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  Although she has been declared brain dead and her family wants support withdrawn, the hospital has kept her on a ventilator because at the time of admission she was 14 weeks pregnant.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.