Joseph Maraachli, Medical Ethics, and Making Sense

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Update (March 14, 2011)

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As I finished this post (8:11 p.m. February 28, 2011 Central Time, 2:12 a.m. March 1, 2011, UTC), a new development in Joseph Maraachli's situation:

"The Canadian hospital under fire for ordering parents to remove their young son from life support because he is a vegetative state has backed down and agreed to one of the family's requests: to let the boy die at home.

"London Health Sciences Centre in London, Ontario, issued a statement Monday afternoon saying that it will bring 13-month-old Joseph Maraachli to his family's home, but it then insists that staff members remove the boy from a respirator, possibly giving him only minutes more to live, the London Free Press reported.

" 'London Health Sciences Centre is and always has been willing to organize and pay for a medical transfer home to Windsor (where the family lives) for Baby Joseph, accompanied by LHSC physicians and staff,' the hospital said.

"But the hospital still will not agree to the parents' request to perform a tracheotomy on Joseph, a measure the hospital calls needlessly invasive but the family has said helped their older child who suffered a similar condition live another six months...."
(FoxNews.com)

Since they were going to let the boy die, I think it was rather considerate of the hospital to let him go home - even paying for the trip.

Particularly since watching Joseph Maraachli die might have given them material for an article in a medical journal. Cynical? Maybe. It wouldn't be the first time a doctor took advantage of an interesting lab specimen that came along. (February 3, 2009)

This is probably the best outcome that the Maraachli family could hope for, contemporary medicine's standards being as they are.

Now, the post as written before the latest development.

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Before getting started, a sort of position statement. I think:

• Medical ethics shouldn't be an oxymoron - a contradiction in terms
• It'd be nice if everybody enjoyed perfect health

And - a point I'll get back to - I think it's a bad idea to threaten a hospital. Even a hospital that seems to be doing something wrong.

Excerpt from today's news:

"The Canadian hospital at the center of the 'Baby Joseph' controversy finds itself on the receiving end of threats sent via email and phone calls, reported the Toronto Sun. Many of these threats have been said to come from the U.S....

"...The hospital went on to say that it is working closely with police and have taken the 'necessary steps' to protect its staff and physicians.

"The uproar comes after Joseph Maraachli, 13 months old, who is currently kept alive by a respirator, was denied a transfer to a Michigan hospital to undergo a tracheotomy. [NOTE: THE DENIAL OF TRANSFER CAME FROM THE MICHIGAN HOSPITAL, NOT THE ONE IN ONTARIO]

"The boy suffers from a rare, progressive neurological disease which, Canadian doctors say, has left him in a vegetative state beyond recovery....

"...Police are investigating some of the threats he called serious enough they could break the law.

"Many of the threatening comments have come from the U.S., [London, Ontario, police Deputy Chief Ian] Peer said.

" 'South of the border people seem to be quite emotional and happy to share their opinions.'...

"...Canadian health care allocation officials already ruled that Joseph had to be taken off life support and allowed to die in the hospital."
(FoxNews.com) (emphasis and [inserted text] mine)

Daft Attitudes: Not An Option

There are quite a few ways I could go, commenting on this article.

Loony Liberal

If I was one sort of knee-jerk liberal, I could declaim on the violent tendencies of this country's white-racist-male-dominated-authoritarian-oppressor government. Or maybe not. I'm not sure what the current fashion is.

Counter-Culture, It's Not What You May Think

I'm part of a counter-culture, so that's out. I never thought political correctness made much sense, anyway. (Counter-culture? I'm a practicing Catholic: and that's 'way out of the American mainstream. (January 12, 2010))

Crackpots by the Barrel

I could rant and rave about somebody else: Hollywood liberals; or some conspiracy that's 'really' running the world. But that doesn't seem like a good idea. I'll get back to that, too. Speaking of conspiracy theories, I don't take them seriously: but they've got some entertainment value. One of my favorites involves space-alien, shape-shifting lizard people. And I'm getting off-topic again.

