A Boy’s Death

Here’s a moral and religous dilemma which I pray no one would ever face, but which will happen to a fair number of us in the light of advances in life-sustaining technology.

When does death occur ? More to the point, when is it morally proper to pull the plug ?

Motl Brody of Brooklyn, N.Y., was pronounced dead last November 4 after a half-year fight against a brain tumor, and doctors at Children’s National Medical Center in Wahington D.C. say the seventh-grader’s brain had ceased functioning entirely. He was brain dead. His orthodox Jewish parents went to court to maintain the boy on life-support, essentially to compel the hospital to keep him alive indefinitely through mechanical means by keeping his heart and lungs functioning. Under some interpretations of Jewish religious law, including the one accepted by the family’s Hasidic sect, death occurs only when the heart and lungs stop functioning. The hospital argued that its “scarce resources” were being used “for the preservation of a deceased body.”

Orac, a doctor-blogger, writes movingly of the unfolding tragedy from the Brody family’s point of view:

In the case of Motl Brody, the reason there is a conflict is because he has a brain tumor that has resulted in brain death, but apparently some sects of Orthodox Jews, including the one to which Brody’s parents belong, do not accept the concept of brain death, but rather only accept death as occurring when the heart and lungs stop functioning permanently. Consequently, because a machine is keeping Brody’s lungs ventilating and medications are maintaining his blood pressure, they do not view him as dead.

When a child suffers brain death, it’s incredibly difficult for the parents to accept that the child that they love is dead. After all, the child is still warm, still smells like their child (and smell is a very primal sense), still has a beating heart, and still looks like a child. It doesn’t take religion for parents to go into profound denial over the true situation. However, there is no doubt that religion can be a powerful force that can reinforce such denial, but something as simple as a parent’s love for his or her child. Accepting the concept of brain death goes against every human instinct with regard to telling when someone is truly dead. Throughout thousands of years of human history, it was obvious when a person is dead. Now it’s possible to be dead and not appear so, thanks to the technology of the last 40 years or so.

At the same time, Orac gives the convincing rationale for the hospital’s position:

For one thing, no one who hasn’t taken care of a brain dead patient can understand how depressing it is. The nurses know it’s a futile effort, and unless there is a purpose to it, as in a plan for harvesting the organs, the longer a brain dead patient stays in the ICU, the more corrosive the effect on staff morale. Moreover, it’s a huge waste of resources, tying up an ICU bed and costing thousands of dollars a day to maintain. Finally, Arthur Caplan, a professor of bioethics at the University of Pennsylvania, said physicians aren’t obligated to provide care that can’t possibly be medically helpful.

“Doctors are well within their rights to say, ‘We are stopping,'” he said. “I don’t think medicine can become subservient to religious, spiritual or mystical hopes and beliefs concerning how to manage death.”

Motl Brody expired before the matter could be resolved by the courts.

What would you do ?

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