Baby Joseph can go home to die, but without tracheotomy: hospital

Life Site News ^ | March 1, 2011 | PATRICK B. CRAINE

[NYer]

LONDON, Ontario, February 28, 2011 (LifeSiteNews.com) - Dying one-year-old Joseph Maraachli, whose parents are entangled in a legal battle after doctors refused to perform a simple procedure that would allow him to die at home, should have had that procedure “a long time ago,” a pioneer in the field of neonatology has told LifeSiteNews.com.

But the physician’s statements came on the same day that the hospital where Joseph is being kept said it is willing to send him home, but with an important catch: they still refuse to perform the tracheostomy that allowed a sibling of Joseph’s who had a similar condition to live another six months at home. Instead they will simply return Joseph home, and then remove his ventilator, after which he will almost certainly die within a matter of minutes.

Alex Schadenberg of the Euthanasia Prevention Coalition, who has been working closely with the family, told LSN that this solution is unacceptable to them.  The family’s lawyer, Mark Handelman, said the same to the Canadian Press.  But Joseph’s father, Moe Maraachli, later told LSN that while they remain committed to fighting the hospital’s effort to remove the ventilator, how they will respond to the latest offer is not yet completely finalized and they are still discussing it.

“They need to do a tracheostomy,” said Dr. Paul Byrne, an Ohio neonatologist with nearly five decades of experience and a former president of the Catholic Medical Association.  “If the baby is stable otherwise, and has a tracheostomy, then the baby can be taken care of at home.”

In a “public information campaign” launched Sunday night, London Health Sciences Centre, where Joseph has been treated since October, defended their refusal to perform the tracheostomy.  They called the procedure, which involves inserting a breathing tube through a tiny slit in the throat, “invasive,” and said it is “not a palliative procedure.”

“It is frequently indicated for patients who require a long term breathing machine,” they wrote.  “This is not indicated for Baby Joseph because he has a progressive neurodegenerative disease that is fatal.”

This wording was repeated in today’s statement in which the hospital said Joseph could go home to die.

But Dr. Byrne told LifeSiteNews that “there’s no case” when a child is on a ventilator where the tracheostomy wouldn’t be indicated.

The hospital is now asking Ontario’s Office of the Public Guardian to intervene and allow them to take Joseph off his ventilator, after the parents have continued to refuse consent.  That office has been unsuccessful in asking other family members to consent instead, and could intervene itself any day.

Dr. Byrne called the attempt to have the state remove Joseph’s ventilator “terrible, absolutely terrible,” and insisted that in his fifty years in neonatology he’s never removed a child’s ventilator.  “I’ve never seen a time to turn off a ventilator,” he said.  “If a baby has a disease process that’s so bad that they’re going to die, then they die on the ventilator anyway.  So you don’t have to stop the ventilator.”

He also criticized the common phrase “life support,” saying, “Life is either there or it’s not there. You don’t have to hold up the life.  What we do in medicine are actions ... that support the vital activity of respiration.”

“Assuming doctors can do something to support the vital activities, we ought to do them,” he explained.  “And a tracheostomy ought to be done, and the baby ought to continue on the ventilator.”

Though doctors have said Joseph is in a “vegetative state,” Dr. Byrne called it a “made-up term” similar to the notion of “brain death,” which he said was invented “simply to get beating hearts for transplantation.”

Even Joseph’s doctor in London has admitted that the tracheostomy could prolong his life.  “A tracheotomy would likely provide for a longer period of life, however, in our view would not result in improvement of well-being and could reduce quality of life,” Dr. Douglas Fraser told the Ontario Consent and Capacity Board in January.

Along with their public information campaign, the hospital announced Sunday that they are considering legal action against unnamed individuals who they say have alleged that doctors might “kill” Joseph or that his death would be a case of euthanasia.

Joseph suffers from a severe neurological disorder, but his specific condition remains undiagnosed.  Doctors have given him no chance of recovery, so his parents, Moe Maraachli and Sana Nader, have asked them to perform a tracheostomy which would enable him to breathe on his own, so that they could take him home.  Their daughter died from similar complications eight years ago, but in that case doctors performed a tracheostomy and they were able to take her home.

