1. According to my source (the missus), in this hospital setting, doctors don't typically directly administer meds; they place orders, the pharmacy delivers the meds and then a nurse will give the meds, particularly with schedule drugs. Was that the technical "out" for the jury in this case, that somebody else followed Mr. Husel's orders, or did Mr. Husel deviate from normal policy by directly giving meds, and if so did he get the meds without following policy? I tend to think the latter, because an order for an "elephant dose" of fentanyl should have tripped some alarms in the ordering system.
2. While Mr. Husel may have gotten away from the criminal charges, I'd bet he's going to be facing some civil litigation.
3. It seems that in these "gray" areas of near death, there is a zone where the body transitions from a single complex organism to become a group of independent organ systems which may in themselves be living, but can no longer interrelate as part of a single human person. This seems like something that is extraordinarily difficult to qualify and quantify. I don't envy the task of an ethicist these days.
side note: do you *have* to link to paywalled sources?
It looks like a bunch of civil wrongful-death lawsuits already happened in 2019 resulting in settlement and payout by the hospital system. I would hope that other hospital systems might assess the risk/benefit of detecting and preventing this kind of behavior after the first wrongful death (detecting would not be hard since it was allegedly contrary to hospital policy, and presumably a software system could alert on policy violations for pharmaceuticals even if it's not possible to detect that a guy keeps verbally advising families to DNR; but, then one has to have the appetite to do something about it, which cannot be solved in software), instead of having to fire a guy and then pay out a few million dollars to families of the people that he had killed during the several years he worked there.
The question of brain death is like the question of lying. We all know that lying is bad, but it is not difficult to think of some situation, such as the Underground Railroad, where lying might be good. There are some theologians and philosophers who say that even in that circumstance, lying is still bad. Others say that lying to save another's life is good. This is a reasonable debate. But what is definitely wrong is the centuries of casuistry which spoke of mental reservation and equivocation. If lying can be an act of love, then we admire and praise the best liar. If you are hiding people from slavers, and you are going to lie, lie well. Don't use mental reservation; don't equivocate. Just lie, and lie convincingly.
So also with organ transplants. It is possible to argue that heart transplantation is always wrong. Transplanting kidneys or corneas is fine, but taking out someone's heart might be always wrong. But if it isn't wrong, then do it well. There must be no tricks about neurological activity or clamps or balloons. Come up with a valid definition of when it is okay to take out a human heart, then take it out in such a way that the heart transplant has the greatest chance of success: still beating, if that is what actually works best.
It would seem that to validly transplant a heart, you would have to be 100% sure that the donor was done with it. A valid definition of death does not need to be about neurological criteria nor about the heart not beating. A real definition of death has to do with the conscious experience of the person being related to the sense experience of the body. A person is dead when they do not and never will again consciously experience sense data. But we do not understand the link between body and soul well enough to know when that happens, and we certainly cannot tell the future, at least not until the body is far past the possibility of heart transplants.
One of the answers is to make the process as open as possible. The more we treat it like abortion, a hidden medical procedure, the more that we will justify bad things as a society. Clamps and balloons are like this, merely trying to hide what should not be hidden. We do not need some kind of definition of death that relies on hiding signs of life. Let the reality be shown and then let us consider whether what we are seeing is an act of love or not.
Jesus uses sleep and death interchangeably, which suggests that they are more related than we realize, and since we believe in the resurrection of the body, we all will wake up from that final sleep.
So if a person dies in their sleep, and did not wake up before dying, it would, in a manner of speaking, be correct that they died when they went to bed that night. But this is complicated by the fact that dreams are a form of sense data, and we do consciously experience dreams while we sleep.
You changed "will not" to "cannot" and added "naturally" but someone who is unconscious via anesthesia for a surgery will not "naturally" wake up, but they are not dead, and someone whose heart has stopped but it will be restarted by CPR cannot naturally wake up, but they are not dead since they can be woken up. "Will not" is a statement about the future, so it has the advantage of being testable. If someone wakes up, then at the earlier point in time they were definitely not dead.
