The Middlesex District Attorney prevented Michael Costin's family from donating his heart for a transplant
January 28, 2002 9:24 AM Subscribe
The Middlesex District Attorney prevented Michael Costin's family from donating his heart for a transplant in case Thomas Junta's lawyer had argued Costin died of a pre-existing heart condition.
"With heart transplants, it's literally a life or death situation," said Dr. Lachlan Forrow, an internist and director of the ethics program at Beth Israel Deaconess Medical Center. "It's very, very likely that, because of this decision, someone with heart disease died. I think it's tragic."
"With heart transplants, it's literally a life or death situation," said Dr. Lachlan Forrow, an internist and director of the ethics program at Beth Israel Deaconess Medical Center. "It's very, very likely that, because of this decision, someone with heart disease died. I think it's tragic."
That's an incredibly irresponsible remark on the doctor's part. Transplant opportunities are missed every day of the year in this country, for good reasons (like this one) and bad ones. Dr. Forrow all but pins the death of an unknown other on an overzealous d.a., when in fact the ruling was absolutely called for. (In fact, if Forrow has any grounding in forensic pathology, he knows there has to be a medical finding of the precise cause of death at autopsy for a successful prosecution to be made.)
Dr. Forrow ought to be censured. Would he make the same comment about a colleague when a post-op infection kills a transplant recipient? Bet not.
posted by nance at 10:58 AM on January 28, 2002
Dr. Forrow ought to be censured. Would he make the same comment about a colleague when a post-op infection kills a transplant recipient? Bet not.
posted by nance at 10:58 AM on January 28, 2002
There is nothing irresponsible about the remark at all. It is a deliberately provocative comment, intended to have the effect of (logically) provoking debate about a little known policy of police and prosecutors impeding transplants from victims of homicide.
"Missed transplant opportunities" do in one sense cause the death of those who could have used the transplant.
The mission of a prosecutor is neither to see that victims are avenged, nor that miscreants are punished, but, rather, to serve and protect society by applying the criminal law with due discretion. It is entirely appropriate for a prosecutor to weigh the probative value of the heart left in the corpse against the life-saving value of the transplant ... and for public attention to the matter to influence prosecutors to reweight their considerations, or for legislators to impose a statutory remedy.
(It surely worthy of noting that the crime Junta was convicted of, involuntary manslaughter, is exactly the offense that one is properly convicted for when one attacks someone unjustifiably in a fight and they die of a pre-existing heart condition as a result. In other words, the prosecutor gained nothing for the cause of justice in refusing to allow the organ donation.)
posted by MattD at 11:28 AM on January 28, 2002
"Missed transplant opportunities" do in one sense cause the death of those who could have used the transplant.
The mission of a prosecutor is neither to see that victims are avenged, nor that miscreants are punished, but, rather, to serve and protect society by applying the criminal law with due discretion. It is entirely appropriate for a prosecutor to weigh the probative value of the heart left in the corpse against the life-saving value of the transplant ... and for public attention to the matter to influence prosecutors to reweight their considerations, or for legislators to impose a statutory remedy.
(It surely worthy of noting that the crime Junta was convicted of, involuntary manslaughter, is exactly the offense that one is properly convicted for when one attacks someone unjustifiably in a fight and they die of a pre-existing heart condition as a result. In other words, the prosecutor gained nothing for the cause of justice in refusing to allow the organ donation.)
posted by MattD at 11:28 AM on January 28, 2002
The fact that an EMT had said at the scene that a possible cause of death was a heart attack, in my view, makes the D.A.'s decision the right one. It was an issue that had already been raised, and the D.A. had to act to counter that possible defense strategy.
On the other hand, when asked to weigh decisions of justice versus life-or-death situations, I'd not be so quick to side with justice. There are cases in which I'd prefer to risk letting a criminal go free in exchange for granting an innocent person a reprieve on a medical death sentence. I'm not saying I'd always make that bargain (particularly in the case of very violent offenders), but I don't think it's clear cut.
We'll never know, of course, if Costin's heart would have saved someone else's life. But it's quite possible, and I don't think Dr. Forrow was in any way out of line by pointing that fact out.
And dhartung, I hope that you never experience someone in your family being in need of a transplant. And if you do, I hope you never encounter someone so flippant as to say, "extend by a few years the life of someone with a preventable heart condition." Not all heart disease is due to lifestyle factors, and transplant recipients are now often living decades after the surgery.
posted by Chanther at 11:41 AM on January 28, 2002
On the other hand, when asked to weigh decisions of justice versus life-or-death situations, I'd not be so quick to side with justice. There are cases in which I'd prefer to risk letting a criminal go free in exchange for granting an innocent person a reprieve on a medical death sentence. I'm not saying I'd always make that bargain (particularly in the case of very violent offenders), but I don't think it's clear cut.
We'll never know, of course, if Costin's heart would have saved someone else's life. But it's quite possible, and I don't think Dr. Forrow was in any way out of line by pointing that fact out.
And dhartung, I hope that you never experience someone in your family being in need of a transplant. And if you do, I hope you never encounter someone so flippant as to say, "extend by a few years the life of someone with a preventable heart condition." Not all heart disease is due to lifestyle factors, and transplant recipients are now often living decades after the surgery.
posted by Chanther at 11:41 AM on January 28, 2002
Wow. So if a transplant was ruled out by a family's religious objections, would Forrow be justified in saying, "Due to the family's superstitious beliefs regarding an afterlife, another's life was lost?"
