Alex Schadenberg: The Baby Joseph case affects us all

I thought I explained it quite clearly in my last post to you...if not, well too bad you cannot understand it. Sorry about that. Don't know how else to explain extraordinary. I have had patients that had gastronomy tubes directly into the stomach. Alert ambulatory patient. I don't consider that extraordinary either as the patient could do it themselves. Some types of cancers make such a procedure necessary. If alert, feeding is not extraordinary yet some in the medical field are pushing to make it so..Food and water are NOT extraordinary, no matter what the condition of the patient.. Feeding a patient is normal no matter what their condition..

It was made extraordinary by a judge without any medical background and also inhuman by such a judge. If you can refuse nutrition to a coma or semi-comatose patient, you open the door to refuse food to anyone. I have also had patients that would go in and out of coma. Be alert and talk with you and suddenly lose consciousness and not even respond to painful stimulus...Some doctors use no stimulus to pain as a condition for the depth of coma.

You say there is no case where a trach is extraordinary care; I might accept that if you can back it up.

You are looking more like a troll by the minute.

Look up the terms "logical fallacy" or "disproving a negative" and you will see the problem.

From my time in medicine, traches were not consider “ordinary” in all circumstances.

Name one under which they weren't. You want to make a case, you need to prove it.

This case raised many questions for me, and I can see both sides.

A real conservative is only going to be interesting on one side of this case.

A simple assertion on your part that it isn’t extraordinary isn’t very educational.

Actually, it is.

Let me be perfectly clear, I am only interested in this baby's life -- I don't give a damn about "educating" you.

Do you have a citation or reading suggestion? If not, I’ve obviously learned all I can from this discussion.

Your intention was never to learn, it was to push pro-death talking points.

I have taken care of thousands of patients over my 10 years working in a hospital...I remember one little 7 year old boy dying of brain cancer. When I went in to care for him I would talk with him, tell him what the weather was outside and that his mother would soon be in to rock him. He was totally unresponsive except for a smile. I tested him with talking and he was definitely responding to my voice. I mentioned this to his mother when she came in and she said he always smiled at her when she rocked him or talked with him...

His type of brain cancer, he was going to die, no doubt bout it but he deserved to be treated with love and talked to and rocked by his mother until he took his last breath. He also deserved nutrition and fluids to keep him comfortable. His death was peaceful and its the way we should treat all those dying unless as adults they sign forms that say otherwise.

For me, I have signed such a document, and talked with my kids about their Power of Attorney for health care. All adults should do this and not have the family make the decision..and do it in writting. No one likes to think about it, but it will happen to everyone living today. If someone wants extraordinary means its their decision. If they don't again its their choice..Its no doctors job to determine what quality of life is except for his own life..

You seem to be a reasonable person, so I will answer your questions.
A trach does not help a person breath. A trach is just a way air can get into your lungs. It is a conduit only.Inhaling and exhaling is a brain stem function, which this baby does not have.A trach does not perform the function of inhaling and exhaling.
This baby is nasally intubated. You can tell by the pictures. Intubation serves the same function as a trach. There is no difference.You have to extubate and place a trach for long term use because of issues with tissue erosion.
The Canadian hospital has tried to wean this baby off a ventilator, but cannot because the baby stops breathing when they do.
You can keep a person on a ventilator after death ( which this baby is) for a long time. Eventually, the body stiffens, pulmonary resistence occurs ( decreased chest wall compliance), and you keep pumping oxygen in, to no avail.
Eventually the chest does not rise . This “suffocation” they are all talking about is going to happen no matter what.
This is care beyond the extraordinary.Way,way beyond.The family is from Lebanon, so there are cultural differences between them and the western health care system. They want to bring this baby to the US- so then your tax dollars are on the line for the care. If not your tax dollars, then your health insurance premium, because hospitals will pass the buck to the insurance companies .They will negogiate for higher rates when they lose money on patients like this..
This poor baby has no reflexes, is blind, no brainstem function,pupils fixed, cannot eat, cannot breathe without a ventilator,cannot maintain metabolic balance. He will eventually get bedsores, and could die of sepsis as a result.
His sister had a trach, but no ventilator. This baby is much more severley disabled.
There is no way a hospital in the US will accept this patient. They are not going to give up a precious ICU bed, have questionable compensation, and have difficulty sending this baby home.
Not only that, when you operate on a patient, the complications are yours. Therefore,the hospital performing the procedure would be on the line for postop infections, respiratory issues. They have searched for a week, so far, no American hospital will accept this patient.
Time to let this baby go with some dignity to be with God.
The parents are in denial. Send the baby home with the ventilator, extubate at home with clergy there, and let this baby have some peace.

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