Paul A. Byrne, M.D.
Execution again in a New York hospital
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By Paul A. Byrne, M.D.
November 16, 2020

On October 29, 2013, I wrote about an execution in a New York Hospital. Michael (not his name by baptism), suddenly collapsed. His family called 911. The emergency medical team resuscitated Michael. On the way to the hospital, a pulse was detected. Medications to support blood pressure were used during the resuscitation. On admission to hospital, Michael was breathing, but unresponsive, His temperature was normal, but the next morning was elevated to 103 degrees (occurs with infection).

In less than 24 hours after admission to hospital, the neurology consultant wrote, "The patient is unresponsive. Pupils are fixed. Absent corneal reflex bilaterally. Absent doll's eyes. No purposeful movements of the extremities noted. No movements of extremities to noxious stimuli. Reflexes are absent throughout. Toes are mute. IMPRESSION:... clinically, the patient is brain-dead status post cardiac arrest, likely with severe anoxic damage to the brain. May consider, do not resuscitate."

EEG showed electrical activity. Two days after admission he was determined to be "brain dead" per neurology. During an apnea test, no breathing was observed.

It didn't matter that there was brain wave activity and that his heart was beating 100,000 times per day and that circulation and respiration were occurring with support from the ventilator.

Michael's relatives were assured that the determination of "brain death" was done in accordance with the hospital policy of certification of death by neurological criteria, which is patterned after, and consistent with, the New York State Department of Health and New York State Task Force on Life & the Law "Guidelines for Determining Brain Death," published November 2011. In this document "brain death" is defined as "irreversible loss of all function of the brain, including the brain stem. The three essential findings are coma, absence of brainstem reflexes and apnea." It was determined by a neurologist, an intensivist, and a hospitalist that there were no "confounding clinical circumstances." Under New York State law, Michael was determined to be "brain-dead" and was legally dead.

A Catholic priest, chairman of the Ethics Committee at the hospital, volunteered that the hospital operated in accordance with the Ethical and Religious Directives for Catholic Health Care Services of the United States Catholic Conferences of Bishops. This man was legally "brain dead" and ventilator support of the vital activity of respiration would be stopped at a precise hour and Do Not Resuscitate (DNR), which was already in place over the objection of the relatives, would be carried out. The ventilator was then taken away at the precise hour, even though Michael's relatives strongly objected. Prior to removal of the ventilator, Michael's heart was beating; blood pressure was normal. Michael had respiration supported by a ventilator that pushed air in. Michael had to exhale the air out before the ventilator could push the air in again. A ventilator can push air into a cadaver, also known as a corpse, but quickly after death, the air will not and cannot come out of a cadaver.

True death was imposed on Michael. The Uniform Determination of Death Act (UDDA) includes "irreversible cessation of all functions of the entire brain, including the brainstem." Note that the word "functions" is plural. The Guidelines in New York, however, include "total and irreversible loss of all brain function, including the brainstem." Thus, in New York the singular "function” is stated, instead of the plural "functions." The brain has many functions, but what is the single function that is all brain function in New York? There is no single function of the entire brain. (Emphasis mine.)

The NY rules and regulations call for providing "reasonable accommodation of a surrogate decision-maker's religious or moral objections to use of the brain death standard to determine death." Michael's mother and sisters pleaded with the administrator of the hospital not to take away the ventilator, but the judgment had been made; nothing could be done to stop the removal of the ventilator. It was the hospital's decision that they had provided "reasonable accommodation" to Michael's family's religious and moral objections to the "brain death" criteria used by the hospital. They had a Catholic priest, the Ethics Committee, and it was stated that they were operating in accordance with the Ethical and Religious Directives for Catholic Health Care Services of the United States Catholic Conferences of Bishops. It was also stated that they had a judge who agreed with what they were doing and they would give no more time to Michael, not even one more hour or one more day!

