Blunt, But True: Brain Death Is Death

(Getty Images)

(Getty Images)

It’s been more than three weeks since 13-year-old Jahi McMath was declared brain dead after what appeared to be a tonsillectomy at Children’s Hospital Oakland. In the interim, the family has battled the hospital to keep McMath’s body hooked up to a ventilator while they have searched for a facility willing to accept her. Friday morning, at a hearing in Alameda Superior Court, the two sides seem to have come to an agreement that the family can possibly remove her, as long as they accept full responsibility for her.

“This isn’t a patient with a bad prognosis. This is about someone who died. And what the family is hoping for … is resurrection.”

But none of this changes the sad fact that Jahi McMath is dead, as experts patiently explained on KQED’s Forum earlier this week.

David Magnus, director of Stanford’s Center for Biomedical Ethics, pointed to six separate independent evaluations that have all come to the same conclusion, that McMath is “medically dead, she is legally dead.”

And here we get into how language does not clarify, but instead causes confusion. Too often, McMath is referred to as being on “life support.” But David Greer, professor of neurology at Yale’s School of Medicine, says that is not an appropriate term in this case. “She is legally dead,” he explained. “They are simply ventilating a body — or a corpse if you will — and putting oxygen through tissues. … Of course, that was never the intention for these machines, just to preserve organs in this setting.”

The concept of brain death “is not a cutting-edge area of law,” Magnus said. According to the Uniform Law Commission, the concept of brain death was first established in 1978 when it became clear ”that legal recognition only of traditional criteria — which rely on measuring cessation of respiration and circulation — would no longer suffice.” In 1980, the Uniform Determination of Death Act, identified ”cardiorespiratory and brain death in accordance with the criteria the medical profession universally accepts.” Brain death is specifically defined as “irreversible cessation of all functioning of the brain, including the brain stem.”

Over and over, host Dave Iverson and the Forum guests reiterated that this was a tragic case, that their hearts went out to the family, that losing a child is so difficult to accept. But the medical intervention going on is not benefiting Jahi, Magnus said. “She’s gone. She passed away. … What we need to do is focus on the family now.”

Magnus and Greer also specified the difference between someone who is “comatose,” or in a “persistent vegetative state.” Someone who is comatose is unconscious, but very much alive. Someone in a persistent vegetative state has severe brain damage and cannot interact any more. But they can breathe on their own and they have sleep and wake cycles. This was the case with Terri Schiavo. “Terry Schiavo was alive,” Magnus said. “She had a horrible prognosis.” He acknowledged the debate about “who decides under those circumstances what should be done.”

But the Schiavo case is “fundamentally different,” he said, from a patient who has passed away. In McMath’s case, “this isn’t a patient with a bad prognosis, this isn’t a patient who is highly unlikely to recover. This is about someone who died. And what the family is hoping for is a miracle. … What they’re hoping for is resurrection.”

And on this idea of resurrection, I found fascinating reading about McMath’s case from Catholic theologians. “Brain death is an acceptable means of determining death even from a ‘pro-life’ religious perspective,” writes Beth Haile for Catholic Moral Theology. “Brain death criteria are acceptable according to the magisterial authority in the Roman Catholic Church.”

And then she addresses the question of a miracle head-on:

“Of course, God can work a miracle. But prudential medical decisions cannot be made based merely on the hope that God might choose to act miraculously.”

Haile echoed the guests on Forum, who said the family needs more support to address their grief. From her post:

They need to grieve their daughter, not fight for an unrealistic hope of recovery. The pro-life community needs to step up to the task here and make it clear that valid determinations of death, as it appears this one is, are not “anti-life” moves made by death panels, but scientifically and morally valid ways of recognizing a great tragedy.

To learn more about how medical professionals define brain death and to hear more about helping families cope with grief during a crisis, listen to Forum:

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  • nonwzisgdnwz

    Excellent article. Although important to clarify that her surgery was NOT a routine tonsillectomy, but a triple procedure: a tonsillectomy, uvulopalatopharyngoplasty (UPPP), and removal of nasal turbinates. This degree of surgery in children is not routine. It is extensive. When performed on a child, the risk is high. This is why Jahi had a pre-planned PICU stay.

    • http://blogs.kqed.org/stateofhealth Lisa Aliferis, KQED

      I have removed the word “routine” since you are correct that the multiple procedures she had done is more than “routine.” While I have seen some of the detail you cite reported, you seem to have additional info which I have not seen elsewhere (blood disorder, etc). Can you contact me: laliferis@kqed.org I’m curious about this other information.

      • nonwzisgdnwz

        Will do.

      • nonwzisgdnwz

        (Edited to delete questionable health issue as cannot find the source.)

  • Monique

    They got me wondering now if maybe Children’s hospital wasn’t as direct as they could’ve been initially,concerning what brain-dead actually means. If they hadn’t, like someone else pointed out,they should know by now.
    I agree that they really shouldn’t use that term brain-dead anymore and just inform them that the loved one is deceased and then then inform them by what means. I think after this unfortunate situation, that there will be more awareness about brain-death meaning actual death.

  • Frances of Melbourne, au

    I live in Australia and a few years ago a young man was declared brain dead, and they wanted to take his organs. His family refused. He eventually woke up. The bible says that death is when someone breathes their last. Not when their brain in injured.

    • Rob Del Medico

      The Bible says nothing of the sort. Nor is Jahi’s brain “injured”, it has gone through complete necrosis, which is irreversible.

      The Australia case you are probably referring to involved someone who was dead for less than an hour – brain death cannot be accurately diagnosed in that timeframe as it is a complex diagnosis and often requires multiple resources make it. While it is true that doctors like Sam Parnia are able to slow brain death using new procedures, and bringing folks back to life even longer after brain activity ceases, even HE admits that you cannot reverse brain death.

      Technically, Jahi has breathed her last. She is getting no respiratory effect from the ventilator. She is not breathing. Her heart is beating, but only because a machine is making it do so. it is preserving her organs, but she is getting nothing from it. She has breathed her last – a machine is making her vitals appear as if they are working, but it is an ilusion.

      But go ahead and continue misquoting the Bible and believing in some phony miracle which even the Catholic church would consider foolish.

  • derrick

    I hope the mother realizes that her daughters’ death has become a shameful spectacle because of the mother’s actions.