Dr. Orient's article is a warning to all those that scoff at the notion of death panels in health care decisions. Before Obamacare the protocols for terminating certain patients by refusing care were already in place. Just as heresy builds upon heresy these protocols will be further refined and used to save money.
"In Texas, hospitals can refuse to perform “futile” care, even if it as simple as hydrating a patient. The hospital, or perhaps a court, determines when someone’s care becomes futile. Care that effectively prevents death, while failing to restore a patient to productive life, may be deemed futile. It does not, after all, help us achieve the goal of improving “population health.” In fact, it diminishes the overall health score." - Dr. Orient
So we have a subjective standard; "productive life", that will be decided by an individual, or group of individuals either in a courtroom or a hospital. As the costs mount for mandated government health care the new defense of mandated care will be how much more the health of Americans has improved. In an ironic way that will be true since the seriously ill who can no longer lead a "productive life" will be denied care. It is like legalizing bank robbery and then pointing out that individuals are no longer committing the crime of bank robbery.
"In California, it is actually against the law to do surgery on a dead patient, including a brain-dead patient, such as one who was recently referred to as “dead, dead, dead, dead.” A surgeon who did so could lose his hospital privileges, his medical license, and even his liberty. The exception, of course, is to harvest still-living organs for transplantation. Indeed, the organ shortage is the reason the concept of “brain death” was developed." - Dr. Orient
Read the Reuters article on Jahi McMath.
Was Jahi McMath the 13 year old girl from Oakland, California really brain dead?
"Besides the cost of care or the need to free up a bed, there may be other reasons why a hospital needs a patient to be dead. If a patient is in a coma after a surgical complication, a malpractice suit is likely. Tort reform may limit recovery for pain and suffering if the patient dies, but there are no limits on the cost of lifetime care." - Dr. Orient
So there is now a financial reason for the hospital to get Jahi out of the building and buried as soon as possible.
"A brain-dead patient is not in the same situation as the Terri Schiavo saga. Although in a persistent vegetative state for 15 years, no one ever suggested that Schiavo was brain-dead. The controversy was over whether she had some awareness. If allowed, she could have lived for years longer with a feeding tube and nursing care." - Dr. Orient
"This is not true of a brain-dead patient. The hospital need not worry about having the patient on a ventilator for weeks or months. Two days is about the maximum. The patient rapidly loses the ability to regulate body temperature, blood pressure and other basic functions. The temperature may fluctuate wildly, and then the body soon assumes room temperature, where metabolic activity cannot occur.
If this does not happen, the patient is not brain-dead. The definitive test is an arteriogram or nuclear medicine scan that demonstrates absence of blood flow. This test is seldom done. Instead, doctors rely on absence of detectable neurologic functions, such as brainstem reflexes or brain waves. Cells that are not able to function in this way may yet be alive, able to maintain their structural integrity — and potentially recover." - Dr. Orient
Jahi has lived more than the two days that Dr. Orient cites as proof that a patient is not brain dead. Dr. Orient would certainly be the surgeon I would choose if I needed one.
http://www.reuters.com/article/2013/12/31/us-usa-braindead-california-idUSBRE9BT0PX20131231
http://www.washingtontimes.com/news/2014/jan/9/orient-a-return-to-back-alley-medicine/
