Wednesday, November 07, 2007

A strange thing happened on the way to Bioethics class...

Well, you don't see this every day.

We're on the death and dying unit in my Bioethics and the Law class. Recently on the Long Island Rail Road on my way to school, I did the reading for that class, including the case of In re T.A.C.P. For those of you to whom this means something, 609 So. 2d 588 (Fla. 1992). It was riveting, and moving, and I wept.

That's right. My law school reading -- a casebook! -- moved me to tears. I just sat there on the train, reading and reading and weeping and weeping.

It was amazing. Granted, I can often be found tearing up at movies, a fair amount of books, and even some "silly little things" in random daily life. But a law school casebook? Honestly, my texts may have induced tears before, but they wouldn't have been this kind.

So what was the case all about, you ask? Well, "T.A.C.P." was a baby born with anencephaly, which is basically a condition in which the child is born with only a brain stem and no brain. This particular child was missing the back of its skull and the brain stem was exposed to the air. Babies born anencephalic tend to die within a few days; apparently what happens is the body can briefly function on a kind of "auto pilot" of breathing and heartbeat, which soon stop because there is no brain and therefore no brain regulation of bodily functions.

That's not even the part that made me cry though. In learning of this condition of their soon-to-be-born child, the parents of "T.A.C.P." agreed to have a Caesarean section for the express purpose of having the child's organs be less damaged so that they might be donated to other children. They knew their child was going to be born with no brain and die extremely soon, and they tried to give life to others.

Unfortunately, it didn't work out that way, because of the inability to define the child as dead and the resulting inability to harvest the organs. The most success with transplants from anencephalic infants has occurred when the child is placed on life support and the organs are taken as soon as possible. Even so, there have not been many transplants from anencephalics. Most states have a clinical cardio-pulmonary definition of death, which this child did not meet while the body continued breathing. Most states also have a definition of "brain death." It is odd in this case, because there literally was no brain, but because the brain stem had not entirely ceased to function, T.A.C.P. did not meet the criteria for brain death. Several states have introduced bills in their legislatures to try to get newborns with anencephaly declared legally dead, but so far none have passed.

I think one contributing factor to how emotional it was to read this case was how poignant and well written it was . If there's one thing I've learned in law school it's that some judges' writing is spectacular (including, believe it or not, Scalia -- his opinions are among the best as far as engaging the reader) and some are more like craptacular. This one was heartfelt. "We have been deeply touched by the altruism and unquestioned motives of the parents of T.A.C.P...we express no opinion today about who is right and who is wrong on these issues --if any 'right' or wrong' can be found here. The salient point is that no consensus exists...we find no basis to expand the common law to equate anencephaly with death..." and so on.

Have I mentioned that Bioethics is one of my favorite classes? In fact, it's not just one of my favorites this semester. It may be the best class I have had in quite some time, period. Maybe since Norman Corwin's Colum Writing, or even Cecilia Konchar Farr's Women's Literature... And my Bioethics professor, Janet Dolgin, is quite personable, analytical, funny, and insightful, and also just happens to be a major health law expert. It's almost time to register for next semester and I might take another class from her just to take another class from her. I am planning to do that with a couple professors, actually.

Because nothing is simple. Right? Even (especially) defining death.

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