
Killing a Patient to Save His Life - danso
http://nytimes.com/2014/06/10/health/a-chilling-medical-trial.html
======
quotient
I'm annoyed by the headline. I know it's meant to grab attention by seeming
counter-intuitive, but as it is, the headline is simply wrong. This medical
procedure does not involve "killing" the patient. It involves cooling the
patient down internally to essentially suspend them, so the doctors have a
greater window of time to perform the necessary procedures. The best way of
doing this happens to be to _temporarily_ replace the patient's blood with a
saline fluid, and if you think that's "killing" the patient, then I suggest
you grab the nearest dictionary and smack yourself with it.

~~~
enoch_r
> happens to be to _temporarily_ replace the patient's blood with a saline
> fluid

Which, according to the article, has the effect of stopping the heart as well
as brain activity. This seems pretty close to "death." If someone decided to
stop the operation halfway through without replacing the saline solution or
reviving the patient, it would make sense to me to claim that the "time of
death" was the time at which brain activity ceased.

~~~
pygy_
General anesthesia also stops brain activity, and you can die during open
heart surgery. The time of death won't be the time of loss of consciousness.

It is about conserving information. As long as your brain can be turned back
on you're still alive.

~~~
Crito
Do you have a source for that? Obviously it suspends consciousness, in a more
dramatic way than even falling asleep, but I find it difficult to believe that
_all_ brain functions are suspended. At the very least, with some varieties of
general anesthesia, the brain stem keeps vital functions working.

Edit: Looking at wikipedia a bit, it looks like "brain death" is currently
defined as including a dead brain stem. Kind of seems like an ethical gray
area when the cerebrum really is dead (non-recoverable), not merely suspended.
Still, I'm not convinced that general anesthesia fully suspends the cerebrum.
I believe at least some forms merely suspend the ability to form memories.

~~~
pygy_
The brainstem is not needed to sustain the heart beat and blood pressure. It
participates in its regulation, but both parameters have "sane defaults"
without any input.

Furthermore, while necessary, the brainstem is not sufficient to sustain
consciousness.

Third, phenobarbital at a sufficient dose completely wipes electric brain
activity (metabloism goes on, at a lower pace).

Fourth, even if you suspend someone using the procedure described in the
article, there is still residual biologic activity in the cells. Chemical
reactions are slowed down, but not stopped.

------
skizm
I think I've seen this House episode before. Spoiler alert: The chick dies in
the end.

Seriously though, with these new types of procedures I feel like we need
another checkbox next to the organ donor one that says: "Try risky medical
procedures if the attending doctor honestly thinks it gives me a better chance
of living with no permanent brain damage when compared to conventional
treatment." Or probably something a little more succinct.

~~~
digitalengineer
How about: "I reserve the right to have my life terminated if I come out of a
procedure with no brain activity"? Edit: From the older discussion on HN:
"Assuming they (patients) have been getting 'good' CPR for the 10-15 minutes
the ER team spent attempting to resuscitate them, there is still a good chance
that their brain was not being perfused."

~~~
gonzo
CPR is nearly worthless, but not always.

~~~
Retric
A 2+% chance to either save a life or reduce the chances of brain damage is
worth ~20 minutes. And that's for a full recovery the odds of a partial
recovery can be as high as 50%. [http://www.cnn.com/2013/07/10/health/cpr-
lifesaving-stats/](http://www.cnn.com/2013/07/10/health/cpr-lifesaving-stats/)

With current thinking you don't even need to do mouth to mouth disease
transmission is a vary low risk.

------
js2
Reported on and discussed here a few months ago:

[https://news.ycombinator.com/item?id=7477801](https://news.ycombinator.com/item?id=7477801)

------
venomsnake
They are not dead until they are warm and dead.

There are enough cases known to science where cold has done wonders. And the
technology seems viable. I say go for it. At worst we will be getting valuable
knowledge.

~~~
Fuxy
Yep.

If your odds are already very low taking a risk for better odds seems like a
good deal to me.

You're most likely dead anyway why not try something new to give you a better
chance.

------
afarrell
"But researchers at a number of institutions say they have perfected the
technique, known as Emergency Preservation and Resuscitation, or E.P.R., in
experimental surgeries on hundreds of dogs and pigs over the last decade."

Did they actually do dry runs of the surgery from shooting to triage to
finish? I wonder whose job it was to shoot the dog with a .45

~~~
spingsprong
[http://www.independent.co.uk/news/uk/home-news/ministry-
of-d...](http://www.independent.co.uk/news/uk/home-news/ministry-of-defence-
defends-practice-of-shooting-and-injuring-pigs-for-army-medic-
training-8328148.html)

~~~
afarrell
Huh. More medical organizations should do this sort of training.

------
digitalengineer
I like the 'out-of-the-box' thinking. The 'opt out' if you don't want to, in
combination with a high change of poor black males being the guinea pig... Not
so much.

~~~
67726e
"The 'opt out' if you don't want to, in combination with a high change of poor
black males being the guinea pig... Not so much."

My understanding is that they only use this procedure if your chances of
otherwise surviving without this are very slim, per the article the injuries
are the kind where "Less than 1 in 10 survive". As for the opt-out/opt-in, you
cannot really opt-in to any procedure if you're undergoing cardiac arrest, so
perhaps we should let anyone in this scenario die since they cannot truly
consent?

~~~
vog
-1 for the strawman: The alternative to "opt-out before" is "opt-in before", not "opt-in afterwards".

~~~
mikeash
Most people won't opt in before, so I think his question is entirely
legitimate: in an emergency situation, the patient often can't give consent,
and most of them won't have the foresight to give it in advance, so are we to
simply let them die?

~~~
vog
That depends a lot on the quality of the treatment. If it is a good treatment
with some risks, that makes sense. However, if you don't enforce any minimum
quality for the treatment, this is nothing more than misusing the patient's
situation for scientific experiments.

Rephrased with some exaggeration: "Our patient will die anyway, so let's run
the experiments. Maybe one of our experiments is successful. If not, who
cares?"

I believe the main dissent here is whether to think of this as a medical
treatment with minor risks, or as an experiment done on defenseless victims.

~~~
reversal
I believe this is a case for Dr. Jay Freireich who was considered a barbarian
and labeled as a pariah in the medical community because he gave out
experimental treatments on childhood leukemia patients who had no chance of
survival outside of a few months. Mind you this treatment is literally
poisoning the patient and hoping the cancer dies while the patient still has a
thread of life remaining. There was also a very good chance that the chemicals
would end up doing the job the cancer was already doing.

He was able to save very few of his patients from the same end, as well as
developing what would become modern chemotherapy that's saving countless more
cancer patients today.

So a better question is: is the situation we're presented with so grim that
we're willing to use a method that's just as deadly as the disease/injury but
has a glimmer of hope for survival?

