successful. If not, who cares?"
I believe the main dissent here is whether to think of this as a medical treatment with minor risks, or as an experiment done on defenseless victims.
It's experimental, but they also have good reason to believe that it works. Now it's being tested in a scenario where it's likely to save lives.
I can understand the objections overall. But in this particular case, where it's being used as a last-ditch effort to save people who otherwise are almost certain to die, seems pretty reasonable.
How else are medical researchers to advance the state of the art in emergency care? I assume that we don't want to just take what we have now and set it in stone forever, but I don't see any other way to validate new procedures.
He was able to save very few of his patients from the same end, as well as developing what would become modern chemotherapy that's saving countless more cancer patients today.
So a better question is: is the situation we're presented with so grim that we're willing to use a method that's just as deadly as the disease/injury but has a glimmer of hope for survival?
Since the group leaving the status unspecified is by far the largest, your practical ability to evaluate the procedure depends on what default is selected for the patients who haven't decided beforehand.
Given the need, potential to save lives and widespread agreement among the public, I'd say there is no real ethical controversy here.
Your comment did made me think about not-so-old CIA experiments on poor powerless people: http://en.wikipedia.org/wiki/Unethical_human_experimentation...
But lets be clear: this is not CIA stuff.
(Hitlerian? as if Americans aren't racist.)
You make it sound like being experimented on is a bad thing, when you have only a 10% chance of surviving. There's thousands of people out there who would do anything for an experimental treatment funded by the government.
If this were in an area with more white people, they would ask for permission first because they respect you more than they respect these black people who are getting stabbed. <- Speculation, but plausible.
There are only four possibilities: perform the procedure on everybody, perform the procedure on nobody, allow people to opt out, allow people to opt in. They've settled on the third. It's possible that they'd settle on a different one in an area with more white people, but it has to be one of those four.
The point is, they never asked the community they're in. They didn't try to get consensus, or make sure that most people around them are OK with it. They just unilaterally decided that the trauma victims in that neighborhood were guinea pigs.
What are you basing this on?
Chances are this is absurdly expensive (ICU stays can cost millions) and may be unlikely to see wide use in poor areas - the hospitals'd be eating the cost most of the time.
I was under the impression that they already ate those costs.
> 13. Can the hospital inquire about the patient's ability to pay?
> Yes, but timing is everything. The statute does not prohibit an inquiry into availability of medical insurance; it does provide that neither examination nor treatment may be delayed to make the inquiry.
> Prior to 2003, some knowledgeable commentators had suggested that no discussion of any payment issues should take place before the medical screening examination and any needed stabilizing treatment are provided. CMS has even recommended that hospital personnel not answer any questions initiated by the patient, apparently on the theory that some patients may be dissuaded from staying if they learn that they will be financially responsible for the treatment, even if they are assured that they will be seen without consideration of payment issues. Such recommendations, however, do not arise to the level of a definitive statement of what is required.
I don't know if the Affordable Care Act changed any of this.
However not all ERs are equal. It's entirely possible that procedures like this wouldn't be available in a less well funded (read: poorer) hospitals. At least until it becomes what's known as the "standard of care", where the healthcare provider can be culpable for not providing the treatment.
Though, honestly, I don't really see that happening. If this is successful, I would expect to primarily see first adoption in hospitals which already have high trauma rates. Which, typically, are hospitals serving poorer areas.
So... if "generic major surgery" goes horribly wrong, they'll chill you and fix it rather than letting your brain die.
I wonder if you could come up with a cancer chemotherapy treatment that has such severe effects that the patient literally can't live thru it, but if you chill them first and then reboot them with a clean blood supply... imagine something that successfully kills tumors but coincidentally liquifies brain tissue. Well, just shut off the brain for awhile by shutting off its flow of blood. Can't poison something if no poison ever gets there. Do the treatment and kill the cancer, then flush out the circulatory system with saline, replace with fresh blood, reconnect the brain to the circulatory system (note to self; don't forget this step) and then reboot them.
I would have to think if there's anything else interesting you can do with a complete "flush -n- fill" of the circulatory system. Maybe treat horrific industrial or research lab accidental poisonings. Sure maybe its less risky to just pour in and drain out 100x your blood capacity to flush it, but what if the industrial accident affected 50 people, that's 5000 people's worth of blood, lots will have to die untreated unless you find a more scalable treatment.