Category Archives: Do-Not-Resuscitate

the D.N.R.

Early Death, Their Way, by: J. Hoffman

Early Death, Their Way, by: J. Hoffman

From The New York Times that came with today’s paper…

Tumors had disfigured Ashley Leigh McHale’s features and spread to her organs.  A year ago, AshLeigh, 17, flew from her home in Catoosa, Oklahoma, to the National Institute of Health in Bethesda, Maryland, with thin hope of slowing her melanoma.

A social worker stopped by her hospital room, and they began a conversation that would be inconceivable to most teenagers: If death approached and AshLeigh could no longer speak, what would she want her loved ones to know?

The social worker showed AshLeigh a new planning guide to help critically ill young patients express their preferences for their final days—and afterward.

If visitors arrived when AshLeigh was asleep, did she want to be woken?  What about life support?  Funeral details?  Who should inherit her computer?  Or Bandit, her dachshund?

When she died in July, AshLeigh was at home as she had requested.  Per her instructions, she was laid out for the funeral in her favorite jeans, cowgirls boots and the white shirt she had gotten for Christmas.  Later, the family dined, as AshLeigh had directed, on steak fajitas and corn on the cob.

“I don’t know what I would have done if I’d had to make these decisions during our extreme grief,” said her mother, Ronda McHale.  “But she did it all for me.  Even though she got to where she couldn’t speak, AshLeigh had her say.”

A national push to have end-of-life discussions before a patient is too sick to participate has focused largely on older adults.  Recently, providers have begun approaching teenagers and young adults directly, giving them a voice in these decisions.

“Adolescents are competent enough to discuss their end-of-life preferences,” said Pamela S. Hinds, a contributor on pediatrics for “Dying in America,” a 2014 report by the nonprofit Institute of Medicine.  “Studies show they prefer to be involved and have not been harmed by any such involvement.”

There are no firm estimates of the number of young patients facing life-threatening diseases at any given time.  Cancer, heart disease and congenital deformities together account for an estimated eleven percent of deaths among adolescents in America, about 1,700 per year.  And thousands live with the uncertainty of grave illness.

“If you are one of the children for whom this matters, or one of their parents, this is a huge opportunity,” said Dr. Chris Feudtner, a pediatric palliative care physician and ethicist at the Children’s Hospital of Philadelphia.

But shifting from hushed talks with parents to conversations that include young patients has met some resistance.  Many doctors lack training about how to raise these topics with teenagers.

Yet research shows that avoiding these talks exacerbates the teenage patient’s fear and sense of isolation.

In a 2012 survey examining end-of-life attitude among adolescent patients with H.I.V., fifty-six percent said that not being able to discuss their preferences was “a fate worse than death.”  In a 2013 study, adolescents and parents described such talks as emotionally healing.

Teenage patients can guide, even lead, their medical care, Dr. Freudner said.  Including them in the discussions acknowledges a terrible fact that patients and family members struggle to keep from each other: the likelihood of death.  “Then people can be together, as opposed to be alone,” Dr. Freudner said.  The teenage patient can address intimate topics, including, “the scariest aspects of the human condition—mortality and pain—but also love, friendship and connection.”

Karly Koch, a college student from Muncie, Indiana, has been treated for many serious illnesses, including Stage four lymphoma, all related to a rare genetic immune disorder.  Her older sister, Kelsey, died of the condition at twenty-two.

Last spring, Karly, then nineteen, developed congestive heart failure.  As Karly lay in the intensive care at the National Institute of Health, a psychotherapist approached her mother, Tammy, with the new planning guide.

“Do we talk about dying?” Mrs. Koch recalled wondering.  “Maybe Karly hasn’t thought about it—do we put it in her head?”

“We had already buried a child and had to guess what she wanted,” she continued.  “So we wanted Karly to have a voice.”

Karly’s reaction?  “She said it wasn’t like we were telling her something she didn’t already know,” Mrs. Koch said.

The guide used by Karly Koch and AshLeigh McHale is called “Voicing My Choices.”  It is the first guide created for adolescent and young adult patients.

The intention was to create a way for them “to make choices about what nurtures, protects and affirms their remaining life and how they wish to be remembered,” said Lori Wiener, a principal investigator on the research that led to the planning guides.

