Who decides when to pull the plug when a person is pronounced brain dead? The answer to that question is, tragically, being hotly debated in Oakland, Calif., as a result of an elective surgery gone horribly wrong.
Thirteen-year-old Jahi McMath went to the Children’s Hospital & Research Center in Oakland for a tonsillectomy to help her severe sleep apnea on Dec. 9. The operation was done and initially everything appeared fine. It wasn’t.
Jahi McMath,13, had her tonsils removed on Dec. 9 and was declared brain dead three days later.
She began bleeding, a lot. Jahi was rushed into the hospital’s intensive care unit. There she reportedly got transfusions and medicine to help stop the bleeding, but they did not help. She went into cardiac arrest. She went on life support. Doctors tried to revive her, but nothing worked. A few days later, brain scans and other tests done by doctors with no connection to the surgery showed no signs of activity in her brain. Media accounts say the tests were repeated again with no brain activity detected. Jahi had lost, irretrievably, all brain function. The doctors pronounced her brain dead.
Her parents were devastated. They could not accept that their daughter had gone in for a simple surgery and somehow died. They refused to accept her death. They hired a lawyer and sent a letter demanding life-support to go on. They now say they want a judge to review any decision about life-support.
This case is so sad it is almost beyond description. But that fact should not be a reason to take the view that we don’t know what to do when someone is pronounced brain dead.
Brain dead is dead. It is as reliable a way to determine death as declaring that a person’s heart has forever stopped beating. In fact, due to the strict tests and procedures that have to be followed to determine brain death, it is probably even more error-free than pronouncing someone dead due to cardiac failure.
Brain death is not a coma. People wake up from comas—they still have brain activity. Brain death is not a vegetative state. People in a vegetative state still have some, minimal brain activity. Those who are brain dead have lost all brain activity except the random firing of a few cells. They will not come back.
In this way Jahi is different from the well-known case of Terri Schiavo, who was in a permanent vegetative state before she was removed from life support in 2005. I was an outspoken defender of her husband’s right to stop her treatment against the objections of her parents.
Jahi’s story is, unfortunately, clear cut. Once brain death is declared, doctors have the right to stop treatments including life-support. There is no duty to treat the dead. No matter what the family might say, death is a clear line beyond which treatment need not and should not continue.
So why are we hearing so much dispute about stopping the technology that is keeping Jahiu’s heart beating and breath going even if she is no longer here? It is because the hospital is trying hard to let the parents and family accept her death. They have the legal right to stop, but given all that has happened they feel a moral duty to try and honor the family’s wishes. The technology is not being turned off yet -- not because we don’t know who has the authority to do so. It is because those in authority are using the technology not to support a little girl but to support her family, who are so heart-broken by their loss they cannot yet accept it.
Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.
First published December 19 2013, 9:10 AM