How long should compassionate care continue in a case of a brain-dead patient? Does the definition of ‘death’ need to be reconsidered? Who should decide when treatment should stop on a loved one? All these questions were brought up in the recent case of Jahi McMath, a 13-year-old girl, who underwent surgery at Children’s Hospital Oakland, on December 9th.
The procedure was meant to cure her case of sleep apnea, by having a routine tonsillectomy as well as clear some tissue from her nose and throat. However, due to complications she went into cardiac arrest, and was placed on a ventilator. On December 12th, she was deemed “brain-dead” by several neurologist, and was to be removed from the ventilator. With her daughter’s heart still beating, the mother believes her daughter is still alive, and filed a lawsuit against the hospital, to keep her daughter on the ventilator. The court declared Jahi to be brain-dead, but gave the mother until January 5th to find a new long term care facility, because Children’s Hospital in Oakland refused to continue providing care, on the grounds that it is unethical to operate or provide care to someone who is deceased. The court allowed Jahi’s body to be released to her mother, after issuing a death certificate. The mother had arranged for an emergency team to transfer Jahi to an undisclosed hospital who has stated it will continue to provide care.
Certainly the definition of death needs to be addressed. There are currently two standard medical/legal definitions of death. The first being cardiopulmonary death, which is the irreversible loss of function in the heart and lungs. The second being brain-death, which is the irreversible cessation of all brain functions. This can be a difficult diagnosis for relatives and friends to understand and accept. The patients have a heartbeat and are breathing, and appear to just be sleeping peacefully. They even feel warm to the touch, but the stark reality is that this is only due to the machines, providing mechanical support breathing for the patient, and the medication given to maintain their blood pressure.
Nevertheless it is unethical for physicians to operate, or provide care to someone who is deceased. So in this regard the doctors of Children’s Hospital Oakland acted accordingly. Physicians have no obligation to offer treatments that do not benefit the patient. Futile interventions may give the patient’s family false hope, and expend finite medical resources. Christopher Dolan, the attorney for Jahi’s family, is challenging the law linking the end of life to brain death. He states “families – not hospitals, judges or governments – should decide when treatment stops on a loved one.” But I don’t think Mr. Dolan quite understands the full ramifications of what this would lead to. The deceased person would be taking up a hospital bed, medical equipment, not to mention the time of physicians and nurses. Time that should be used to provide care to those that it will actually...