In straightforward language, the guide offers young patients check boxes for medical decisions like pain management.  Another section asks about comfort.  Favorite foods?  Music?  What gives you strength of joy, the guide asks.  What do you wish to be forgiven for?

By offering young patients opportunities to write farewell letters, donate their bodies to research and create rituals for remembering them, the planning guide allays one of their greatest fears: They are too young to leave a meaningful legacy.

Last July, Karly Koch had an experimental bone marrow transplant.  With twelve medications a day and a surgical mask, she is out and about in Muncie.  Karly takes classes to become a physical therapy assistant.  She delights in “normal people” activities.

Her parents keep Karly’s copy of “Voicing My Choices” in their bedroom cabinet.  “It isn’t gloomy to go through,” Karly said.  “It’s kind of fun to get your feelings out there.”

“Now looking at it,” she continued, “I think I’d like to add some things.”

So, this, is a way, of helping young people who are diagnosed with terminal illnesses cope with their own final affairs, and, it’s a great thought, because it will give the families some comfort, knowing that their offspring had the chance, of voicing their opinions on how they wanted to go, and it gives respects to the terminally ill, and shows respect toward life too.

 

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The Tragedies that Were Caused by Misunderstandings in Terminal Care

On the medical fronts, translated…

From the horrible experience of a 24-year-old young woman diagnosed with liver cancer:

Even though, Pearl had been inoculated with hepatitis B shots as she was younger, but because the antibodies were gone, she’d still contracted hepatitis B.  She didn’t know she needed to go for an abdominal ultrasound every six months, along with the importance of getting her alpha FP fetal proteins checked, and when she’d found out she had liver cancer, the tumor was already nine centimeters, too big to be removed.

The family decided to not tell her, just told her, that it was a benign tumor.  Pearl believed the words of her family and friends, and only took to natural therapies and alternative therapies.  But the cancer cells spread too quickly, in a short four months time, the patient was already terminal, and she’d felt a ton of abdominal pains.

Pearl’s mother works for a church, the pastor’s wife had positive experiences with terminal care, she’d worked hard, to convince the parents to send the daughter into the terminal treatment ward, to allow her to be well taken care of in the body, the mind, the soul and the heart.  Pearl’s parents went for a tour in the terminal ward, felt satisfied, and hoped to place their daughter there; but unfortunately, Pearl’s sister refused, said, “as long as my sister is alive, I will NEVER allow her to be placed in the terminal wards!”

And so, Pearl stayed in the regular ward, but because they couldn’t manage the pains well, she’d cried out in pain every single day, and wanted to die.  And she’d lived on for three more weeks afterwards, and, the girl passed away, in her own screams, as the tumors in her liver burst open.

The Common Misconception that the Public Has for Terminal Care

Most of the knowledge that the Taiwanese people have of terminal care is negative, but in reality, terminal care is already in abundance in the more advanced countries, and the WHO spoke positively of it, that it’s a modern day method, to making the quality of life better for the terminally ill.

Terminal care is not the same as waiting for death, nor is it giving up hope, or giving up on the aggressive treatments!  After all, there IS no such terms as “aggressive treatments” or “passive treatments”.  Related treatment measures include: healing, controlling the illnesses, supportive treatments, less invasive therapies, along with terminal care, which option one chooses, should be reliant on the conditions, and not on which doctor’s methods the patients choose to follow, or which ward they’re staying in.

For instance, a person with multiple organ failures, because of her/his vital organs had failed, and couldn’t trade in for a brand new set, even though, the person is in the ICU, at this time, the only thing that CAN be done is the supportive and the alleviating types of therapies.

And so, this, is why there’s a need for this terminal care program, because we don’t want our loved ones, or ourselves, to suffer to the very end, do we?  Nope, and yet, because there’s barely ANY education in the matter, that, is why the subject is not being discussed enough at all.

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A Father Couldn’t Continue to See His Son with Acute Lymphoma Suffer, So, He’d Let Him Go

From the MSN news pages in Taiwan, translated…

This, would be the biggest blessing for Yun-Han, because he won’t be made to suffer any longer; it’s also a blessing of our love toward him, and we wouldn’t blame each other for any of it.