But putting "will not/cannot" and "naturally" aside, the rest of the definition is just the normal definition of being alive/awake. The point is that we should not rely on symptoms of life, such as neurological activity, when what we actually mean is life. No one would care if somehow they had no neurological activity but continued to consciously experience the world. Of course, that is probably impossible, but by focusing on the thing itself rather than on one symptom, we avoid the equivocation that the article is talking about.
But that is the problem exactly. If a person is unconscious, not sleeping/dreaming but actually unconscious, and there is certainty that they will never recover consciousness, no matter what we do, then it is time to take out their heart for a transplant. It would not be murder. But how can we possibly know that a person is not conscious, not even dreaming? And how can we be sure that the person will not regain consciousness?
This threshold state, totally unconscious and never going to regain consciousness, in a pre-medical society is perhaps only momentary, but modern technology has created a situation where it could last long enough to remove organs for a transplant. It certainly is not true that someone in the threshold state must be treated the same as someone in a different state. In a pre-medical situation, we would just pray. But something that causes someone in the threshold state to cross the threshold into death is not murder.
Death is just not a bright line when dealing with modern technology.
That patient is not in the threshold state, but yes, if an earthquake strikes in the middle of surgery such that the patient dies on the table, then their last moment of life was not in the middle of surgery but rather the experience of being put under anesthesia.
The essential point for heart transplants is that once a patient enters the threshold state, we should not be concerned about technicalities. If it is ethical, than take out the heart of anyone in the threshold state, regardless of any supposed signs of life. If it is unethical, then wait until after rigor mortis clears before removing any organs.
Great point on openness. That is the ultimate key, the solution to these ethical dilemmas in my view. If we cannot be transparent why not? I think the answer is because there are hidden agendas at play. Money, power whatever. Fallible people fall prey. What’s acceptable to the Establishment broadens to the rest of us, evidenced by the Husel verdict. Interesting that Nurse Vaughn in Tennessee will be going to prison for accidentally causing a death. While Husel is free after intentionally killing people in his care.
Thanks to Dr. Ely and Mr. Camosy for this conversation.
Is there an agreed upon standard of death that is “accurately” and not “loosely” defined that we as Catholics could use in end of life instructions or in our medical powers of attorney?
Several years a family in our community lost a three year old son. The family decided to donate his organs. However, the experience shared by the family of the son leaving the mother, while seemingly still alive, for organ harvesting haunted many friends and caused several to change previous decisions to donate organs.
An agreed upon named standard (“I will donate organs in accordance with the X standard”) endorsed by faithful, Christian ethicists could be helpful. Or perhaps this already exists?
As a Catholic Neurologist, the issue of brain death hits home for me. I have declared people brain dead many times. Each time it is quite a burden to bear, to be the one that in some sense "kills" a person that to many still appears quite alive. They are obviously on a ventilator, but other than that they can have fairly healthy looking skin and not be hooked up to too many other things. I rail against those that would try to hurry the process of declaring brain death. There are well publicized standards that have been used for years; all neurologists (and many other types of doctors) are trained in how to do this.
The issue of "whole brain" death is one we are still struggling with. Parts of the brain (as described in this article) may well still be functioning when people are declared brain dead. But that really only matters depending on how you define the "brain" correct? Where do you cut the line of brain vs not brain? Deciding this based on anatomy is one way, based on function another, based on blood supply another. Usually it doesn't really matter; if someone has a problem with some part of their body we deal with it despite the naming system. We could change the name of something without changing "it" in a sense (pluto is still a planet!). So, we could just define the pituitary and hypothalamus (another part that often times remains functioning) as "not brain" and get around the issue. Or we could just say brain death doesn't have to worry about parts of the brain that aren't part of making "you" you.
