How would you judge this case?

[Neil D]

As girl hangs on to life, where are all the plug-pullers?

By MICHELLE MALKIN

I have a question for the hordes of bleeding-heart Hollywood stars who joined the "Save Tookie" brigade, who bowed their heads in prayer with ex-Crip gangster Snoop Dogg and the Rev. Jesse Jackson and pleaded to protect convicted Death Row murderer Stanley "Tookie" Williams, and who lobbied so hard for the government to err on the side of life.

Where are you now?

In Boston, an innocent girl was sentenced to death by the state. Her name is Haleigh Poutre. Last fall, she was hospitalized after her stepfather allegedly burned her and beat her unconscious with a baseball bat. Haleigh was kept alive by a feeding tube and ventilator. Doctors said she was "virtually brain dead." They said she was in a "persistent vegetative state." The medical professionals pronounced her "hopeless."

Less than three weeks after Haleigh's hospitalization, the Massachusetts Department of Social Services was raring to remove Haleigh's feeding and breathing tubes. Even her biological mother (who had been deemed unfit to care for Haleigh and whose former boyfriend was accused of sexually abusing the child) wanted her to be put to death. The only person who wanted Haleigh alive was her stepfather, who will likely be charged with murder if Haleigh dies.

Earlier this month, the Massachusetts Supreme Court ruled in favor of killing Haleigh, saying it was "unthinkable" to give the power to make a life-and- death decision to the man accused of putting Haleigh in a coma. Instead, the court did something just as unthinkable: It handed that power over life and death to the same child welfare agency that had failed time and time and time again to protect Haleigh from her abusers in the first place.

According to the Boston Herald, a report by her court-appointed guardian showed that the Department of Social Services had received 17 reports of abuse or neglect involving Haleigh in the three years before her adoptive mother and stepfather were charged with pummeling her into a coma.

"State can let beaten girl die," the headlines trumpeted. But there was just one small complication for all of those who, for whatever reason, were in such a rush to "let Haleigh die":

Haleigh is fighting to live.

As state officials prepared to remove Haleigh's life support, the supposedly impossible happened. She began breathing on her own, responding to stimuli and showing signs of emerging from what the medical establishment had deemed her hopeless condition. Everyone had given up on Haleigh — except Haleigh. "There has been a change in her condition," announced a DSS spokeswoman, Denise Monteiro. "The vegetative state may not be a total vegetative state."

Unbelievably, the state had weaned Haleigh off her breathing tube before the state Supreme Court had made its ruling — but the government failed to inform the court of the development. Haleigh's medical records and the social service agency's brief remain sealed.

Politicians in Massachusetts are vowing full-scale investigations of the state's incompetent child welfare bureaucrats.

But where's the accountability for the medical experts whose faulty diagnosis led to Haleigh's court-approved death sentence? Will they step forward and reveal themselves? Will they explain how they erred? Will they apologize?

It was The Experts' unequivocal assessments that led the court to declare Haleigh in "an irreversible vegetative state" and to assert that "the child could not see, hear, feel or respond." Now, they admit they were wrong. And now, Haleigh's life depends on the whims of a hopeless government agency that didn't think the court needed to know that the child was breathing on her own.

Haleigh's story is a wake-up call to "right-to-die" ideologues who recklessly put such unlimited trust in the medical profession and Nanny State. With such uncertainty surrounding persistent vegetative state diagnoses, the presumption must be in favor of life. Yet, the "right-to-die" lobby's mantra seems to be: When in doubt, pull it out.

While Haleigh clings to life, I've pondered how we might help persuade the plug-pullers to put off the child's state-sanctioned death sentence. I propose nominating her for a Nobel Prize. It bought Tookie Williams five extra years.

Jamie Foxx and Susan Sarandon, will you join me?

Malkin is a nationally syndicated columnist based in North Bethesda, Md.

[:"blue"] Is this a case where the courts are failing this person? Is this another "Terri Shavio"? What are your thoughts on this? [/]

[Gregory Matthews]

1) Re: "As state officials prepared to remove Haleigh's life support, the supposedly impossible happened. She began breathing on her own, responding to stimuli and showing signs of emerging from what the medical establishment had deemed her hopeless condition."

