Jesse Ramirez Woke Up − Will We?

David C. Stolinsky, MD
July 24, 2008

Recently I was listening to the Laura Ingraham radio show. I heard a man speak who should be dead. At least, that’s what his wife thought. And that’s what his doctors thought. But if we listen to his story, we will learn something important.

Jesse Ramirez is a 36-year-old Arizona resident, a Gulf War veteran and a father of three. He was severely injured in an auto accident on May 30. 2007. He states that he was driving when he and his wife got into an argument about her infidelity. He says that he asked for a divorce, and then his wife grabbed the wheel and caused the crash. He sustained a severe head injury and − like Terri Schiavo − was in a persistent vegetative state, or was minimally conscious, depending on whom you believe. His wife had only minor injuries.

Also like the Terri Schiavo case, the spouse moved the patient from the hospital not to a rehabilitation facility, but to a hospice. Why was this allowed? Hospices are for terminal patients who need help in dying with dignity and in comfort. They are not for patients who are inconvenient.

Again like the Terri Schiavo case, the spouse, who had an obvious conflict of interest, told the doctors to remove the feeding tube and stop water and food. This happened only 10 days after the accident, far too early to know whether recovery might occur. We can speculate why the wife was in a hurry. Subsequently the couple divorced. Why the doctors were in a hurry is harder to determine, but even worse in its implications.

Once more like the Terri Schiavo case, the parents went to court and asked the judge to restore the feeding tube. As in the Schiavo case, the judge was confronted by conflicting medical testimony. But unlike the Schiavo case, this judge did not decide against the continuation of the patient’s life. In fact, he didn’t decide anything. He postponed his decision, leaving the feeding tube out. Had this situation gone on for a few more days, the lack of a decision would have been a death sentence for Jesse.

But here, fortunately, the Ramirez case diverges from the Schiavo case. Hospice officials read the legal papers that the family had filed. For whatever reason − legal, medical or public relations − they reconsidered their decision to remove the feeding tube, and told the doctors to replace it.

As it was, water and food were withheld for five days. We cannot say whether damaged nerve cells were pushed over the edge by dehydration and starvation. We can say that this clearly did not improve Jesse’s condition.

The judge then appointed a guardian, who called neurologists to see Jesse. But their expertise soon became moot, as Jesse’s improvement was obvious. He began to recognize and react to his family. He regained the ability to talk and to eat and drink. Sadly, he is blind in one eye and can see only shadows with the other.

Nevertheless, he retained his positive attitude, and walked out of the hospital in October 2007. He continues to progress in rehabilitation and looks forward to going back to work. In the radio interview, he spoke clearly and to the point, and obviously has regained his mental faculties. This case is hardly unique. Sometimes the patients wake up. Sometimes they don’t. But they are still patients to be cared for, not trash to be discarded.

What should we learn from all this?

·         The outcome of traumatic brain injuries is notoriously difficult to predict. When there is any doubt, it is best to wait. Ten days is much too early to give up, unless one was ready to give up before the injury.

·         As both the Schiavo and Ramirez cases demonstrate, the spouse cannot always be assumed to have the patient’s best interests at heart. This is especially true when the spouse demands, against the parents’ wishes, to “pull the plug.”

·         The presumption always must be for the continuation of life. In order to rebut this presumption, evidence must be persuasive that the condition will never improve, and that the patient clearly would not want to continue living in that condition. The second requirement was not fulfilled in the Schiavo case, and neither requirement was fulfilled in the Ramirez case.

·         If the family lacks means to hire competent attorneys, a volunteer group should be ready to step in. In the Ramirez case, the Alliance Defense Fund did yeoman work in assuring that Jesse was given a second chance at life. It deserves your support.

·         However you feel about the relation between church and state, you must admit that Christian organizations like the Alliance Defense Fund have taken the lead in defending vulnerable human life. If I as a Jew can be grateful for this, why can’t many Christians?

·         The decision that patients in a persistent vegetative state (or other patients) can be dehydrated and starved to death was not voted on by Congress, state legislatures or the people. No, like so many life-and-death issues, it was decided 5-4 by the U.S. Supreme Court. Can we call our nation a republic when we allow unelected judges with lifetime jobs to make such crucial decisions?

Hubert Humphrey taught us that a nation can be judged by how it treats those in the dawn of life, the twilight of life, and the shadows of life. So how will our nation, and our civilization, be judged?

·         In the dawn of life, we abort viable fetuses. But if the abortion produces a living baby with a good chance to survive, we may kill the child − and many, including Barack Obama, approve.

·         In the twilight of life, our “universal” health schemes do not cover palliative cancer treatment, but they do cover assisted suicide − which they suggest to the patient. We do not show respect for autonomy by telling patients, “You should be dead.”

·         In the shadows of life, we treat the severely disabled as though they were subhumans − “Untermenschen,” to use the Nazi term. This is true whether the disability is longstanding, as in the Terri Schiavo case, or recent and more likely to be reversible, as in the Jesse Ramirez case.

Jesse Ramirez is described as an Arizonan, a Gulf War veteran, a son and a father. Unstated but most important, he is also a human being. The key question is not what the precise diagnosis is in a particular case. The key question is what we owe all human beings, whatever their diagnosis. If we fail to remember that people remain human, regardless of their medical condition, we will deserve a stern judgment indeed.

Jesse Ramirez woke up, despite the efforts of others to make his sleep permanent. In contrast, we are still asleep, despite the efforts of people like Jesse to wake us up. But if we don’t wake up and do something about the growing culture of death, our own prospects for a long sleep will be excellent.

Thank you, Jesse, for your service to our country − twice. First, you defended our freedom by your courage. And then, you defended our humanity by your triumph over disability, neglect and dehumanization. After what you went through, the least we owe you is to learn from your experience.

Dr. Stolinsky writes on political and social issues. He can be contacted at dstol@prodigy.net.

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