I read an article about an inmate serving
a life sentence who momentarily died but was soon revived. He suffered from severe
sepsis due to large kidney stones that caused him to fall unconscious. Interestingly,
the inmate had a do-not-resuscitate order and his brother only advised the
doctors to give the inmate medication to ease his pain, “otherwise to let him pass”
(Bogel-Burroughs, 2019). He was resuscitated five times with epinephrine and
underwent surgery to repair his kidneys (Post, 2019). This happened in 2015. Four years later, the inmate argued that since
he momentarily died, he has served his ‘life’ sentence and should be released. However,
the Iowa Court of Appeals judges ruled that the inmate “will remain in prison until
a medical examiner determines he is dead for good” (Farzan, 2019).
This situation raises many questions.
What does it mean to be dead? Under what conditions are a do-not-resuscitate
order carried out? Did the doctors violate his rights?
In previous years, death was determined
to be the point where any vital function (heartbeat, electrical brain activity,
respiration) stops, but the advancement of ventilators and the ability to perform
cardiopulmonary resuscitation (CPR) has created the category of being brain
dead (June 19 & Health, 2014). To be considered dead, the person must be brain
dead, which is defined as “the irreversible loss of all functions of the brain,
including the brainstem” (Goila & Pawar, 2009). This is the determinant for
death since it is the last structure to die (Burkle, Sharp, & Wijdicks,
2014). However, even with declared brain death, the patient is still able to be
kept alive with ventilators, feeding tubes, and other necessary instruments. So,
was the inmate truly dead? The line between life and death has been blurred
because of the possibility for someone to be revitalized.
The inmate argued that the doctors violated
his do-not-resuscitate (DNR) order that was on file, as well as his brother’s directions
to let him pass. The implementation of a do-not-resuscitate order was not as
simple as I originally thought it was. It is common to equate do-not-resuscitate
with do-not-treat; however, a DNR does not automatically mean that all
treatments are ceased (Vranick & Stanton, 2019). When the patient is unconscious
and there is no family member present to make the appropriate decision, the
doctors have to determine the conditions of the DNR themselves (Hébert, 1991).
In this case, the brother’s directions may have been considered vague as it did
not discuss the withholding of intravenous medications, CPR, intubation, defibrillation,
etc. The doctors have determined the best care for the patient at the moment.
Currently, it is unknown whether
the inmate will fight his case in a higher court, but this situation was
definitely a loophole that the laws had not expected.
References:
Bogel-Burroughs,
N. (2019, November 8). A Prisoner Who Briefly Died Argues That He’s Served His
Life Sentence. The New York Times. Retrieved from https://www.nytimes.com/2019/11/08/us/prisoner-dies-life-sentence.html
Burkle, C.
M., Sharp, R. R., & Wijdicks, E. F. (2014). Why brain death is considered
death and why there should be no confusion. Neurology, 83(16),
1464–1469. https://doi.org/10.1212/WNL.0000000000000883
Goila, A. K.,
& Pawar, M. (2009). The diagnosis of brain death. Indian Journal of
Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society
of Critical Care Medicine, 13(1), 7–11. https://doi.org/10.4103/0972-5229.53108
Hébert, P.
C. (1991). Do not resuscitate orders: Considerations for family physicians. Canadian
Family Physician, 37, 1381–1385.
) 2014). Clinically Dead? The Blurred Line
Between Life and Death. Retrieved November 23, 2019, from Livescience.com
website: https://www.livescience.com/46418-clinical-death-definitions.html
Post, A. N.
F., The Washington. (n.d.). A Murderer Died While Serving a Life Sentence. Now
He’s Alive Again, And He Wants Out. Retrieved November 23, 2019, from
ScienceAlert website: https://www.sciencealert.com/an-inmate-claims-that-his-sentence-ended-because-he-died-and-was-revived
Vranick, J.,
& Stanton, M. (2019). Do Not Resuscitate (DNR). In StatPearls.
Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK470163/
Thao,
ReplyDeleteThis is a very thought-provoking post and has me wondering about another ethical issue tied up in this whole case. I’m wondering how his kidney stones got to the point of sepsis in this setting before the doctors at the jail decided to treat him. I recently was watching a medical drama (all-fiction) TV show that depicted the poor healthcare received by inmates in jail, that combined with your post has me wondering about the ethics of medical treatment in jails. Along that train of thought I did some research about health outcomes in inmates. The National Commission on Correctional Health Care (NCCHC) has reported high rates of communicable disease, as well as chronic physical and mental problems among the nation’s inmates ( Hatton et.al, 2008). Considering that many inmates report poor health prior to arrest, it would seem to me that there would be extensive medical care provided within jails to manage these conditions. Additionally, inmates do not always have access to preventative screening that would help identify issues before they become life-threatening. Inmates reported that many conditions they experienced resulted from a “lack of provisions needed in order to maintain good hygiene” (Hatton et.al,2008). Furthermore this article argued that the most common problems in detention facilities are those caused by the facility itself such as treatments delays and lack of access to medications (Hatton et.al, 2008).
I find it to be incredibly problematic that something as benign as a kidney stone was not identified and treated by the correctional healthcare staff long before it turned into sepsis and resuscitation was needed. There are many ethical issues tied up in the treatment of inmates and healthcare is a huge issue.
Hatton, D. C., Kleffel, D., & Fisher, A. A. (2006). Prisoners Perspectives of Health Problems and Healthcare in a US Womens Jail. Women & Health, 44(1), 119–136. doi: 10.1300/j013v44n01_07
Reading the blog post “Is this inmate dead or alive”, many questions arose. This is a unique case in which an inmate is brought back to life which was problematic due to the fact he had a DNR. The inmate was suspected to be unconscious with untenable vital signs. The physician that was present at the time revived him anyways, using epinephrine to restart the heart. This was questionable in the act because of the current DNR that was present and known of. With a DNR, this withholds cardiopulmonary resuscitation, breathing interventions, and the use of medications (Martin, 2018). Due to the fact that the physician at the time used epinephrine, this is when the DNR order was violated. The physician is in the wrong in reviving the inmate. What the doctor did was not apart of the do not treat action. An example of treating a patient would be stopping bleeding in the presence of an open wound; not trying to restart a heart. The definition of death is the cessation of all vital signs which include pulse, respiratory rate, heart rate, and spo2 (Sheil, 2018). Since all vital signs were ceased at the time, the inmate was technically “dead”. I think it is a viable argument that this inmate has served his life sentenced. On top of that, because the DNR order was not obeyed, the inmate should be released.
ReplyDeleteReferences:
Shiel, William C. “Medical Definition of Death” MedicinNet, n.d.
https://www.medicinenet.com/script/main/art.asp?articlekey=33438
Martin, Laura J, et al. “Do-not-resuscitate order.” MedlinePlus, February 2019.
https://medlineplus.gov/ency/patientinstructions/000473.htm
Hey Thao!
ReplyDeleteThis is a great topic to post about. It reminds me of a story I once heard in which a man was hanged but he didn’t die however since the clause of “until dead” was not yet on the law, he had to be allowed to go free. While the story is definitely more fiction than fact, the idea of prisoner rights stands out. While the man in the story was a criminal, he still had some rights, whereas I question whether the inmate in your story truly has any. By this I am referring to the lack of rights that prisoners have in America. By law, when you are a convict, you unfortunately become rightless. A great example of this is in the piece “The New American Slavery” in which the author tells the tale of how Blacks in America are still under slavery. Only now instead of slavery, it’s called prison labor. There are many companies in the United states that have admitted to using and even at times relying on prison labor. Which begs the question is our society still reliant on slavery? In the end, the rights of incarcerated people should be examined. Afterall, they are human too.
reference
Schwartz, S. A. (2011). Trends That Will Affect Your Future …. Explore, 7(3), 143–147. doi: 10.1016/j.explore.2011.02.009