“I’d told him, daddy says, you will totally get discharged from the hospital today.  Getting out of the hospital could mean going home, or going to the home in heaven, but, you WILL go home today!” at the end of the year four years ago, the C.E.O of the Carnegie Foundation in Taiwan, promised his seven-year-old son who’d been diagnosed with acute leukemia, Yun-Han Hei.

“I did keep my promise (meant the child did get discharged from the hospital on that day!)”, after he’d spoken, Li-Yen Hei started sniffling his nose.  His wife, Yuan Chu too, bid farewell to their son.

An hour after that, the young boy, Hei finally gave up his fight of a year and four days.

“I’m a fighter that won’t give up until the last second, and I feel, that it wasn’t time yet.  But, I’m real glad, that Li-Yen had reminded me to say my goodbye to our son.”  Chu told the press, with her beautiful smile.

Being able to say the proper goodbyes at the final stage of life, is a blessing in its own, for those who were survived, and those who’d passed away.

At first, Hei and Chu were onboard for the invasive treatment measures that their son had undergone.

Yun-Han had a high fever on Christmas Eve, and was rushed to the emergency room of NTU Hospital, and that same day, the doctors confirmed their diagnosis of acute leukemia, his white blood cell count rose up to forty thousand and he was immediately admitted into the children’s intensive care unit.

The doctor on duty at the E.R. that day was the expert on children leukemia, Xien-Tang Chou, who’d mapped out a plan of attack for the family, and he’d told the parents, that they’re working with St. Jude’s Children’s Cancer Research Hospital in the U.S., plus, Hei’s younger brother, is the assistant manager of the Washington University Seattle hospital, he too, helped with the reading of the charts.

The parents ended up giving up on the treatment options, because they saw how much pain their son had undergone, and decided to let go of him, and, it must’ve been really hard, after all, the child is still very young, his life hadn’t even started yet, and, for the parents to give up on the treatment options, it must’ve been a really hard struggle, but, they decided it’s for the best, because they don’t want their young son to suffer so much, after all, the treatments are too painful for adult, and this, is a child we’re talkin’ ‘bout here…

 

 

 

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He Couldn’t Stand to See His Wife Being Tortured by Her Illness, He’d Murdered Her in the Hospital Ward, Then, Attempt to Commit Suicide

Tragedy that stemmed from too much burden on the primary caretaker’s shoulders, from the Front Page Sections, translated…

The retired veteran pulled up the drapes, stabbed his own wife’s chest once, then, stabbed himself twice, there were six or seven other people in the same hospital room, and they never noticed, the neighbors didn’t believe it, “He loved his wife dearly”.

A retired serviceman, Ku, didn’t want to see his wife keep on being tortured by her illness continuously, yesterday at noon, he’d asked the caretaker to go away, in the MacKay Hospital in Danshui, was suspected of stabbing his wife to death, then attempted to commit suicide; there were six to seven OTHERS in the same hospital ward, but nobody noticed anything, it wasn’t until an hour later when his friends came by to visit, was he discovered, and, his life was spared.

“Please, just give me the death penalty!”, the eighty-three year old elderly man, Ku lay weakly on the bed, and was very helpful in answering the inquiries of the district attorney; he’d told the D.A. “Even though I’m a murderer, but, don’t be afraid of me.”, as he begged to be given the death penalty, he wanted to follow his wife.  The D.A. considered that he’d admitted to murdering his own wife, and that he was injured and elderly, that there was NO need to jail him, said that his bail was set at $100,000N.T., and, returned him to his family.  The elderly man, Ku’s children couldn’t believe that their father had murdered their mother, they’d melted down.

The police pointed out, that the sixty-four year old Kuo, started nine years ago, would faint often and have dizzy spells a lot, just last month, she’d passed out abruptly, and was rushed to the MacKay Memorial Hospital in Taipei, and was diagnosed with viral encephalitis, and sent to the ICU, at the bottom of last month, she was transferred to the neural department hospital ward in the Danshui hospitals, the family hired an around-the-clock bedside assistant for her just last month, and the elderly man would go accompany his wife every single day, and didn’t go home until dusk, and had made soup for his own wife too.

The woman was bedridden and couldn’t walk, but is lucid, the caretaker, Yeh said, that yesterday, she’d taken the elderly to rehabilitation, at eleven fifty, she’d returned back to the hospital ward.  Ku told him to take her lunch, she’d returned to the hospital room at twelve thirty, and found the curtains drawn, and she saw the elderly man lying on the folding bed next to the hospital bed, she thought they needed time together, and so, she’d left them alone.