On February 17th, Ontario Superior Court Justice Helen Rady upheld a January verdict from the Consent and Capacity Board of Ontario, which had supported the doctors’ move to take Joseph off life support against his parents’ wishes.  The hospital had appeared set to remove Joseph’s life support last Monday, but that got delayed when the family hired expert lawyer Mark Handelman with the financial support of the Euthanasia Prevention Coalition.

Justice Rady’s decision was based on doctors’ testimony that he is in a permanent vegetative state with no brain stem reflex.  But the family says that footage released Thursday by LifeSiteNews belies the doctors’ claim.  The videos, taken last weekend, show him flailing and reacting to tickling.  They also show that his hands have been tied down - a measure the hospital took after Joseph removed the tube from his throat on at least two separate occasions.

The family has been trying to have Joseph transferred to a hospital in the U.S., where they believe he’ll get better care or at least a reassessment, and possibly the tracheostomy they need to bring him home. 

In the last couple days, the case has drawn attention from major pro-life and anti-euthanasia groups in the U.S. who hope to find a hospital willing to take over Joseph’s care.  Family members of euthanasia victim Terri Schiavo travelled to London last week to advocate for Joseph and Fr. Frank Pavone, national director of the U.S.-based Priests for Life, has pledged to pay for Joseph to be moved to a hospital in the U.S.

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, warned in a Fox news interview that the court decision facilitates a system where doctors are authorized to force life and death decisions on patients.  He has said he believes it is far worse than the “death panels” recently debated in the U.S. as part of the federal health care law.

“It’s the hospitals and the doctors once again usurping their power over the people,” he said.  “That’s what’s happening.  And they have significant power - they have the money and the courts behind them.  It’s absolutely ridiculous.”

Over 12,000 people have rallied behind the parents through the Facebook page “Save baby Joseph”.

To make a donation to cover the legal costs please click here.

[NYer]

Even Joseph’s doctor in London has admitted that the tracheostomy could prolong his life.

The mindset has moved towards no longer prolonging life. Euthanasia is now the expedient solution to a life-threatening condition.

[Carley]

Sin

[muawiyah]

Hmm, another misuse of the expression "quality of life" to justify ending a life.

There are people who think the doctors in this case cannot possibly have a good "quality of life"~ so should the doctors be taken out and executed quickly?

Just how firm are they in their beliefs?

[A_perfect_lady]

Weird. Very weird. Why are they resisting this simple procedure? And yes, it is relatively simple. My best friend’s mother had this done in January. She had a chronic lung disease, and they knew she would die eventually from it, but it enabled her to live another month and say her goodbyes to members of her family out-of-state, who flew in to see her one last time. She only lived one month like that, but it was valuable to her.

[oneamericanvoice]

Since the parents are paying for it, the doctors should do what they wish. I hope they get to bring poor little Joseph to the US, and that he will live a very long life.

My Dad suffered a brain injury from a fall. The medical staff insisted that he there was no hope and that he was brain dead. Well, he squeezed the nurse’s hand when we asked him to, and when my sister entered the room the first time, he opened his eyes and tracked her the whole way. Then he turned to look at the nurse who was changing his ventilator. No one would listen to me. I also, blame the transfer to the other hospital across town. It makes no sense to jog a brain bleed patient. I’m having a hard time letting go and it’s been a few years now.

[TiaS]

These issues seem black and white when trying to intellectualize decisions such as those we see with Baby Joseph. It is a totally different situation when the person in question is a loved one. Then, the emotions become involved.

[Mr. Lucky]

Sine the parents are paying for it, the doctors should do what they wish.

But this is Canada and the doctors are paid by the same type of single payer system that is soon to come to the US.

[bert]

I don't understand the problem. Just go home and do it

Ask forgiveness, not permission

Emergency tracheotomy Procedure

This procedure, technically called a cricothyroidotomy, should be undertaken only when a person with a throat obstruction is not able to breathe at all-no gasping sounds, no coughing-and only after you have attempted to perform the Heimlich maneuver three times without dislodging the obstruction. If possible, someone should call for paramedics while you proceed. What you will need

* A first aid kit, if available * A razor blade or very sharp knife * A straw (two would be better) or a ballpoint pen with the inside (ink-filled tube) removed. If neither a straw nor a pen is available, use stiff paper or cardboard rolled into a tube. Good first aid kits may contain "trache" tubes.

There will not be time for sterilization of your tools, so do not bother; infection is the least of your worries at this point.

