End-of-Life Care: Brain-Dead Means Dead

Jan 5, 2014 | 2 comments

Jahi McMath

Jahi McMath

The sad situation with Jahi McMath, the 13-year-old brain-dead girl on a ventilator in Oakland, California, shows the need to have more education on end-of-life issues.

The parents protested the hospital’s intention to remove the girl from a ventilator that’s keeping her alive. They hope for a miraculous recovery and seek to have her body transferred to a nursing care facility in New York.

But brain-dead means dead. If the ventilator was turned off, she would be totally dead. Right now, her organs are being kept alive with the actions of the ventilator.

Jahi suffered heavy bleeding, cardiac arrest and “whole-brain death” — defined as an irreversible cessation of all functions of the entire brain, including the brain stem — on December 12, three days after tonsillectomy surgery and complications in the recovery room.

Two hospital physicians and three outside doctors requested by the family deemed her brain-dead, court records show, and the county coroner was notified of the death. Testing showed no blood flow to the brain, no ability to breathe without the ventilator and no sign of electrical activity in her brain. This is not a coma, which offers the possibility of coming back to consciousness.

Three weeks of court maneuvering over the holidays have played out in the national news. Memories of other life support and right-to-die situations – Nancy Cruzan, Terry Shiavo and Karen Ann Quinlan – resonate with the family’s burning desire to keep their daughter alive. However, these other cases involved vegetative states, not brain death.

While her parents are no doubt suffering from the shock of this awful turn of events, why couldn’t they consider saving lives in the face of losing their daughter? Organ donation could help many other people to live beyond Jahi’s death. Helping others live could offer some measure of comfort in the face of this tragedy.

Another question is, who is paying for this extended care for a brain-dead girl? Are the family’s own finances covering the exorbitant medical costs for her continued care? Is it covered by Medicaid? Do they have private insurance that’s covering this effort? Outside fundraising?

You can moan about Obamacare and “death panels,” but having a conversation before such end-of-life situations occur can help reduce so much of this emotional drama.

Sometimes the most heroic measure doctors can take is to help families and patients come to terms with end-of-life. When futile measures are avoided, everyone involved, including society, benefits.

There’s a thoughtful discussion of these issues in this Washington Post article, “Oakland hospital, coroner return Jahi McMath to family,” and this Washington Times article, “Shades of Terri Schiavo in case of girl left brain-dead after bizarre tonsil surgery mishap.”

A Good Goodbye