Ku’s neighbor, a woman named Chen went to visit them at one in the afternoon, back then, the other two beds had three to four visitors conversing, she’d asked about here Kuo was, and when she’d pulled open the curtains, she’d screamed, and carried the bloody knife back to the nurse’s station for assistance.

Kuo was lying in her bed, with multiple layers of clothes covering up her face, there was a knife wound in her chest area, in the heart; the elderly man, Ku slashed his own left wrist, and stabbed his own torso on the right side.  The paramedics worked hard, to resuscitate Kuo, but she still died, and, after Ku was rushed to the E.R., he was okay.

Ku told, that he and his wife married for forty years, had never had a spat, that his wife was hospitalized for encephalitis in August, and when it got serious, she was in a coma, he didn’t want to see her keep suffering, that, was why he’d taken the advantage of the time when the foreign bedside assistant was out on lunch, to kill his own wife.  The D.A. and the police examined the wife’s body, and found that the knife wound on her chest was what killed her, and they’re going to do an autopsy at another date, to clarify the cause of death; and Ku’s own knife wound on his abdomen wasn’t just on the surface, it showed that he’d intended to kill himself.

The neighbors said that Ku loved his wife dearly, and never heard them fight, and sometimes, they would go out together, to walk, none of them believed he was capable of murdering his own wife.

Because taking care of one’s own spouse became way too hard, and, she’s NOT getting any better, and so, killing her, putting HER out of HER misery seemed like the only logical thing to do, and, that, would be from the “humane” side of things, but, from the legal front, you are taking the life of another human being, and that, is just wrong, and so, there’s a LOT of moral concerns up for debate on this one…

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The Doctors Pulled the Plug, the Terminally Ill Patients Died with Dignity Intact

From the Front Page Sections, translated…

The very first documentary on the reality of terminal care and assisted suicide, was put forth, recently, by the Chenggong University’s medical department.  The activist toward the cause, the professor from Chenggong University, Professor Chiao said, that even though, there was an amendment to the constitution last year, but today, there are still a limited number of doctors who dared unplug the patients, he hoped, that the film can help the doctors, so they can help the terminally ill patients, to die, with their dignities intact.

Ke-Shih Chiao, who singlehandedly made euthanasia into a legislators’ problems pointed out, that since 2000, there had been three amendments to this law in the constitution, until the third amendment last year, because the rules are too strict, there are very limited number of cases where the patients actually got to decide upon when they are going to die.

Most of the Medical Staff Wouldn’t Dare Unplugging the Patients

Even though, the amendment last year had made the rules more lenient, with the signature of just ONE family member, but, the paramedics on the front lines, dealing with the matters of life and death, may still act hesitant, and unable to unplug, that, was why Chenggong University had made the documentary, to educate them.

The family the film was about was of the volunteer at Chenggong University Hospital’s volunteer, Hsu, at age seventy-four, when her husband went out, he’d had a heart attack and was lifted to the hospitals, when Hsu and her family were notified, her husband was already tubed, because he was in a comatose then.  From before, Hsu and her husband talked about how at the end of their lives, they would give up on the unnecessary measures to save their lives, so they can leave this world peacefully, and they’d both signed the DNR too.

Initiated the “Limited Medical Trials”

She understood well, that tubing was not her husband’s will, but, to pull it, it’s a hard trial for her, her husband had not been declared brain dead, and his organs are still functioning well, and, it didn’t meet the requirements of the “terminally ill patients” in the constitutional clause for allowing the terminations of life.  She’d discussed with her son, and the hospitals employed the international rules of waiting for five days, and, if the conditions improved, then, they will start treatment, and if the conditions worsens, then, they’ll unplug him.

As the Patient’s Wife:  Wanted to Help Fulfill Her Husband’s Wishes

Hsu stated, that the entire process had become the family’s most awfully endured pain, but, to fulfill her husband’s wishes when he was still alive, and allow those who are terminally ill to leave this world peacefully, she was willing to go public with the footages, but every time the film played, she couldn’t help but cry.

Chiao stated, that the clause of “terminating care”, there was a part, “If the patient was diagnosed as untreatable by the doctors, and that there was medical proof, that death is eminent soon”, then, the patient can be unplugged.