Joseph Maraachli and Family

As for Joseph Maraachli and his family? They're going through a lot of stress just now. My wife and I lost two children - and just about lost her, too, when the latest one died. That's tough, even when they die quickly. What young Joseph is going through, I think, is probably harder to handle.

They have my sympathy. And, more to the point, I think, my prayers.

Contemporary Medicine, Rules, and Ethics

The hospital in Michigan may have a reasonable motive for refusing to treat young Joseph. Ontario hospitals may have reasonable motives for letting some patients die. I don't know, one way or the other.

One thing I do know is that we've got ethical concerns today that weren't on the radar a century or two back.

Medical Technology: A Mixed Blessing

I've discussed contemporary medical technology before. (September 22, 2009) It's a mixed blessing, in my view. We're able to keep people alive much longer than we could in the 'good old days.' The problem is that we can keep parts of people alive even longer.

I'm not against supporting the functions of a person's organs. I'm around today in large part because a hospital was able to take my digestive system offline for a few weeks while repairs got done. Technologies like artificial kidney dialysis help folks live longer, better lives.

The problem is that the question of just when parts of a person stop being that person isn't limited to philosophical speculation any more. Young Joseph's family is struggling with that question now - or, rather, struggling with doctors who seem to have made their decision.

As for that 'vegetative state' - I'll get back to that.

The Catholic Church has - what else? - rules about using medical technology.

Killing Granny's Out, Painkillers are Okay

Euthanasia is not acceptable. (Catechism of the Catholic Church, 2277) I can't kill a member of my family 'for their own good.' Not and follow Catholic teaching. American law - but that's almost another topic.

Would the Church make me keep a member of my family hooked up to life-support equipment indefinitely, even though there was no hope of recovery? At all?

First, the Church can't "make" me do anything. I can abandon the Church's teachings any time I want. Just as someone on a cruise ship can voluntarily go overboard in mid-ocean. I don't think either is a good idea. And that's yet another topic.

In secular terms, the Catholic Church does not have the coercive power that even a county government does, here in America. I've discussed - imaginative? - end-times preaching about the Catholic Church elsewhere. (November 12, 2008)

Second, although you've probably met a Catholic or two who's a few tacos short of a combination plate, the Catholic Church is almost coldly practical. Which suits me just fine. If I wanted a church that gave me an emotional buzz, plus cool music, I'd probably be a Southern Baptist. Good grief - more topics.

About keeping someone's body going 'artificially:'

"Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of 'over-zealous' treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected."
(Catechism, 2278)

So, the Church says that I will have to suffer terrible, agonizing, excruciating pain: instead of having someone kill me?

No.

The next paragraph specifically says that painkillers are okay.

"...The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable...."(Catechism, 2279)

As I've said before, it's no wonder that some folks think we're 'vague' on issues.

I'll take that sort of 'vague,' built on nearly two millennia's experience with humanity's condition, any day.

By the way, paragraph 2279 is a very personal, practical matter for me. Before he died, my father breathed with the help of some high-tech equipment (which extended his life) and morphine (which shortened his life). Used together, the gadgets and drugs kept him alive a bit longer than he would have lived, otherwise - and made him more comfortable, by far, than he'd have been without either.

We'd discussed the matter, I agreed with his decision, and happily we were dealing with a really fine set of medical people. (September 22, 2009)

Back to young Joseph.

'Vegetative State,' and Napping in the Lobby

That phrase, "vegetative state" has been applied in quite a number of ways: generally, it seems, as a reason for killing someone. I'm aware that medical conditions can make folks unfit for playing hockey or driving a car - or even conversing with their relatives.

I'm also aware that folks in a "persistent vegetative state" have gotten up and walked out of the hospital - when someone decided to let them live.

Then there was the woman who died - doctors said so - but whose sons wouldn't play along. She woke up a little later. (October 22, 2010)

I've quipped that there are some hospitals where I wouldn't dare fall asleep in the lobby. Almost another topic, again.