This situtaion is not unkknown. I have seen people removed form Vents who began to breath on thier own, and in some cases permantly breathed on their own. We in medicine cannot predict with 100% certainty what the person may do if removed from a so-called "life-support" machine. It happens.

It should also be noted that one can be in a PVS, and breathe on their own. PVS does not require that one be unable to breathe on their own.

2) Some may misunderstand what it takes to diagnose a PVS. The bottom line is that medical personel may not be able to make the diagnosis with good accuracy, for a period of time.

I will give you an example, but to protect the privacy of involved people I will disguise thier identity.

Sarah was involved in an industrial accident that caused her to enter into a comotose state. The doctors examined her, and informed family members that she appeared to be in a PVS, and that the family should consider removing so-called life support measures which would result in her death.

The family stated that they would give Sarah more time, and that they wanted life-support to continue. As is typical for people on a Vent, Sarah was periodicly removed to see is she could breath on her own. She failed several times and was again placed on a Vent. But, one time she was able to breathe on her own, and does so to this day.

At this time, family and friends were informed that she was still considered to be in a PVS, but obviously was going to continue to breathe on her own.

Today, Sarah is living in a family home, talking, walking, out in society, and shows signes of intelligent thought.

What went wrong with the diagnosis of PVS? Very simple, that diagnosis was provisional. The doctors, due to her medical condition, were not able to conduct the medical tests that would have povided objective evidence to support their provisional diagnosis. After a period of time her medical condition stabalized, and the objective tests showed that Sarah was not in a PVS.

The reality is that Sarah is going to live. But, it is unknown what the future holds, and the life that she will have.

On a personal note:

I have a close relative who was seriously injured as a teen. He spent 20 years in rehab! And during many years of that, his life was what some would describe as [deleted by me]. Today, he is married, owns his home, recieving top grades in a college program.

By the way, thank you Wall-Mart for hiring him at a time he was in a wheel-chair, and disabled. He no longer needs assistance to walk.

[Gregory Matthews]

1) Re: "Earlier this month, the Massachusetts Supreme Court ruled in favor of killing Haleigh, saying it was "unthinkable" to give the power to make a life-and- death decision to the man accused of putting Haleigh in a coma."

One-hundred per-cent correct. One who has such power must be seen as one who will act in the best interest of the person. The one who put her in that coma cannot act in that manner.

2) Re: "Haleigh is fighting to live."

What is life? That is a fundamental question that we who work in medical ethics, and make such decisions face.

Is life simply a mechanically beating heart, and lungs that respire. Or, is life something that has quality?

I beleive that "life" has a quality to it, and without quality, it is not life.

3) "In Boston, an innocent girl was sentenced to death by the state."

No, she was sentenced to death by the person who put her in that medical condition.

4) Artificial means of beating a heart, or pumping blood are good when they allow a body to recover and resume function. But, beyond that, they simply prolong the attempt of the body to die. Their withdrawal only allow the body to do what it is naturally attempting to do. Death is a natural part of life.

[Gregory Matthews]

1) We cannot predict exactly what will happen when we stop some kind of medical treatment. We may remove a person from a Vent, and expect them to die within five hours. That person may die in less time, they may live for 12 hours, one day, or three months. Typically, we are not far off in our assessment. But, we do not know. They may permantly begain to breathe.

2) I sit on a hospital ethics committee. We make recommentdations to send people to surgery under great risk to the patient, to remove them from so-called life support, and to effect other decisions. We do this because we beleive that there are times when we have no other choice, and someone has to decide. We make those recommendatiosn without perfect knowledge. Often there are no easy answers.

Let me give you an example: Ruth came into our hospital. She was bleeding internally. If we did not determine the source of that bleed, and stop it, she was going to die. We spent a great amount of time keeping her transfused, and alive, but cound not determine the source of that bleed, let alone stop it.

During that period of time we did not do one diagnostic evaulation as we beleived that Ruth had a good chance of dying during that proceedure. Finally, after a total failure with all else, we, the family, and Ruth, decided to do that proceedure. Ruth survived, and we determined the source of that bleed.