And so, this, is a success, on the legislation front, of how we are in control of whether or NOT we must endure through the pains of being kept alive, but, for the families, even though the decisions were reached, it is still hard, after all, even though they knew, that it was for the benefit of the terminally ill, how can you bear the thought, that the one you loved was still alive, and you’d allowed her/him to die?  A struggle between the human mind and spirit here!!!

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Forcefully Saving the Terminally Ill IS Torturing Them

 

If you have a loved one who’s suffering right now, consider this, translated…

The amendments for terminal care on January 9, 2013 had been passed into law.  Based off of this newly amended clause, the terminally ill can choose whether to be kept alive on a respirator, or to be unplugged, but, even though, this new law had been set up for more than a year and a half, the public still knows too little about it, and, those who’d registered for this service in the total populations is low to the point of unimaginable.

Naturally, for any social services education to be successful, it would be very slow, just like organ donations, and, the issues relating to life and death is even harder, and, for these values to become mainstreamed, it will need a long-term education of the public.

The Laws are Set Up to be More Lenient

The amendment this time focuses on lowering the standards of the use of CPR and the respirators.

So long as the patient her/himself agrees, or without the papers signed, there would only be two doctors to confirm, along with a family member, like a spouse, an adult child, a grandchild, or parents, and, there would NOT be a need for the decision to go through the morality department of the hospital to evaluate, and the person can be taken off life support, and this, is already more workable compared to before the amendments were written out.

This amendment, IS based off of morality of medical treatment, and is a very forward legislation measure.

Actually, CPR is used to help people who’d gone into cardiac arrest, for instance, drowning victims, electrocuted, in a car accident, or someone who’s having a heart attack, and it’s a necessary measure.

But, to the “terminally ill” who’d suffered for a long term, like cancer patients, and those with heart, lung, liver, kidney, or brain deteriorations, you can’t save them with CPR, and the individuals can only die after they’d been tortured and wasted by the advances in medical measures.

Actually, the National Health Insurance Agency spends of four hundred billion patients on saving the terminally ill, which is over a-tenth of the total amount paid into the national health insurance; of them all, most attempts are in saving those who couldn’t be saved, even WITH the advances in medicine AND technology, the already terminally-ill.

It shouldn’t be that hard, to differentiate those whose hearts stopped and those who are terminally ill.  If there’s trouble, then, the medical world should define more clearly, so, there would be clear-cut guidelines.

DNR

In an article on my blog, “If I can’t wake up again, do NOT conspire with the doctors to torture me”, in the article, I’d stated how I viewed the issues of do-not-resuscitate, and, right after the post, my article had been passed all over the internet.

All the replies, are all in support of DNR; only some, had focused on the precisions of the words I’d used, and they’d had a difference of opinion.

Terminal care would naturally be used for those with a detrimental deteriorating condition, if the doctors knew that emergency measures, such as CPR or tracheotomy couldn’t save the lives, and these measures are merely lengthening the sufferings, then, they should consider NOT tubing the patients up.

Take Away the Fears Toward Death

If it’s pointless to put the tubes into the terminally ill, then, there must be responsibilities to help the patient to unplug, so they can pass away in peace.  Not using tracheotomy and not hooking the patients onto the respirators, naturally couldn’t be thought of as the last resort that the doctors can give to the patients and the members of the family.  But, if the patient is lucid and clearly showed that s/he would like to know all the options, the doctors must tell the options truthfully to the patients.

I believe, in order to make medical treatment for the terminally ill understood, education is a must, but, the point is in taking away the fears that people may have toward death, and lessening their expectations of the hopes that the treatment options may bring.

Death is a natural part of life, also a part of life itself, it’s the basics of life education.  And, the mythical belief of a magical cure must be take away too, the paramedics must have the courage and the duties, to tell the patients along with the families the truth about the patients’ conditions, along with the limits of the medical staff and the medical measures too.

Maintaining the Dignities of One’s Life

What’s more importantly, the education of the paramedics.  The paramedics’ lack of understanding of what terminal care is, and waiving the rights to tell the ill about the options, and forcefully saved the lives of those who are going to die, in my opinion, is torturing the patients.

