OAKLAND, Calif. — The tragic case of Jahi McMath, a 13-year-old California girl who was declared brain-dead by an Oakland hospital and a month later reluctantly released into the custody of her family, has drawn national attention to end-of-life issues and raised important questions about the definition of death in this technologically advanced age.
In addition, the ethical debate over brain death has divided some reliable pro-life voices, with many citing statements from Blessed John Paul II that the Church recognizes an accurate diagnosis of whole brain death as true death and others questioning the entire concept of brain death when a patient is on a respirator and the heart is still beating.
The debate has been typified by neonatologist and pediatrician Dr. Paul Byrne, who for years has led a movement against the acceptance of brain death, taking aim at noted assisted-suicide opponent Wesley Smith, senior fellow of the Discovery Institute. Byrne and Smith differ as to what constitutes "brain death." Byrne headlined an online essay, "Jahi is not truly dead, Wesley Smith," a point-by-point response to Smith’s defense of the possibility of "death by neurological criteria," the medical term for what is popularly known as brain death.
The legal debate over the life-or-death status of Jahi McMath extended from early December into the new year. There was an understandably distraught mother, other family members and the family’s lawyer jointly insisting that medical treatments should be given, even after doctors declared the girl brain-dead, against a hospital that sought to take her off a respirator and did not provide assisted feeding, saying that it was against medical ethics to provide treatment to a deceased person. A coroner even issued a death certificate.
The deep emotions running through the case were enhanced by the fact that the teenager went into the hospital in early December to have her tonsils and other tissues removed in an apparently routine procedure. After surgery at Children’s Hospital and Research Center in Oakland, according to media reports, she began bleeding and suffered cardiac arrest, robbing her brain of oxygen for an extended period. It seemed like a nightmarish convergence of circumstances that touched the heart and fears of anyone going to have surgery, and there has been great sympathy for a mother who expected to get her daughter back healthier than before.
Five physicians, two from the hospital and three independent doctors requested by the family, have declared the girl to be brain-dead, Catholic News Agency reported. The doctors have said the girl is unable to breathe on her own, and other tests show that there is no blood flow to her brain and no signs of electrical activity.
After a judge ordered the hospital to keep her on a respirator until Jan. 7, the hospital agreed to release Jahi while still on a respirator. On Jan. 5, she was taken by her family to an undisclosed location for care and medical treatment.
The family’s lawyer, Christopher Dolan, said at the time that Jahi was in "very bad shape" after being denied food for weeks while the legal battle waged. Yet a few days afterward, Dolan sent a message to the media that the girl was "doing very well" after undergoing a tracheostomy and the placement of a feeding tube.
The Terry Schiavo Case
Some commentators have made comparisons to the case of Terry Schiavo, who was at the center of a legal battle between her family, who wanted to take care of her, and her husband, who wanted her feeding tube removed after she was in a coma for a number of years. Following court interventions, and with even Congress and President George W. Bush getting involved, her husband ultimately prevailed. Her feeding tube was removed, and she died days later, in April 2005.
Yet Terry Schiavo was never declared brain-dead; she could breathe on her own without a respirator. Rather, she was said by doctors to be in a persistent vegetative state (PVS); all she needed to survive was a feeding tube and comfort care.
Schiavo’s brother, Bobby Schindler, who heads an advocacy organization in her memory, issued a statement after Jahi’s release from the hospital. Noting that he did not know the medical condition of the girl, he said that the doctors declared her brain-dead rather quickly and that the girl should be given a chance to recover in a medical facility that was willing to treat her.
"Sadly, these cases are becoming more common in our current medical environment, where government bureaucrats and faceless hospital boards, in the form of ethics committees, strip away the rights of parents and families to make their own decisions regarding medical treatment," Schindler said.
Taking a contrary stand was Father Michael Orsi, an expert in law and religion at Ave Maria University in Naples, Fla. In a Jan. 5 opinion piece in The Washington Times, he wrote, "Since the brain stem, which controls the involuntary muscle system, is dead, her heart will stop once she is removed from the ventilator. … To keep a body alive is to deny the natural dying process and to delay the inevitable."
Yet this is the kind of language that opponents of the concept of brain death point to. If Jahi is truly dead, how can her body be kept alive "to deny the natural dying process"? they ask. A person is either dead or not, they insist.
Dr. Byrne and others contend that the concept of brain death was developed so that living organs could be taken from unconscious patients. He wrote to Wesley Smith, "The need for ‘brain death’ is, and has been, from the onset, to remove ‘controversy’ about cutting out the beating heart and other vital organs from patients with a beating heart, circulation and respiration."
John Paul II’s Statement
Although the precise definition of brain death varies among states, and its application to individual cases is inconsistent, most Catholic medical experts refer to a statement given by Pope John Paul II to an international organ-transplant society in August 2000.
While saying that death is a "single event" of the separation of the soul from the body that cannot be definitively pinpointed by medical science, John Paul II concluded that reliable scientific methods can accurately determine the fact that death has occurred. He said that brain death is "the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity."
Dr. Daniel Sulmasy, a Franciscan brother who specializes in medical ethics at the University of Chicago, said that if the diagnosis of brain death is accurate, there should be no further attempts to provide treatment.
"The Church accepts the diagnosis of brain death as legitimate death," he told the Register.
He added that the first Catholic health-care response in the Jahi McMath case would be "recognizing and acknowledging the deeply sad situation that the family is going through and showing them the deep sympathy they deserve."
While he was the medical ethicist at St. Vincent’s Medical Center in New York City years ago, Sulmasy said, he faced situations in which family members would not accept the declaration of brain death. However, he added, that, in most cases, the patient is so unstable that the heart stops after a short time, even while on a respirator, because "the person cannot sustain bodily functions as an integrated whole."
The fact that Jahi’s heart has continued beating while on the respirator may indicate that there is still a connection of the body’s involuntary system to the endocrine system, Sulmasy said, and if so, she may continue that way for weeks.
Bishop Robert Finn of Kansas City-Saint Joseph, Mo., noted the concerns regarding the morality of diagnoses of brain death and offered support for the family’s efforts on behalf of Jahi in an article posted Jan. 9 on his diocesan website.
"It seems clear to me that the effort to keep Jahi alive is a matter of ‘extraordinary means,’" Bishop Finn wrote. "As such in Catholic moral teaching, a person or family could choose to end life support with moral justification. However, Catholic moral teaching would also support the extraordinary efforts required to keep the child alive, if that was the chosen path."
"As I write this, so much is changing, and by the time you read this, so much may have occurred in the life of Jahi and her family," Bishop Finn said at the conclusion of his commentary. "But I still ask you this: Pray for Jahi and for this family. Pray also that authentic moral principles will be upheld in the midst of a scientific endeavor which is always complicated, but which requires many, many prudential decisions. We must work hard and speak out clearly for the protection of human life at all its moments."
Stephen Vincent writes from Wallingford, Connecticut.