Now we knew that Ruth needed surgery to stop it. But, we beleived that there was a good chance that Ruth would either die during durgery, or be confined to a bed for the rest of her life if we did the surgery. Yet, she would die without it. In discussion with Ruth and her family we decided to do the surgery. However, we brought in a cardiologist to the opperating room to deal with potential issues. Ruth survived, and was restored to her baseline.

But, we faced an ethical issue in which all possible decisons that we could have made could have resulted in Ruth's death.

3) In a few days I will do a funeral for a family member. Recently we were told that she was expected to die within the next 14 days. She died on the 6th day. One evening my wife and I were visiting her. As I observed her, I told my wife, privately, that I expected her to die within the next 12 hours, and probably less. She lived another 36 hours. She had a short-term recovery, and then lasped into her final hours of life.

Folks, medical personnel do not know with 100% accuracy what will happen. We can only tell family what we think is probable.

Some of the ethical decisions that we make are extremely hard, problematic, and have no good solution.

[cricket]

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We can only tell family what we think is probable.

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...and we can pray.

[Bravus]

Two quick points, without really an agenda:

(1) Gregory has done a great job of outlining the complexities of these cases - and illustrating why simplistic slogan sets from eithre side of this debate are not useful.

(2) Are those on the 'right to life' side of the debate equally vociferous about adequate funding and support for the kind of child welfare and domestic violence support services that might have kept Haleigh alive and well? If not, why not?

[Neil D]

Gregory,

Just wanted to express my thanks to you for opening up this discussion on medical ethics. I also want to thank you for the excellent discussion on explaining issues dealing with medical ethics...And the fact that the medical arts, while accurate in many areas, is an ART. Art is not all that accurate as in we can not predict the exact time of death in an individual.

I also appreciate the discussion of what is concidered "life". Is a beating heart the criteria for life? More than once, I have been invovled in a cold water drowning of greater than 10 minutes with no heart beat, only to rescusitate them to a normal life. What about vegitative states? Quality life issues factor into the concept of "life". Thank you for those questions and insights.

I put up this article primarily for discussion of this very issue. The bottom line is, if you don't have a will, then make one NOW and fax it to your doctor, your local hospital.

I also put up this article so that others could see the type of thinking in some individuals...there is some very convoluted thinking out there regarding this, based upon some myth that is held as truth.

I also liked the question that Bravus put up-

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Are those on the 'right to life' side of the debate equally vociferous about adequate funding and support for the kind of child welfare and domestic violence support services that might have kept Haleigh alive and well? If not, why not?

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Tis a good question, and I see more non right to lifers supporthing domestic support services than right to lifers. Tis a shame and a sham.

[cricket]

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I see more non right to lifers supporthing domestic support services than right to lifers.

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I wonder if this is true overall, or if it has just been Neil's personal observation.

[Gregory Matthews]

Re: "I have been invovled in a cold water drowning of greater than 10 minutes with no heart beat, only to rescusitate them to a normal life."

Yes, as we both know the situation above does have a potential for revival to life.

[bonnie]

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Cricket said:

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I see more non right to lifers supporthing domestic support services than right to lifers.

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I wonder if this is true overall, or if it has just been Neil's personal observation.

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Interesting observation Cricket.

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I am also curious as to the two comments made by Bravus and Neil

What gives you, Bravus the idea that those that may favor the right to life are not as vociferous about adequete funding and support for child welfare and domestic violence? As you and Neil seem to have a very dim view of what those that favor "right to life' are willing to do, what have each of you done personally to aid abused children? Right to life can either mean the extreme end of the spectrum where no matter what the situation life must be sustained at all costs. Most "right to lifer's" I am acquainted with are not in the extreme camp. Just as most that advocate the right to die are not in the extreme camp of pulling the plug due to any and all handicaps.

What besides verbally supporting on a forum any and all tax hikes, no matter how recklessly used have you done for abused and battered children? How many have you taken into your homes?

Have you taken a battered woman into your home till adequete help could be obtained to keep her safe? How many marginally mentally handicapped children have you cared for? Would you judge it more expedient and kind to allow or advocate these marginal children be aborted in your right to die belief and your definition of quality of life?