And so, this, is a very SERIOUS issue that we’d encountered today, like it or don’t, you MUST be prepared for it, because, nobody CAN know the precise moment, or HOW one will die, and so, it’s better to be prepared for death, and, there are so many options out there, and, you just have to sort through them, and figure out, what, exactly it is that you may want, and, talk to your kids about it, so they’d know how to handle these issues, if and when it does come up in the future.

 

 

 

 

 

 

 

 

 

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The Conclusion of the Case Where the Pregnant Woman Became Brain-Dead

This is, after many, many, many days, along with a total of one-hundred forty-two “children” of mine had been “created” too, the JUDGE had R-U-L-E-D!!!  From the News online…

A Texas judge ordered a Fort Worth hospital to remove a pregnant and brain-dead woman from respirators and ventilators on Friday, perhaps ending a wrenching legal debate about who is alive, who is dead and how the presence of a fetus changes the equation.

Erick Munoz, husband of Marlise Munoz, broke down in tears after Judge R.H. Wallace told John Peter Smith Hospital to act on his order by 5 p.m. Monday.

Munoz and other family members had been fighting to have the body released for burial. Hospital officials resisted, saying they were trying to obey a Texas law that says “you cannot withhold or withdraw life-sustaining treatment for a pregnant patient,” in the words of the hospital spokesman.

Munoz left the courthouse without talking to reporters, but the family’s lawyers spoke out. Jessica Janicek argued that the hospital was “utilizing (Marlise Munoz’s) body as a science experiment.”

A breakthrough came when the hospital and the Munoz family agreed on crucial facts listed in a court document: that Marlise Munoz, 33, has “met the clinical criteria for brain death since November 28” and that “the fetus gestating inside Mrs. Munoz is not viable.”

The woman’s husband repeatedly made these claims in his efforts to have her removed from the machines.

Mom of pregnant woman: Change the law

The story may have more chapters. The hospital could appeal or decide to remove Marlise Munoz from a ventilator and respirator before that deadline. The judge did not rule on the constitutionality of a state law regarding the treatment of a pregnant patient.

Erick and Marlise Munoz, two trained paramedics, had been awaiting the arrival of their second child when she was found unconscious on her kitchen floor around 2 a.m. November 26. She was rushed to the north-central Texas hospital.

Once there, Erick Munoz said, he was told his wife “was for all purposes brain dead.” The family also says the fetus may have been deprived of oxygen. Erick Munoz had contended doctors told him his wife “had lost all activity in her brain stem” and an accompanying chart stated that she was “brain dead.”

Husband said wife didn’t want to be on ventilator

During Friday’s hearing in Fort Worth, representatives of the hospital — in this case, from the Tarrant County District Attorney’s office — argued that state law was correctly applied.

                       

 

Erik Munoz and other family members said the hospital should abide by her wishes — which weren’t written down but, they said, relayed verbally to them — and not have machines keep her organs and blood running.

In an affidavit filed Thursday in court, Erick Munoz said little to him now is recognizable about Marlise. Her bones crack when her stiff limbs move. Her usual scent has been replaced by the “smell of death.” And her once lively eyes have become “soulless.”

After the Friday hearing, another family lawyer, Jessica King, said, “Pregnant women die every day. They die in car accidents, of heart attacks and other injuries. And when they die, their fetus dies with them.

“It’s the way it’s always been and the way it should be.”

Lawyers: Records back claim that woman is brain dead

In his lawsuit, Munoz claims subsequent measures taken at the hospital — and, in turn, the state law used to justify them — amounted “to nothing more than the cruel and obscene mutilation of a deceased body against the expressed will of the deceased and her family.”

The hospital and the Tarrant County District Attorney’s Office, which defended the medical facility, did not offer the same level of detail as members of the Munoz family.

But earlier this month, hospital spokesman J.R. Labbe told CNN that his hospital believed “the courts are the appropriate venue to provide clarity, direction and resolution in this matter.”

Late Friday, the hospital issued this statement: “JPS Health Network appreciates the potential impact of the consequences of the order on all parties involved and will be consulting with the Tarrant County District Attorney’s office.”

So, this woman, in the end, still got her way, in death, and, the hospital wasn’t right in keeping her on life support, after all, the autopsy of the fetus does prove, that it was, abnormal!!!

 

 

 

 

 

 

 

 

 

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