Emergency Find the indentation between the Adam's apple and the Cricoid cartilage.

Make a half-inch horizontal incision about one half inch deep. Pinch the incision or insert your finger inside the slit to open it. Insert your tube into the incision, roughly one-half to one inch deep. How to Proceed

1. Find the person's Adam's apple (thyroid cartilage). 2. Move your finger about one inch down the neck until you feel another bulge. This is the cricoid cartilage. The indentation between the two is the cricothyroid membrane, where the incision will be made. 3. Take the razor blade or knife and make a half-inch horizontal incision. The cut should be about half an inch deep. There should not be too much blood. 4. Pinch the incision open or place your finger inside the slit to open it. 5. Insert your tube in the incision, roughly one-half to one inch deep. 6. Breathe into the tube with two quick breaths. Pause five seconds, then give one breath every five seconds. 7. You will see the chest rise and the person should regain consciousness if you have performed the procedure correctly. The person should be able to breathe on their own, albeit with some difficulty, until help arrives.

http://www.tracheostomy.com/resources/surgery/emergency.htm

[txlurker]

Very sad story. Is it wrong to ask if the parents knew that this child would have the same condition as the daughter who died, why would they risk having another baby? Not meaning to be cruel. Just wondering.

[miss marmelstein]

On the very day my dad died, my mom collapsed and we ended up in a local emergency room. After many, many hours in which she was ignored, we finally decided we had had enough. My mother needed some sort of asthma treatment before we left but the doctors withheld it. Why? Because she was determined to leave the chaotic, miserable, unhelpful hospital that had no pity for what my mother was enduring. Basically, they were insulted that we wanted to quit their Dantesque hell.

As we approached the parking lot, a kind male nurse ran out with a vaporizer and allowed my mother to take it. He also expressed condolences on behalf of my deceased father. I wish I had HIS name.

[wagglebee]

I think this is the same story from yesterday:

http://www.freerepublic.com/focus/f-news/2681510/posts

[yefragetuwrabrumuy]

The serious problem here is that the doctors are “actively campaigning to force death”. There is a major difference between permitting death through omission of “extraordinary efforts”, and trying to force situations in which death *must* happen.

In this situation, a simple legal waiver for the hospital and attending physician, to permit another physician to conduct an “emergency” pediatric tracheotomy, before transporting the infant out of the hospital, would be acceptable. As would transferring the infant, with ventilator, to his home, where another physician could conduct the surgery before disconnecting the ventilator.

In either case, it is “no skin off the nose” of the hospital or its doctors.

But instead, like priests of Moloch, they are trying to force a situation in which the child *must* die, inside or outside of their “care”.

This is not a situation of benign indifference, but one of active malevolence. And if that child survives a significant amount of time outside of that hospital, the credibility of both the institution and its doctors must be called into question.

[yefragetuwrabrumuy]

I would also add, that it would probably be a good idea to arrange for a 24-hour a day guard for the infant. The determination of this hospital that the child must die can only be interpreted as their having a hostile, even dangerous attitude to the infant. Under such circumstances, it would not be out of the question that they would attempt to kill the child.

Thus, any medications or sustenance given to the infant should be inspected beforehand, to insure there is no “accidental” contamination; that all life sustaining equipment is watched, and that no “accidental” switching off of oxygen, or other such lethal efforts are permitted.

[ViLaLuz]

“Though doctors have said Joseph is in a “vegetative state,” Dr. Byrne called it a “made-up term” similar to the notion of “brain death,” which he said was invented “simply to get beating hearts for transplantation.”

Well there you go. There’s the reason right there. There’s mucho $$ made selling organs.

[jerseyrocks]

The last I checked the one who decides life and death does not walk among us. The hospital should due its duty and use everything possible for this beautiful child to survive. GOD will decide the rest.

[Michel12]

But the duty of an hospital in Canada is to save its resources as it is paid by the taxpayer... This is the problem. The parents do not pay... This is what happens when you nationalize healthcare.

[jerseyrocks]

I should have said doctors. Don’t all doctors take the same ethical oath?

[kaila]

If you want to bring a baby that will cost your state’s social welfare system hundreds of thousands of dollars, then have the Catholics pay for it themselves.

[Krodg]

Maybe someone needs to remove your ventilator.