Doctors must define meaning of ‘brain dead’
When Jahi McMath’s parents took her to the Children’s Hospital & Research Center Oakland on Dec. 9 for a tonsillectomy, they were hopeful that the procedure would improve McMath’s airflow during her sleep at night, according to the Los Angeles Times. The last thing they were expecting was that their 13-year-old daughter was going to become brain dead due to complications from this supposedly routine procedure.
The tragic story of what happened to McMath has sparked much debate within the medical community regarding the ethics of life support and the exact definition of “brain dead,” and has demonstrated the need for a better definition of medical death.
Though she was conscious and recovering from the surgeries, McMath was moved to the intensive care unit where she began to bleed from her nose and mouth before eventually going into cardiac arrest. Doctors at the hospital declared her brain dead, meaning that she was legally dead and would be taken off of life support. Her parents insisted on keeping her on life support, maintaining their belief that their daughter would fight and come back to life.
Because McMath was declared legally dead by the Alameda Family Coroner on Dec. 12, doctors did not want to keep her on life support. The issue was brought to court to determine whether McMath was alive or dead, according to California law’s definition of brain dead. The judge granted the parents’ wishes to keep her on life support, primarily to help them deal with the grief of losing their daughter, even though California law states that if the brain is dead, the person is dead. McMath’s body was kept in the hospital for a short while subsequent to the court order, but was then transferred to an unnamed facility on Jan. 7 where her parents said she is receiving much better care, according to CNN.
This debate over whether McMath has any chance of coming back to life if kept on life support is positive for our society but horrible for McMath’s family. This case is forcing both medical professionals and government officials to more clearly define what it means to be “dead,” as well as clarifying the difference between being brain dead, being in a coma and being in a persistent vegetative state. In contrast to being comatose or vegetative, brain dead means that the person is dead and nothing can change the outcome. Perhaps doctors should refrain from using the term “brain dead” completely in order to avoid confusion, and rather refer to their patients as either dead or alive.
There needs to be more well-defined and clear laws stating the difference between brain death and actual death, and what should be done when a patient no longer has brain activity. Once laws are more clear and widely recognized, families will no longer have to endure the agonizing pain of wondering if their child will come back to life.
It is completely understandable that McMath’s parents are in shock over what happened to their daughter. They brought their daughter in for a common procedure, unaware that they were putting her life at risk and now have to deal with the worst possible outcome. Many argue that keeping her on life support is helping them deal with the grief and allowing them to come to terms with their daughter’s death at a slower pace. Several medical experts, however, argue that this gives the parents a false sense of hope — that keeping their daughter on a ventilator merely creates an illusion of life.
“This is basically organ support; it’s not life support. Her organs are alive, but she’s not alive. Her organs are slowly dying. Her fate is written; it’s just a question of when everything fails,” Dr. Neal E. Slatkin, a neurologist and chief medical officer at San Jose’s Hospice of the Valley, told the Contra Costa Times.
It’s a terrible reality that McMath’s parents are having a difficult time accepting. Supporters of the McMath family are saying that parents have every right to keep Jahi on a ventilator if they have the finances to do so. Though the McMaths have received a lot of donations to keep their daughter on life support, the money will eventually run out and Jahi’s body will continue to decay, as it has already begun, according to the Los Angeles Times. By pumping oxygen through a corpse of a young girl, the hospital is draining its medical staff and resources, allowing the family to hold onto a thread of false hope and prolonging the appropriate memorial service for a young girl who passed away too soon.
Izzy Albert is a sophomore majoring in business administration.
http://Medic.nbcbayarea.com/documents/HeidiFlori.pdf
Read the above.
Absolutely NO documented cases of recovery from brain death. Mis diagnosis? Yep…rare. Brain death = death.
Izzy, why are you are getting this wrong, a month after the issue erupted all over the news and the net?
It was NOT a “simple tonsillectomy” … it was “Uvulopalatopharyngoplasty” … a complicated remodelling of the girl’s nasal passages, soft palate and upper throat. (please see Wikipedia) During that surgery, not only were her tonsild and adenoids removed, but the nasal turbinates were surgically remodelled as was the uvula. Her parents would have been informed of the planned surgery, and the risks. They would have read and signed the consent forms for the surgery.
“There needs to be more well-defined and clear laws stating the difference between brain death and actual death, and what should be done when a patient no longer has brain activity. ”
Brain death is “actual death”. There is no difference. If you die because of cardiac arrest (heart stops, brain loses blood supply and dies), respiratory failure (breathing stops, heart and brain die from lack or oxygen), or massive damage to your brain and brainstem stops your breathing and your heart then stops from lack of oxygen …. you are dead.
California law already addresses the issue of what to do when patients lose brain and brainstem activity.
Actually, there are a few cases in the literature over the last several decades of supposed brain death reversal – mainly in infants and fetuses (where you may still have an active neurogenesis niche) – none ever had positive long term outcome, but the papers do exists in PubMed if you look for them – and they are hotly contested amongst thought leaders – And do keep in mind, the brain death diagnosis does NOT constitute zero cerebral activity as is commonly mentioned in the press – it is “no cerebral activity greater than 2 micro-volts” – most thought leaders in the space acknowledge residual “nests” of neuronal activity and residual blood flow do indeed exist in the brain dead – just not enough to support an “integrated whole person” – Since 1968 and the Harvard Ad Hoc Committee on Brain Death, the definition of death has remained static, in spite of 1) the major thought leaders in the space acknowledging that brain death is a process, not an event, and 2) the continued development of new technologies, including those of regenerative medicine – and on top of that, even in the year 2014 we really have no widely accepted idea on how memories are truly stored in the brain, and how much of the brain can be destroyed while maintaining identity – Ira S Pastor, CEO, Bioquark Inc.