Oh, my, what a predicament. Jahi McMath has been released from Oakland Hospital to the custody of the coroner and her family. She has been issued a death certificate. And she's being transferred to an undisclosed care center, where it is hoped she will begin receiving artificial nutrition. This is the height of both irony and tragedy.
The comments by physicians and bioethicists in the CNN articles all harken to the idea that there appears to be no error, she meets criteria for brain death and thus she's "legally dead." This misses the point. Her parents don't care if she's "legally dead." The legal definition does not comport with their own intuitions about death and her mother says as much. She will accept that her daughter is dead only when her heart stops beating. I can understand why a person may take this stance.
This article
in the January 4th, 2014 New York
Times reports on the tragic case (the "Oakland Case") of a
13-year-old girl who suffered complications from elective surgery in early
December 2013, whose condition deteriorated and who has been declared brain
dead. While it is not articulated directly in the article, her parents
appear to object to the medico-legal conceptualization of brain death and they
wish to force the hospital to continue to provide care for her. A judge
has placed an injunction against the hospital, prohibiting them from removing
her from life support (in this case, this most likely means mechanical
ventilation) until Tuesday January 8th, 2014. The medical establishment at the
hospital where she is/was a patient has clearly taken the path of defending the
concept of brain death and their rights and responsibilities under the laws concerning
brain death -they have refused to insert a tracheostomy or a permanent feeding
tube into the girl - and they may have, and we may be tempted to, ascribe her
parents' behavior to anger, grief, bereavement, etc. But I think this
case illuminates some broader issues about bioethics, brain death, and organ
procurement.
For those unfamiliar with the medico-legal definitions, brain death is a diagnosis that is made after
severe brain damage from a variety of insults. It is a very specific
diagnosis that is based on a host of physical examination techniques and
sometimes corroborating diagnostic studies, and it means that there is evidence
of irreversible cessation of ALL brain function that has been caused by
total lack of blood flow to the brain. A patient who is declared brain
dead is legally dead. I have diagnosed brain death dozens of times.
The medical mantra is that, properly diagnosed brain death always means
that there is NO brain function and that "real death" (that is,
cessation of heartbeat) will inevitably ensue in coming weeks or months as the
body cannot continue to function without brain function. But isn't
this interesting! That we need to reassure people that "real
death" will inevitably ensue seems to reveal that we recognize that brain
death is not real death, but that it will, after time lead to real death! (Of course, all paths lead to real death,
eventually.). Clearly this landscape is fertile ground for cognitive
dissonance. Let's explore why.