Now, to recent events: Sharon, after the experience with her brother, Michael, in her own handwriting wrote this advanced directive: “I am a Pro-Life Traditional Catholic, I opt out of any organ or tissue donation, I believe in life support; request Catholic Priests for Absolution and Sacraments. If permanently incompetent/disabled, Christian home services or Catholic religious sister nursing home. I want the rosary, brown scapular, miraculous medal with me. I do not believe in euthanasia; in the event of my death my proxies can claim my body for Christian burial. (Signature) Sharon, September 3, 2019.”

One year later, on September 17, 2020, Sharon was praying the Rosary on the telephone with her friend, who noticed slurring of Sharon’s speech. Sharon collapsed; 911 was called. Sharon had a brain hemorrhage, commonly known as a stroke.

Soon after admission to hospital she was said to be “brain dead.” Sharon was in coma. EEG twice had electrical activity. Scans of her head showed circulation to part of her brain twice. Her First and Second Powers of Attorney directed that the procedure of the apnea test was not to be done. Nevertheless, it was done anyway. During this procedure the life-supporting ventilator was stopped for 7 minutes. Carbon dioxide increased to 56 (normal is 40); breathing was not observed. There was absence of brainstem reflexes including pupillary and corneal reflexes, no cough, no gag, no eye movement when ice water was put into her ear canal. Sharon was declared “brain dead” by neurological criteria on September 21, 2020.

Sharon designated a First Heath Care Proxy and Second Heath Care Proxy. Both expressed strongly, multiple times that Sharon believed in life support and directed that life support be continued. They petitioned the NY Supreme Court for help. The case was dismissed; the Court noted: “The first is that in her handwritten notes...she was very clear in the breadth and depth of her religious faith, and she very clearly said...I believe in life support. What she didn't say is that I want life support” . . . [Emphasis mine]The Court continued: “I was more taken by the printed words...I wish to follow the moral teachings of the Catholic church and to receive all the obligatory care my religion teaches we have a duty to accept. However, I also know that death need not be resisted by every means and that I have the right to refuse medical treatment that is excessively burdensome or would only prolong my death and delay my being taken to God. Those are powerful words coming from – although they're preprinted for her, they're powerful words coming from a devout Catholic who says that she believes in life support, but, at the same time, she accepts the principles and teachings of her church with regard to the limitations on what is required for her to be mindful of and in compliance with the teachings that she holds so dear. As a result of that, I found it was – I wasn't able to reach a specific conclusion as to what her intentions were.”

With that, the Court dismissed the petition from the Heath Care Proxies. Then, a petition was made to Federal Court, but there also the petition was dismissed.

After the experience with her brother Sharon in her own handwriting wrote that she believed in life support. She wrote on a preprinted form obtained from the Diocese of Syracuse, with reference to the Ethical and Religious Directives for Catholic Health Care Services of the United States Catholic Conferences of Bishops and A Catholic Guide to End of Life Decisions, the National Catholic Bioethics Center..

The Health Care Proxies were following the handwritten directions of Sharon who believed in life support. The preprinted words of her directions included, “When patients act with a free and informed consent, they may use advanced medical techniques that are experimental and involve risk—but they are never obligated to do so. Whether to accept such treatments rests entirely within the discretion of the patient or his/her medical proxy.”

The Court chose to use one part of the preprinted pages, but not this part, and the Court stated that Sharon wrote “I believe in life support,” not I want life support. (Emphasis mine.)

First, Sharon’s brother had death imposed, then Sharon wrote in her own words that she believed in life support and designated Health Care Proxies to speak for her. Sharon did what she could; the health Care Proxies did what they could, but the medical and legal systems decided that Sharon was “brain dead” on September 21, 2020 when she was 63 years of age. Sharon’s 64th birthday was October 10, 2020 while she was in the hospital. Then, on November 10, 2020 the life-supporting ventilator was taken away by the doctors after petition by the healthcare proxy to continue life-support was dismissed by the Court.

Sharon became truly dead as manifest by change in color to pale and blue, no exchange of oxygen and carbon dioxide in the tissues, no heartbeat, and no circulation and all vital functions, consequent thereon. Sharon no longer was alive. Her life had ended. The nurse called the proxy to tell her that Sharon had passed at 7:00 pm on November 10, 2020.