Right to die advocates are no more likely to support preventive measures than right to life advocates. There are those on both sides of course that will just make noise without putting their money where their mouth is. That is hardly new. Whether it is this topic or religion or what have you. Or are we once again judging those that do not see things or issues our way.

Bonnie

[Bravus]

</font><blockquote><font class="small">Quote:</font><hr />

What gives you, Bravus the idea that those that may favor the right to life are not as vociferous about adequete funding and support for child welfare and domestic violence?

<hr /></blockquote><font class="post">

I don't have that idea, which is why I asked the question. No judgement implied, just the notion that the one implies the other. As to what I myself have done, I don't believe it's your business in detail but yes, I have put my own money and time where my mouth is.

[Neil D]

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Right to die advocates are no more likely to support preventive measures than right to life advocates

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Most R2D advocates are more interested in quality of life issues rather than the freedom to just die. And those that want the freedom to die are not listen to at all, as they are no better than fanatics ...or rabid individuals out for vengences.

As for my comment regarding :I see more non right to lifers supporthing domestic support services than right to lifers.: , that is my observation. Of course, I am in the medical field, whose population is interested in quality of life and subject to a limited view of a very select public. I meant no intention that MY VIEW was exclusively THE standard for all other views. Please forgive my lack of the phrase "IMO".

[bonnie]

Sorry, took it that was implied by your question. Did not mean you should list what you had done and should have specified that. Only questioned in regards to the question what others might be willing to do.

To often it is easy to take what seems to be the high road as long as you yourself, (general statement) don't intend to take the walk along that road.

Extremes on both sides are to be found and both sides are guilty of shame and sham as Neil stated. Most that truly care, either side actually go about their business quietly doing quite a bit. It is not necessary to characterize all "right to life" advocates as guilty of shame and sham as this sounded like. Anymore than it is either right or intelligent for me to claim all those that advocate "right to die" are just chomping at the bit to pull the plug for the slightest of reasons.

Bonnie

[bonnie]

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Neil D said:

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Right to die advocates are no more likely to support preventive measures than right to life advocates

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Most R2D advocates are more interested in quality of life issues rather than the freedom to just die. And those that want the freedom to die are not listen to at all, as they are no better than fanatics ...or rabid individuals out for vengences.

As for my comment regarding :I see more non right to lifers supporthing domestic support services than right to lifers.: , that is my observation. Of course, I am in the medical field, whose population is interested in quality of life and subject to a limited view of a very select public. I meant no intention that MY VIEW was exclusively THE standard for all other views. Please forgive my lack of the phrase "IMO".

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While I am not in the medical field as you are, a substanstial number of my immediate and extended family are. Do they all agree, NO, Of course Not. One thing they do agree on is the need for support and funding prevention of domestic violence and the abuse of children and including elder abuse. Being in the medical field they see entirely to much.

A cousin sets up hospice programs and obviously sees the ending of life, life that may not have had quality by her terms for a very long time. Two sons, nursing home administrators that see far more than you probably do of the ending of a life they may not believe has had value for a long time. DIL, geriatric nurse,my son is also a nurse. All are not "right to life"or right to die", but they all have one thing in common. They are interested in the quality of life as are their non-medical family counterparts.

It is not just the medical field that cares about the quality of life. Granted, it can be a very difficult decision for the family to be the one to decide to pull the plug. But, on the other hand, that decision should not be made by someone that has something to gain from the end result.

Bonnie

[bonnie]

Bravus,

As a add on to my post to you, the assumption I made was in part because there was not any type of question or doubt as to the integrity or the sincerity of those that advocate the "right to die" position. It seemed only to be towards those that advocated the "right to life" position and were they willing to do anything more than talk about it.

I saw nothing to indicate a question in your mind as to whether or not the other side would be as vociferous about adequete funding and support for child welfare and domestic violence as they are the "right to die"

Bonnie

[Neil D]

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One thing they do agree on is the need for support and funding prevention of domestic violence and the abuse of children and including elder abuse. Being in the medical field they see entirely to much.

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To which, I would agree whole heartedly.

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All are not "right to life"or right to die", but they all have one thing in common. They are interested in the quality of life as are their non-medical family counterparts.

