by Abram Estafanous
In December of 2013, 13-year-old Jahi McMath entered Children’s Hospital & Research Center in Oakland, California for a seemingly routine procedure to have her tonsils removed. Immediately after the surgery, she experienced a heart attack and brain hemorrhaging. Three days later, she was declared brain-dead and issued a death certificate.
The case of Jahi McMath is one of many end-of-life scenarios that have ultimately spurred debate and confusion among health care circles and the general public of ethical dilemmas regarding the personhood of a brain-dead individual, the morality of ceasing life support, and the very definition of death itself.
“There is confusion of how to determine whether someone is permanently comatose and meets the criteria of whole brain-death, which is supposedly an irreversible loss of function, versus someone who is persistently vegetated,” said Dr. Cheryl Lew, pediatric pulmonologist at Children’s Hospital Los Angeles.
Indeed, Dr. Lew believes that determining the definitions of brain death, a coma, and a vegetative state is one issue that stirs debate. Current medical thought defines the central difference between brain death and a coma, as well as a vegetative state, as involving brain activity. While the latter two describe states where brain activity is still present, brain death is the total loss of brain activity.
Yet, confusion still abounds. This confusion of how death is defined has spurred various health care specialists, such as bioethicist Arthur Caplan of New York University Langone Medical Center, to argue for a more blunt approach in explaining to families the state of the patient. Caplan argues that the main driving force behind the legal debacle of Jahi McMath’s case was a lack of knowledge by the family regarding whether Jahi was considered to be in an irreversible condition.
But, clearing up the definition of death seems to be more complicated than simply being blunt. The borders of brain death, comatose, and vegetative state are not clearly defined.
“At the time of the original description of death by neurological criteria, the belief was that if you had complete loss of brain functions, your peripheral body functions, even if you were on a ventilator, would deteriorate. But this is probably not the case because it is very difficult to distinguish between the persistently vegetated individual and one who has permanent loss of brain function,” said Dr. Lew.
Furthermore, Dr. Lew believes that confusion and debate also results from a current trend by many bioethicists to associate death with personality.
“There is current controversy in that some bioethicists think that perhaps death really means the loss of personhood. The difficulty with that is that people tend to be concrete and it’s hard for many people to understand that the shell of the body is not necessarily the person.”
With increasing medical knowledge and advancing technologies, it seems that the debate over the essence of death will rage on, with inevitable perspectives that will move to challenge the current notion of death by neurological criteria.
“There have been years of arguing that the current definition of brain death is very flawed and that there should be a redress of the issue,” said Dr. Lew.