By Theola Labbé-DeBose, David Brown and Keith L. Alexander
Washington Post Staff Writers
Friday, November 7, 2008
The struggle between Children's National Medical Center and the parents of a 12-year-old boy with brain cancer yesterday drew national attention and once again brought to the forefront the emotional debate over the meaning of life and death.
Yesterday, Motl Brody remained in a bed in the Northwest Washington hospital's intensive-care unit while lawyers prepared for a D.C. Superior Court hearing Monday to determine whether doctors can take him off life-sustaining equipment.
In court papers, the hospital says treating him is "offensive to good medical ethics" because, unlike the highly publicized cases of Terri Schiavo and Karen Ann Quinlan, the boy has no brain activity. His parents, Orthodox Jews from Brooklyn, say their faith does not define death in that way, and they reject the hospital's pronouncements that their son has been dead since Tuesday.
The hospital received nearly 200 e-mails and phone calls yesterday, mostly from New York residents, pleading to keep the youth on the ventilator and the intravenous drugs that are powering his respiratory and circulatory systems. Yet the Brody case is far different from that of either Schiavo or Quinlan, women who lived for years in vegetative states while courts considered their fates.
Schiavo died in 2005 after being comatose for 15 years. Quinlan died in 1985 after 10 years in a coma. Despite being profoundly brain damaged, however, both were able to control such functions as breathing and maintenance of blood pressure and blood volume.
Those activities are controlled by the brainstem, which connects the spinal cord to the brain. Doctors at Children's performed various tests on Motl to see whether that structure is working.
The tests included briefly removing the boy from the ventilator. Normally, the brainstem stimulates breathing, even if the efforts are inadequate, as carbon dioxide builds up in the blood. But according to papers filed by the hospital in Superior Court, the child made no respiratory efforts even when his carbon dioxide was double the normal concentration.
Doctors are also giving the boy intravenous drugs to keep up his blood pressure, action that is also controlled by unconscious, primitive parts of the brain.
John Votto, president of the Hospital for Special Care in New Britain, Conn., said that based on the description in the court filing, the boy appears to be too ill to ever be moved out of an intensive-care unit.
"This would not be an appropriate patient to place in a long-term care facility," said Votto, who is also a doctor and lung specialist. "We wouldn't take this child, because there really would not be a chance for long-term improvement," he added.
According to experts in Orthodox Jewish law, there is no consensus within the faith on the definition of death. However, some Orthodox Jews reject the lack of brain activity as a certainty that life has ended, said Edward Reichman, a rabbi, doctor and professor at Albert Einstein College of Medicine of Yeshiva University.
Children's wants the court to uphold its position that it can disconnect the equipment, even over the parents' objections, because the boy's brain does not show any more signs of activity. Under D.C. law, doctors can declare patients dead if there is no brain activity.
The hospital said it was unable to find another medical facility that would take the boy. Cost of care is not their chief concern, hospital attorneys stated in legal papers. They noted that Children's has 32 beds in its intensive-care unit, with all but 12 in use. By keeping the boy there, the hospital is putting other children at risk, the attorneys said, adding, "While our thoughts and prayers are with the family in this hour, we cannot continue to provide the resources they are demanding."
The parents, Eluzer and Miriam Brody, have enlisted the help of Jeffrey I. Zuckerman, a lawyer with the firm of Curtis, Mallet-Prevost, Colt & Mosle, who took on the case for free. Yesterday, he filed court papers saying that the family's position on death is supported by their rabbi, Chaim Jacob Tauber, chief rabbinical judge of the Bobov Hasidic community in Brooklyn.
The parents have declined to comment. Motl's maternal uncle, Yitzchak Halberstam, speaking by phone yesterday from his New Jersey home, shared some personal details about the boy at the center of the emotional dispute.
Motl's name is the shortened version of Mordechai, a cousin of Queen Esther's in the Old Testament. He is the third-oldest of seven siblings. He talked about studying to become a rabbi -- like his father -- and his favorite book in the Bible is Psalms. He often wrote Hebrew poems that he performed at family gatherings, singing in his soprano voice. He had been looking forward to his bar mitzvah and learned many of the prayers.
The boy became ill six months ago and was found to have an aggressive brain tumor. He underwent surgery and other treatment in hopes of prolonging his life. Halberstam said his sister and brother-in-law have faithfully remained at their son's hospital bedside.
"This has been a very traumatic time for both of his parents," Halberstam said. "We all want him to live his natural life and not have it terminated prematurely."
Reichman, the rabbi and doctor at Albert Einstein College, said that in Orthodox Jewish law, death is defined as the moment when the soul leaves the body. "Obviously, no physician or human being is capable of determining when that happens, so we have to have a medical definition," he said.
And that's where the debate begins, he said. Some Orthodox Jews base the definition on brain activity, while others base it on a heartbeat.
As Reichman put it: "The child may not be conscious, may not be interactive, but that doesn't mean that in the eyes of Jewish law, the value of that life is any less."
Staff writer Del Quentin Wilber and staff researcher Meg Smith contributed to this report.