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It is my understanding that people who view the quality of life issue as important also fall into the right to die catagory which is consistant to that philosophy. Right to life advocates, as many indian cultures, would espouse that quality of life doesn't matter, but all must be done, no matter what.

[bonnie]

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Neil D said:

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One thing they do agree on is the need for support and funding prevention of domestic violence and the abuse of children and including elder abuse. Being in the medical field they see entirely to much.

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To which, I would agree whole heartedly.

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It is my understanding that people who view the quality of life issue as important also fall into the right to die catagory which is consistant to that philosophy. Right to life advocates, as many indian cultures, would espouse that quality of life doesn't matter, but all must be done, no matter what.

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You are making assumptions that cannot be backed up. To even insinuate that "right to life" advocates do not have a concern over quality of life is as shortsighted as me saying all "right to die" advocates believe there is no quality of life to the handicapped.

Anyone that has spent weeks and months nursing a loved one thru their final days has the same ability for concern and compassion for their loved one and the quality of their life as you do, even if they are "right to life" advocates.

I am not of Native American culture, I am more right to life than right to die, and NO I do not believe in life no matter what. Nor do most of the "right to life" advocates I know personally. Most have the disagreement when it comes to making the decision as they see it to quickly, or determning for someone else what their quality of life may be. I don't know of anyone personally that believes or wishes to see those in a persistent vegetative state to be kept alive artificially. I do know of and I am one of those that believe they should not be allowed to starve to death if breathing on their own. I watched my FIL be starved to death and anyone that tries to tell me this is humane or concern over quality of life should try it for themselves for a few days.

You are also quite wrong when it comes to the statement "all must be done at all cost" concerning "right to life" advocates. After spending 24/7 with my mother who I absolutely adored during her final illness, I could tell you just how wrong you are, but will spare you the details. Many have been there and done that and are not nearly as callous to a loved ones suffering without hope as they are made out to be.

"Right to die" advocates come in the same shades as the other side. Sincere, misguided, shameful, part of a sham, hypocritical

and all the rest.

[Dr. Shane]

I do not see a conflict between favoring anti-abortion laws and right-to-die laws. I see the two as seperate issues just like capital punishment is a seperate issue. I believe the civil government shouldn't prevent a person from dying that has a fatal medical condition. My religious beliefs may not favor that but the issue certainly should be up to the idividual.

This case is as much about the problems of family protective services as the right to die. Children and families need to be protected. It makes sense to have the government protect them just as the government employs the police and fire departments. There obviously needs to be reform in our child and family protective services. Throwing more money at this is not likely the answer.

[Neil D]

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Anyone that has spent weeks and months nursing a loved one thru their final days has the same ability for concern and compassion for their loved one and the quality of their life as you do, even if they are "right to life" advocates.

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Well, then, in my view, if they are concerned with quality of life, they are right to die advocates...What they profess doesn't matter, as they are more concerned with quality of life.

As I have said, there are those out there that want everything done. My experience has been with native American Indians tribes...Maybe not all Indian tribes, but the several that I have dealt with want all things done. They are right to life advocates. They are not concerned with quality of life.

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I do know of and I am one of those that believe they should not be allowed to starve to death if breathing on their own. I watched my FIL be starved to death and anyone that tries to tell me this is humane or concern over quality of life should try it for themselves for a few days.

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Sounds like a quality of life issue to me....Tell me, did they/would they, withhold antibiotics if there was an infection? If so, would that be an acceptable death?

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You are also quite wrong when it comes to the statement "all must be done at all cost" concerning "right to life" advocates.

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I think we are talking symantics, now..I will not qibble over that....

Shane said

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This case is as much about the problems of family protective services as the right to die. Children and families need to be protected. It makes sense to have the government protect them just as the government employs the police and fire departments. There obviously needs to be reform in our child and family protective services. Throwing more money at this is not likely the answer.

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Actually, I think the answer is more money...in the form of man power...My cousins, who are in CFP and AFP services tell me that there is a high burnout rate and they are totally over burden with case work. Sounds like a money problem to me....

[Dr. Shane]

Pouring money into a troubled government agency is like pouring water onto a grease fire. A troubled government agency needs to get its act together first, before additional money is allocated toward it. That is just common sense.