What is all this? Sharon witnessed death imposed on her brother as life support was taken away from him. She wrote that she wanted life support. She designated Health Care Proxies to speak for her. But what happened? Life support and Sharon’s life were taken away. The medical and legal systems did not protect the life of Sharon or her brother. How and why?

Prior to 1968 ventilators were in use but there was no controversy. Some patients improved on a ventilator and some died on a ventilator. The goal of medical practice was obvious – to preserve and protect the life and health of the patient and not to declare that a living person is dead when he/she is still alive.

"Brain death" did not originate or develop by way of application of the scientific method. "Brain death" began with the appointment of the Harvard Committee to consider the issues. The results of their work were published in the 1968 "Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death." [1] The first words of this report are as follows: "Our primary purpose is to define irreversible coma as a new criterion for death." The primary purpose of the Committee was not to determine IF irreversible coma was an appropriate criterion for death but to see to it that IT WAS established as a "new criterion for death." With an agenda like that at the outset, the data could be made to fit the already arrived at conclusions. There was a serious lack of scientific method in the origination and development of "brain death."

Only persons who are alive can be in a coma, whether reversible or not. Was this the hubris of a few academicians or was it simply a surrender to fear of legal chastisement regarding perceived economic and utilitarian needs in 1968, especially the desire to get healthy living vital organs for transplantation? It seems that a predetermined agenda existed from the onset. There were no patient data and no references to basic scientific studies. In fact, there was only one reference, which was to Pope Pius XII. [2] While there was a reference to and a quotation from this Allocution of Pope Pius XII, they neglected to include the following: "But considerations of a general nature allow us to believe that human life continues for as long as its vital functions – distinguished from the simple life of organs – manifest themselves spontaneously or even with the help of artificial processes."

"Brain death" is not true death. Rather it is observing cessation of functioning of the brain, which is then translated into "brain death." The primary reason for the origination and propagation of "brain death" was and is the desire to obtain vital organs for transplantation and to stop ventilators and life-supporting treatments and care. A validly applied scientific method, sound reasoning, and available medical technology were not utilized in developing the new way of determination of death called "brain death." Death is the absence of life. Life and true death cannot and do not exist at the same time in the same person.

When a person has a head injury or, as in Sharon’s case, sudden collapse due to a stroke, the possibility of getting organs for transplantation is entertained. Sharon had opted out of any organ or tissue donation.

First, Michael collapsed and his sister, Sharon, and their mother fought for him to have treatment including the ventilator continued. They lost. The medical and legal system effectively executed Michael and, more recently, his sister.

Second, Sharon, aware of what happened to her brother, Michael, wrote a life-supporting directive, and designated health care proxies. It made no difference as her life-support was cut off and she, too, was effectively executed – both in the same hospital.

The medical and legal systems in this NY hospital did not protect the life of this brother and sister. The issues are not limited to this hospital or the state of NY.

The medical and legal systems have been implemented to get vital unimpaired organs and to turn off ventilators from patients labeled as “brain dead” but who are still alive.

See: www.lifeguardianfoundation.org for information on how to protect and preserve your life.

NOTES:

[1] Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. Special Communication. JAMA 1968;205(6):85-88.

[2] Pius XII. To an International Congress of Anesthesiologists, Nov. 24, 1957, The Pope Speaks, Vol. 4, No. 4 (Spring 1958), 393–398.

© Paul A. Byrne, M.D.

 

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Paul A. Byrne, M.D.

Dr. Paul A. Byrne is a Board Certified Neonatologist and Pediatrician. He is the Founder of the Neonatal Intensive Care Unit at SSM Cardinal Glennon Children's Medical Center in St. Louis, MO. He is Clinical Professor of Pediatrics at University of Toledo, College of Medicine. He is a member of the American Academy of Pediatrics and Fellowship of Catholic Scholars... (more)

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