Tragic at many levels, a young girl lies dead in the Pediatric Intensive Care Unit of Children's Hospital and Research Center Oakland. Her heart continues to beat, but she is dead nonetheless.
According to accounts in the media, three clinical exams conducted by three separate physicians, including a court-appointed pediatric neurologist not affiliated with Children's Hospital and Research Center Oakland, have all come to the same tragic conclusion that she has no brain function.
Notably, the standard clinical exam includes an "apnea test." The apnea test assesses spontaneous breathing efforts after a period free of artificial ventilation in which the carbon dioxide levels in the blood rise to a level that should normally trigger a breathing reflex. This is one of the most primitive reflexes of the brain and its absence is one of the fundamental criteria for the diagnosis of brain death.
Also according to accounts in the media, confirmatory and largely objective tests show no brain electrical activity and no blood flow to the brain in this young girl, which further and unequivocally support the diagnosis of brain death.
Based on legal, ethical, moral and societal norms, this complete lack of brain function is consistent with being dead. Yet, in the hopes of a miracle, the legal system is forcing the physicians and nurses in the PICU to provide artificial breathing support via a ventilator, hydration, and probably other PICU-based forms of organ support.
One could argue that the occurrence of a miracle does not require the technologies of the PICU.
Remarkably, there is also the possibility that the physicians will be obligated to perform surgical procedures to facilitate the transfer of this young girl to some ill-defined institution willing to provide care for legally declared dead patients.
All of this represents absolutely futile use of medical resources by any reasonable definition of the term, and the medical, legal and ethical ramifications of what has unfolded in Oakland over the past weeks has the potential to negatively and profoundly effect the U.S. health care system at multiple levels.
Surely, there will be further debate surrounding these issues in the coming months. In the meantime, there is no peace and progression through the death process for a dead young girl.
There is much well-warranted and well-intentioned sympathy for this young girl and her grieving family; few things are more tragic and heart wrenching than the death of a child.
The highly dedicated physicians and nurses who work in the PICU of Children's Hospital and Research Center Oakland also deserve some form of moral support.
By the very nature of their work, these individuals face childhood deaths and tragedies on a regular basis. They suffer and grieve these awful events along with the respective families.
In this particular case, the demoralizing mandate to provide PICU-based care without any reasonable hope of benefit, and the subsequent creation of an unnecessary spectacle, only serve to augment the suffering.
Inevitably, this can lead to burnout and the flight of talented critical care physicians and nurses to other areas of medicine, or out of medicine altogether.
To those nurses and physicians, please know that you have the unconditional support of your colleagues in critical care medicine, who understand very well what you are experiencing.
This too shall pass, and you can take some measure of comfort in knowing that your dedication to critically ill children has saved and will save many lives.
Dr. Hector R. Wong is a professor of pediatrics at the University of Cincinnati College of Medicine, and the director of critical care medicine at Cincinnati Children's Hospital Medical Center. The opinions expressed in this piece are his own and do not necessarily reflect the views of his employer.