[bonnie]

Actually antibiotics were withheld. Yes, that was acceptable as that would not have altered the outcome. He was given medication to keep him comfortable and reduce his fever when at times he had one. At that stage of the game, anything that can be used for their comfort level, I believe should be. My FIL was conscious up until his final 24 hours. He was alert and could have and enjoy visitors.He was hospitilized with pneumonia and collasped lung. He was revived 3 times the night he was brought to the hospital. He was placed on a vent for some time. For some reason I don't recall after this was removed he could not eat without inhaling part of his meal into his lung. He was then fed thru a tube in his stomach. Had he been in a vegetative state, unaware, unable to breathe on his own, it would be one thing to go without food and water. To be fully coherent, smiling and talking with hand signals and gestures and then have food and water withheld was quite another. This was decided by family and physicians. In fairness I will add that he was hospitilized for several months, we knew he could not and would not come home again. But I still cannot accept starving someone to death for that reason and call it being concerned for quality of life.

[cricket]

Sorry Brother Neil, I didn't think for a moment that you did mean that it was THE view. I simply was wondering (aloud) what the whole statistics would be. There have been times in the past when the way I've seen things are not the way the world sees them.

[Bravus]

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Bravus,

As a add on to my post to you, the assumption I made was in part because there was not any type of question or doubt as to the integrity or the sincerity of those that advocate the "right to die" position. It seemed only to be towards those that advocated the "right to life" position and were they willing to do anything more than talk about it.

<hr /></blockquote><font class="post">

Fair enough... my point was that a concern for the right to life should imply a concern for the quality of life. As Neil has ably pointed out, those who believe in a right to die are also, ironically, concerned with quality of life. I guess by saying 'at least as vociferous' I was assuming that right-to-die people are vociferous... which may not have been a warranted assumption. But my point was about the logical link between a right to life view and support for life in other ways.

[bonnie]

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Bravus said:

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Bravus,

As a add on to my post to you, the assumption I made was in part because there was not any type of question or doubt as to the integrity or the sincerity of those that advocate the "right to die" position. It seemed only to be towards those that advocated the "right to life" position and were they willing to do anything more than talk about it.

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Fair enough... my point was that a concern for the right to life should imply a concern for the quality of life. As Neil has ably pointed out, those who believe in a right to die are also, ironically, concerned with quality of life. I guess by saying 'at least as vociferous' I was assuming that right-to-die people are vociferous... which may not have been a warranted assumption. But my point was about the logical link between a right to life view and support for life in other ways.

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With that claification I believe we are back to square one and probably will remain so. I thought or assumed you did believe that, Of Course the "right to die" advocates were what they should be given their belief. It was the question or insinuation that those that may not agree with you might lack the integrity and strength of their convictions to do other than make a noise. It had to be questioned as to what they actually did to improve the quality of life for anyone, while you admit the assumption was made favorably for the "right to die" advocates. At least you did concede it may not have been warrented

You may believe that "right to die" advocates are the only ones to care about the quality of life or have the monopoly on caring and supporting life in other ways, it is a pretty narrow view point. It may surprise you, but right to die advocates are not the only ones capable of caring about the quality of life, or domestic violence, abuse or any number of issues.

Your concern that the "concern for a right to life should imply a concern for the quality of life" brings me right back to the beginning. Because someone sees this issue differently than you, the leap has been made, or at least a very strong possibility in your mind that those "right to lifer's" of course do not care about the quality of life.

To me, that is just a tad judgemental, no matter how it gets colored.

So again we agree to disagree. Just try to bear in mind the other side can actually care, react, do, provide, shed as real a tears, give till it hurts and then some, and still not be a liberal or a "right to die" advocate.

[Bravus]

I still suggest I didn't assume they don't, but asked whether they do. There's a difference there. I honestly didn't know, and don't yet know, whether on balance they do or not. All we have is anecdotal evidence and assertions.

It's not what I was thinking at the time, but there's a pretty high correlation between right to life beliefs and right wing politics, and right wing politics as a general thing says taxes and government services, including those for child protection, sjould be slashed. So it's not a completely out of the blue question to ask whether there is a link there.

One final point: I have never identified myself in any way as a right to die advocate, so you're making assumptions about who agrees and who disagrees with me.