Baby Z -- Long Shot Is Successful

An infant, known as "Baby Z," in Melbourne, Australia given zero chance of survival has amazed doctors after being saved with one of the biggest long shots in medical history.  (Herald Sun)

                                                

Baby Z was born, 18 months ago, with a rare condition called molybdenum cofactor deficiency — a fatal condition that poisons the brain with toxic sulphite, resulting in seizures and death in early childhood.  Baby Z's toxic sulphite levels were almost 30 times higher than normal and were dissolving her brain.

But Baby Z’s parents did not give up.  Their team found a research paper by German plant biologist Gunther Schwarz describing how he had developed an experimental drug that was able to save mice with the disease in 2004.  The drug had only been used in animals and nobody knew what it would do in a human.

The Australian hospital's ethics committee approved using the drug on Baby Z, because the only other option was a painful death.  A Family Court also approved the treatment.

Just hours of receiving her first daily dose, tests showed Baby Z's sulphite levels immediately dropped from near 300 to below 100. Within three days they fell to the normal level of about 10.  Baby Z's neurological development is delayed due to some brain damage in the weeks it took to find the cure, but she is now improving.

National Health Law Moot Court Competition - EMTALA to SCOTUS

I am off today to Southern Illinois University, host of the 18th annual National Health Law Moot Court Competition.  To the right is a picture of me as a judge at last year's competition with the other judges and the winning teams.


This year's problem entails a hospital with a critically injured uninsured illegal immigrant.  The hospital plans to deport the patient to an inferior hospital in her home country.  The main substantive issue is whether that violates EMTALA.  (The other issue is an 11th Amendment issue since the hospital is a state university hospital.)  Since the to-be-transferred patient has already been treated at the defendant hospital for several weeks, one might think that EMTALA was totally inapplicable.  Both appellate cases and federal regulations state that EMTALA does not apply to inpatients.


But that reasonably well-settled law has been becoming increasingly unsettled.  The First Circuit has never been fully on board with that reading.  And the Sixth Circuit just directly and explicitly rejected any inpatient exception to EMTALA stabilization requirements.  The hospital in the Sixth Circuit's Moses v. Providence Hospital case has filed a petition for writ of certiorari to the U.S. Supreme Court, since there is now a live circuit split.  It appears likely that the Court will take the case to finish the business that it began to address back in Roberts v. Galen in 1999.

Baby RB -- Suffering Perhaps, but Pleasure Too

Hearings in the Baby RB case began yesterday.  (BBC video with court sketches here)  (Sketch to the right from Daily Mail)  


The mother told of her one-year-old son's "intolerable suffering."  She agrees with doctors that Baby RB should be allowed to die.  Her solicitor said "RB's mother has sat by her son's bedside every day since he was born."  "Every day she has seen the pain he experiences just to survive."  "In deciding to support this application, she has listened to and consulted with some of the best doctors in the world. Their view has been unanimous."  (Mirror)

On the other hand, the evidence indicates that Baby RB's brain is not affected, and he can see and enjoy music and stories.  "[T]here's no doubt that he showed a different quality of bonding when he was being held or massaged by his mother." RB has interacted with his parents "in a way that they described as him smiling" despite the fact that his control of his facial muscles is severely limited and he has problems opening his eyes.  (Guardian)

While UK courts do allow withdrawal of life-sustaining treatment over parent objections, the cases usually involve children whose suffering clearly outweigh benefits.  Here, it seems the balance is not quite so lopsided.

Comparative End-of-Life Policy - U.S. v. China

I'm making a trip to one of the largest law schools in the world in the largest city in the world in a few weeks: Chongqing, China.

So, during November, I will likely be blogging a bit about differences in end-of-life medical treatment policy between the United States and China.

Baby RB – Hospital Seeking to Withdraw Treatment over Father’s Objections

Tomorrow (Monday, Nov. 2), a British hospital will ask the High Court for permission to remove one-year old Baby RB’s ventilator over his father’s objections.  The baby’s mother, who is separated from the father, support the Hospital’s application.

Baby RB was born with congenital myasthenic syndrome (CMS), a muscle condition which severely limits the ability to breathe independently and limb movement.  He has been in hospital since birth.

The Telegraph observes that if the hospital's application is successful, “it would be the first time that a UK court has, against the will of a parent, determined that life support may be withdrawn or discontinued from a child who is not suffering brain damage.”  Indeed, lawyers for the father argue the baby's brain is unaffected by the condition and that he can see, hear and feel and recognize his parents. He is also apparently able to play with toys.  Baby RB’s father will submit video footage showing his son playing with his toys and interacting with his parents. 

This demonstrable potential for some positive quality of life is likely to doom the Hospital’s application, given the language in some prior holdings. Moreover, according to the Muscular Dystrophy Association and others, there is material prospect for improvement.