'Support Peace, Or I'll Kill You!'

A few years ago, in another blog, I posted a few opinions about peaceniks who were anything but peaceful in their words and actions.

Clarification Time

I'm no pacifist, but I think that peace is nice. And certainly preferable to war. We've been hearing about the Beatitudes at Mass, and my Lord obviously has high regard for those who seek peace:

"Blessed are the peacemakers, for they will be called children of God."
(Matthew 5:9)

So, Jesus is a pacifist? Or a warmonger?

No. Not in my opinion. Or, more to the point, according to His Church. I've mentioned the just war doctrine before. (June 7, 2009) (and see Catechism, 2307-2311)

Again, not vague. Practical and principled, yes: vague, no.

About the 'peace or I'll kill you' folks? I think they may have let their feelings trump their reason.

Not that I'd hope to convince a zealot - and that's not quite another topic.

Emotions, Reason, and Making Sense

Particularly since Canadian police say they're investigating the threats, I'm inclined to think that the Ontario hospital really did receive threatening statements. I'll concede that some may have come from America. Quite a few folks live here, and some - in my opinion - are more passionate than wise.

Although I deplore the way that contemporary medical professionals have rewritten the Hippocratic Oath so that they can kill inconvenient or 'unfit' patients: I do not think that threatening a hospital is a good idea.

For one thing, there's a moral aspect to making threats against a hospital - or a doctor - or anybody else. In my opinion. That's because the threat of injury or death is awfully close to kidnapping, hostage taking, and terrorism. Which are strictly off-limits, according to the Catholic Church. (Catechism, 2297)

For another, I think that, even by Machiavellian standards, supporting the sanctity of life by threatening death or bodily harm is counterproductive.

Putting it another way, saying you'll kill someone if they don't value life is like shooting yourself in the foot: You can do it, but it hurts you more than the other fellow.

I've written about emotions, reason, and why I try not to think with my glands before.

Posts about:

• Emotions and thinking straight
  • "Apathy is Rampant, But Who Cares? - The Sequel"
    Apathetic Lemming of the North (February 7, 2011)
  • "Hating People: Not a Good Idea"
    (January 22, 2010)
  • "Anger, Hate, Love, Prayer and Trashing a Maywood, California, Catholic School"
    (May 26, 2010)
  • "Pro-Life Americans Declared Terrorists: It Can't Happen Here?"
    (July 6, 2009)
  • "Emotions, the Frontal Cortex, The War on Terror, Anarchists, and the Illuminati"
    Another War-on-Terror Blog (December 23, 2008)
• Actions not matching the message
  • "Dr. George Tiller's Killer Sentenced"
    (April 2, 2010)
  • "Gimme Peace, or I'll Punch Your Kid"
    Another War-on-Terror Blog (April 25, 2008)
  • "Embrace Peace or I'll Kill You! Violent Peace Lovers (Not) in the News"
    Another War-on-Terror Blog (March 26, 2008)
  • "Embrace Peace or I'll Kill You! More Violent Peace Lovers"
    Another War-on-Terror Blog (March 7, 2008)
  • "Embrace Peace or I'll Kill You! Times Square Blast Linked to Peacenik(s)"
    Another War-on-Terror Blog (March 6, 2008)
• Mostly medical
  • "Remember: 'Clinically Dead' isn't 'Dead' "
    (October 22, 2010)
  • "Death, Dying, Dignity, Intravenous Tubes and Catholic Teachings"
    (September 22, 2009)
  • " 'Hand of Hope' Spinal Bifida Case - Eugenics, Ersatz Compassion, and Life"
    (May 6, 2009)

In the news:

• "Canadian Hospital Agrees to Let Boy in Vegetative State Die at Home"
  FoxNews.com (February 28, 2011)
• "Canadian Hospital Reportedly Receiving Threats Over 'Baby Joseph' "
  FoxNews.com (February 28, 2011)