Monday, December 29, 2014

Time Doesn't Always Heal

Over the past month, the media has been following the untimely deaths of Jahi McMath and Marlise Munoz-two bodies kept on ventilator support despite brain death diagnoses. Much of the discussion surrounding these high-profile cases perpetuates the misconception that brain death is not as final as cardiac death; that somehow these women can recover. Unfortunately, these tragedies highlight the importance of separating specialists from charlatans.

Time Doesn’t Always Heal

Over the past month, the media has been following the untimely deaths of Jahi McMath and Marlise Munoz—two bodies kept on ventilator support despite brain death diagnoses.  Much of the discussion surrounding these high-profile cases perpetuates the misconception that brain death is not as final as cardiac death; that somehow these women can recover.  Unfortunately, these tragedies highlight the importance of separating specialists from charlatans.

On December 9, 2013, thirteen year old Jahi underwent an elective procedure to treat her sleep apnea.  Complications caused her to be placed on a ventilator, and despite several determinations of brain death, her family obtained a court order that prevented the hospital from withdrawing support.  Earlier this week, her body was released to the county coroner who then released it to her family to take to an undisclosed location.  Despite a death certificate, she continues to be kept on a ventilator.

Marlise collapsed in her kitchen on November 26th due to a pulmonary embolism.  Although she has been declared brain dead and her family wants support withdrawn, the hospital has kept her on a ventilator because at the time of admission she was 14 weeks pregnant.  Texas law prohibits a hospital from withdrawing support from a pregnant patient, although a court has yet to decide whether the law was meant to apply to a patient who is deceased.

Medical and legal death occur when either the heart and respiratory system stop, or the brain no longer has function.  The standard was first introduced by a Harvard Medical School committee in 1968 and was endorsed by the American Medical Association and the American Bar Association.  It was published as the Uniform Determination of Death Act by the National Conference of Commissioners on Uniform State Laws.  It has been applied in all 50 states.

Brain death is a condition made possible by modern medicine—a person’s brain has irreversibly ceased functioning, but machines and medication can maintain the functioning of other organs.  The diagnosis is made by performing a series of tests on the person that target basic brain function—responsiveness to pain stimuli, ability to breathe independently, and reflexive movements.  If brain dead, a ventilator only gives the appearance of breathing, but the person cannot, and will not, breathe on his or her own.  The term “life support” only obscures what has actually occurred. 

Brain death is distinct from brain damage, a coma, or a persistent vegetative state.  Comatose patients (e.g. Formula 1 driver and ski accident victim Michael Schumacher) are unconscious, but can retain much of their brain activity.  Sometimes comas are medically induced to help patients recover from brain injuries.  Vegetative patients (e.g. Terri Schiavo) have lost much of their brain function and recovery is rare, but possible, depending on the severity of injury.  Yet, in each case, these patients are alive, and their care is determined by advanced directives, guardians, or surrogate decision makers.

Jahi and Marlise are not injured, comatose, or vegetative.  They are dead and no additional time or treatment can change the outcome.  Claims to the contrary contradict medicine, law, and ethics.  To continue to perform procedures on them is a desecration of their bodies, a drain on the medical staff, and a barrier to closure for their families.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

Follow the Field Clinic on Twitter.

RSS feed.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Latest Health Videos
Also on Philly.com:
Stay Connected