There is a US based task force that is looking at the nation law (the Uniform Determination of Death Act) so stay tuned
A few thoughts arise while reading this:
1. According to my source (the missus), in this hospital setting, doctors don't typically directly administer meds; they place orders, the pharmacy delivers the meds and then a nurse will give the meds, particularly with schedule drugs. Was that the technical "out" for the jury in this case, that somebody else followed Mr. Husel's orders, or did Mr. Husel deviate from normal policy by directly giving meds, and if so did he get the meds without following policy? I tend to think the latter, because an order for an "elephant dose" of fentanyl should have tripped some alarms in the ordering system.
2. While Mr. Husel may have gotten away from the criminal charges, I'd bet he's going to be facing some civil litigation.
3. It seems that in these "gray" areas of near death, there is a zone where the body transitions from a single complex organism to become a group of independent organ systems which may in themselves be living, but can no longer interrelate as part of a single human person. This seems like something that is extraordinarily difficult to qualify and quantify. I don't envy the task of an ethicist these days.
side note: do you *have* to link to paywalled sources?
It looks like a bunch of civil wrongful-death lawsuits already happened in 2019 resulting in settlement and payout by the hospital system. I would hope that other hospital systems might assess the risk/benefit of detecting and preventing this kind of behavior after the first wrongful death (detecting would not be hard since it was allegedly contrary to hospital policy, and presumably a software system could alert on policy violations for pharmaceuticals even if it's not possible to detect that a guy keeps verbally advising families to DNR; but, then one has to have the appetite to do something about it, which cannot be solved in software), instead of having to fire a guy and then pay out a few million dollars to families of the people that he had killed during the several years he worked there.
The question of brain death is like the question of lying. We all know that lying is bad, but it is not difficult to think of some situation, such as the Underground Railroad, where lying might be good. There are some theologians and philosophers who say that even in that circumstance, lying is still bad. Others say that lying to save another's life is good. This is a reasonable debate. But what is definitely wrong is the centuries of casuistry which spoke of mental reservation and equivocation. If lying can be an act of love, then we admire and praise the best liar. If you are hiding people from slavers, and you are going to lie, lie well. Don't use mental reservation; don't equivocate. Just lie, and lie convincingly.
So also with organ transplants. It is possible to argue that heart transplantation is always wrong. Transplanting kidneys or corneas is fine, but taking out someone's heart might be always wrong. But if it isn't wrong, then do it well. There must be no tricks about neurological activity or clamps or balloons. Come up with a valid definition of when it is okay to take out a human heart, then take it out in such a way that the heart transplant has the greatest chance of success: still beating, if that is what actually works best.
It would seem that to validly transplant a heart, you would have to be 100% sure that the donor was done with it. A valid definition of death does not need to be about neurological criteria nor about the heart not beating. A real definition of death has to do with the conscious experience of the person being related to the sense experience of the body. A person is dead when they do not and never will again consciously experience sense data. But we do not understand the link between body and soul well enough to know when that happens, and we certainly cannot tell the future, at least not until the body is far past the possibility of heart transplants.
One of the answers is to make the process as open as possible. The more we treat it like abortion, a hidden medical procedure, the more that we will justify bad things as a society. Clamps and balloons are like this, merely trying to hide what should not be hidden. We do not need some kind of definition of death that relies on hiding signs of life. Let the reality be shown and then let us consider whether what we are seeing is an act of love or not.
Jesus uses sleep and death interchangeably, which suggests that they are more related than we realize, and since we believe in the resurrection of the body, we all will wake up from that final sleep.
So if a person dies in their sleep, and did not wake up before dying, it would, in a manner of speaking, be correct that they died when they went to bed that night. But this is complicated by the fact that dreams are a form of sense data, and we do consciously experience dreams while we sleep.
You changed "will not" to "cannot" and added "naturally" but someone who is unconscious via anesthesia for a surgery will not "naturally" wake up, but they are not dead, and someone whose heart has stopped but it will be restarted by CPR cannot naturally wake up, but they are not dead since they can be woken up. "Will not" is a statement about the future, so it has the advantage of being testable. If someone wakes up, then at the earlier point in time they were definitely not dead.