The victim was beaten, but beaten people can expire of all sorts of things during and after a beating, including from a preexisting and unknown heart condition. It is one thing to punch someone and cause a brain injury. It is quite another to punch someone and have them drop dead of a heart defect. You're right, Matt, that involuntary manslaughter was the verdict, but the charge made voluntary manslaughter available to the jury, as well. For that, you'd need an autopsy that said the beating caused the death, period.
posted by nance at 12:35 PM on January 28, 2002
The victim was beaten, but beaten people can expire of all sorts of things during and after a beating, including from a preexisting and unknown heart condition. It is one thing to punch someone and cause a brain injury. It is quite another to punch someone and have them drop dead of a heart defect. You're right, Matt, that involuntary manslaughter was the verdict, but the charge made voluntary manslaughter available to the jury, as well. For that, you'd need an autopsy that said the beating caused the death, period.
posted by nance at 12:35 PM on January 28, 2002
No, nance, Dr. Forrow would not have been justified in making a statement criticizing a family's religious objections to transplantation. Transplantation is a medical decision, and as such gets made by patients.
But the D.A.'s decision was not about the rights of patients to decide medical procedures, it was a public policy decision - pitting one social need against another. As I said before, I think the D.A. made the right decision. But Dr. Forrow criticizing a public policy decision by a government official is a completely different situation from criticizing a family's private medical choice. The two are not comparable.
posted by Chanther at 12:49 PM on January 28, 2002
But the D.A.'s decision was not about the rights of patients to decide medical procedures, it was a public policy decision - pitting one social need against another. As I said before, I think the D.A. made the right decision. But Dr. Forrow criticizing a public policy decision by a government official is a completely different situation from criticizing a family's private medical choice. The two are not comparable.
posted by Chanther at 12:49 PM on January 28, 2002
I wonder whether any questions about possible heart conditions might not have been answered during the course of a transplant, when the heart is available for (non-destructive) testing. Aren't there safeguards to ensure that a heart that suddenly becomes available for transplant isn't defective?
posted by dws at 1:20 PM on January 28, 2002
posted by dws at 1:20 PM on January 28, 2002
I actually think that honoring religious grounds for objecting to transplantation, as the policies are presently structured, is entirely indefensible.
One should have the complete right to refuse one's organs for transplantation after one's death -- but only if that refusal is accompanied by an irrevocable disqualification from receiving donated organs, except where no wait list in effect. There is nothing more destructive to sound public policy than granting privileges without imposing rationally concommitant responsibilities.
Hence, I would have no hesitation, whatever, with attacking as in some sense "responsible" for the death of another the decision not to allow transplation unless it flowed from a bona fide religious commitment which bars the faithful -- in observed practice, as well as in dogmatic theory -- from receiving organs.
As for the D.A., she was obliged, and hopefully did, make a careful consideration of the value of -- maybe -- getting voluntary manslaughter verus the value of -- probably -- saving a life on the waiting list. Particularly given the lack of objection of the victim's family, I think she made the wrong call. It's not like even the involuntary manslaughter conviction doesn't send a fairly powerful message to raging hockey dads everywhere.
posted by MattD at 3:50 PM on January 28, 2002
One should have the complete right to refuse one's organs for transplantation after one's death -- but only if that refusal is accompanied by an irrevocable disqualification from receiving donated organs, except where no wait list in effect. There is nothing more destructive to sound public policy than granting privileges without imposing rationally concommitant responsibilities.
Hence, I would have no hesitation, whatever, with attacking as in some sense "responsible" for the death of another the decision not to allow transplation unless it flowed from a bona fide religious commitment which bars the faithful -- in observed practice, as well as in dogmatic theory -- from receiving organs.
As for the D.A., she was obliged, and hopefully did, make a careful consideration of the value of -- maybe -- getting voluntary manslaughter verus the value of -- probably -- saving a life on the waiting list. Particularly given the lack of objection of the victim's family, I think she made the wrong call. It's not like even the involuntary manslaughter conviction doesn't send a fairly powerful message to raging hockey dads everywhere.
posted by MattD at 3:50 PM on January 28, 2002
"Missed transplant opportunities" do in one sense cause the death of those who could have used the transplant.
"missed opportunities" cannot be the cause of death. If a doctor is unable to save the patient, she is not guilty of killing him.
This is an unusual case, and the decision makes sense. More concerning are the huge numbers of people who die each year and get burned up or buried without offering help to anyone - this man's remains saved a number of lives already (other organs were used).
According to this site, there are more than 75,000 people waiting for a life-saving organ, and the number of non-living donors in 2000 was 5,984. A few million people in the US must die each year, right? That would mean less than 5% of the population donates their organs... I can't find a chart with all the stats, but that's a much better reason to get upset than one reasonable decision that possibly deprived one person of what would have been a wonderful gift.
posted by mdn at 7:38 PM on January 28, 2002
"missed opportunities" cannot be the cause of death. If a doctor is unable to save the patient, she is not guilty of killing him.
This is an unusual case, and the decision makes sense. More concerning are the huge numbers of people who die each year and get burned up or buried without offering help to anyone - this man's remains saved a number of lives already (other organs were used).
According to this site, there are more than 75,000 people waiting for a life-saving organ, and the number of non-living donors in 2000 was 5,984. A few million people in the US must die each year, right? That would mean less than 5% of the population donates their organs... I can't find a chart with all the stats, but that's a much better reason to get upset than one reasonable decision that possibly deprived one person of what would have been a wonderful gift.
posted by mdn at 7:38 PM on January 28, 2002
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posted by dhartung at 10:38 AM on January 28, 2002