The right-to-life battle over a 13-year-old California girl declared brain dead last month has rekindled a national debate over whether a person in her state should be kept alive.
Jahi McMath underwent a tonsillectomy Dec. 9 at Children’s Hospital Oakland to treat her sleep apnea. She woke up after surgery but began bleeding, later going into cardiac arrest. She was put on life support and declared brain dead.
As Jahi remained on a ventilator in an undisclosed care facility on Monday, her case continues to raise burning questions about what it means to be brain dead — and if there is life after brain death.
Is being brain dead the same as being dead?
Doctors can consider someone dead in two ways: the heart and respiratory system stop, or the brain loses all function.
There are a variety of tests that can be done to determine brain death, said Dr. Trevor Resnick, chief of neurology at Miami Children’s Hospital. Doctors see if the body responds to pain or if certain eye movements can be provoked. There are also brain wave tests that measure the brain's electrical activity.
In Jahi's case, because she was found brain dead, a coroner issued a death certificate with the date of death as Dec. 12. But without performing an autopsy, officials haven't given an official cause of death.
What’s the difference between brain dead and a vegetative state?
While a brain-dead person shows no sign of electrical activity in the brain, a person suffering from extreme brain damage can often exhibits some normal bodily functions, doctors say. The body essentially goes into autopilot: It can sweat when it’s hot, digest food and control its own heartbeat.
“A vegetative state means the person is so brain-damaged that they have no higher cognitive awareness of what’s going on around them,” Resnick said. “But they still have some brain stimulation.”
A brain-dead person, however, can’t even maintain normal blood pressure or body temperature, and would require medications and life-support technology to keep them breathing.
In one of the most famous right-to-life struggles, Terri Schiavo of Florida was diagnosed as being in a “persistent vegetative state” following brain damage from a heart attack in 1990. While she couldn’t communicate, she still had a functioning brain stem. She was kept alive until her feeding tube was disconnected in 2005.
How long does the body of a brain-dead person sustain itself?
There isn’t significant research showing how long a brain-dead person can keep functioning with the help of technology because such cases are rare.
"It's going to be different depending on the age and health of the person," said Dr. Art Caplan, head of the Division of Medical Ethics at NYU Langone Medical Center. “We don’t have much documentation of this because people who are corpses don’t wind up being put on machines."
Resnick added that a brain-dead body is more prone to lung infections and other health risks.
Can their body still process food?
Yes, but poorly, Caplan said. While a feeding tube is needed to get food into the body, those nutrients aren’t being properly processed.
"You need a lot of energy to function," Caplan added. “Your heart could eventually stop for a lack of energy.”
What is the cost of keeping someone brain dead alive?
With medical care, doctors and equipment required, it doesn’t come cheap. Caplan estimates it could be a staggering $7,500 per day.
And would insurance cover it?
No, because, legally, the person is considered dead.
What's next for Jahi?
It's unclear. Now that she's at an undisclosed extended care facility, her family has said that they will provide "treatment to help her get a full recovery" — but they have not said what that treatment would be.