But putting "will not/cannot" and "naturally" aside, the rest of the definition is just the normal definition of being alive/awake. The point is that we should not rely on symptoms of life, such as neurological activity, when what we actually mean is life. No one would care if somehow they had no neurological activity but continued to consciously experience the world. Of course, that is probably impossible, but by focusing on the thing itself rather than on one symptom, we avoid the equivocation that the article is talking about.
But that is the problem exactly. If a person is unconscious, not sleeping/dreaming but actually unconscious, and there is certainty that they will never recover consciousness, no matter what we do, then it is time to take out their heart for a transplant. It would not be murder. But how can we possibly know that a person is not conscious, not even dreaming? And how can we be sure that the person will not regain consciousness?
This threshold state, totally unconscious and never going to regain consciousness, in a pre-medical society is perhaps only momentary, but modern technology has created a situation where it could last long enough to remove organs for a transplant. It certainly is not true that someone in the threshold state must be treated the same as someone in a different state. In a pre-medical situation, we would just pray. But something that causes someone in the threshold state to cross the threshold into death is not murder.
Death is just not a bright line when dealing with modern technology.
That patient is not in the threshold state, but yes, if an earthquake strikes in the middle of surgery such that the patient dies on the table, then their last moment of life was not in the middle of surgery but rather the experience of being put under anesthesia.
The essential point for heart transplants is that once a patient enters the threshold state, we should not be concerned about technicalities. If it is ethical, than take out the heart of anyone in the threshold state, regardless of any supposed signs of life. If it is unethical, then wait until after rigor mortis clears before removing any organs.
Great point on openness. That is the ultimate key, the solution to these ethical dilemmas in my view. If we cannot be transparent why not? I think the answer is because there are hidden agendas at play. Money, power whatever. Fallible people fall prey. What’s acceptable to the Establishment broadens to the rest of us, evidenced by the Husel verdict. Interesting that Nurse Vaughn in Tennessee will be going to prison for accidentally causing a death. While Husel is free after intentionally killing people in his care.
Thanks to Dr. Ely and Mr. Camosy for this conversation.
Is there an agreed upon standard of death that is “accurately” and not “loosely” defined that we as Catholics could use in end of life instructions or in our medical powers of attorney?
Several years a family in our community lost a three year old son. The family decided to donate his organs. However, the experience shared by the family of the son leaving the mother, while seemingly still alive, for organ harvesting haunted many friends and caused several to change previous decisions to donate organs.
An agreed upon named standard (“I will donate organs in accordance with the X standard”) endorsed by faithful, Christian ethicists could be helpful. Or perhaps this already exists?
As a Catholic Neurologist, the issue of brain death hits home for me. I have declared people brain dead many times. Each time it is quite a burden to bear, to be the one that in some sense "kills" a person that to many still appears quite alive. They are obviously on a ventilator, but other than that they can have fairly healthy looking skin and not be hooked up to too many other things. I rail against those that would try to hurry the process of declaring brain death. There are well publicized standards that have been used for years; all neurologists (and many other types of doctors) are trained in how to do this.
The issue of "whole brain" death is one we are still struggling with. Parts of the brain (as described in this article) may well still be functioning when people are declared brain dead. But that really only matters depending on how you define the "brain" correct? Where do you cut the line of brain vs not brain? Deciding this based on anatomy is one way, based on function another, based on blood supply another. Usually it doesn't really matter; if someone has a problem with some part of their body we deal with it despite the naming system. We could change the name of something without changing "it" in a sense (pluto is still a planet!). So, we could just define the pituitary and hypothalamus (another part that often times remains functioning) as "not brain" and get around the issue. Or we could just say brain death doesn't have to worry about parts of the brain that aren't part of making "you" you.
There is a US based task force that is looking at the nation law (the Uniform Determination of Death Act) so stay tuned