Defining "Brain Dead" with some reference to both recent cases.....Lights Out: A New Reckoning for Brain Death
Posted by Gary Greenberg
January 15, 2014“Brain death”
was introduced to the world, in 1968, by a committee at Harvard Medical School. “Responsible medical opinion,” the committee reported, “is ready to adopt new criteria for pronouncing death to have occurred in an individual sustaining irreversible coma as a result of permanent brain damage.” People on ventilators in intensive care units, their brains destroyed by trauma or disease, their hearts still going strong, may have been breathing, taking in nourishment, excreting waste, and healing from infection, but, at least in the opinion of doctors, they were dead—“heart-beating cadavers,” as bioethicists came to call them. Thirteen years later, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research endorsed this opinion, recommending that all states adopt statutes to give doctors the right to pronounce brain-dead people legally deceased. Today, in every state, if your brain, including the brain stem, has been irreversibly and completely destroyed, you are dead.
Each case is heartbreaking in its own way. In California, a thirteen-year-old girl, Jahi McMath, hemorrhaged after throat surgery performed at Oakland Children’s Hospital on December 9th. Blood loss deprived her brain of oxygen, and she lapsed into a coma. On December 11th, her doctor called the neurologist Robin Shanahan to determine, as the attending physician put it to the court, “whether or not Ms. McMath had sustained an irreversible cessation of all functions of the entire brain.” Shanahan detected no brain activity. On December 12th, McMath was declared dead, and a death certificate was issued.
While the families of the brain-dead usually take doctors at their word, or at least accept that their loved one’s life is over, something went wrong; both the hospital and the family lawyered up. The hospital portrayed the family as ignorant. “There is absolutely no medical possibility that Ms. McMath’s condition is reversible or that she will someday recover from death,” Shanahan told the California Superior Court. Meanwhile, experts consulted by the McMaths’ legal team—who included a “forensic-intelligence analyst,” an Ohio doctor who concluded that the teen-ager was reacting to the presence of her family and thus could not be dead, along with a lawyer known for his opposition to California’s malpractice laws—insisted that Oakland Children’s had misdiagnosed her.
In the Texas case, the roles of the family and hospital were reversed. Shortly before Thanksgiving, thirty-three-year-old Marlise Machado Muñoz got out of bed to check on her crying child in the middle of the night. Her husband, Erick Muñoz, a paramedic, got up and discovered her on their kitchen floor, unconscious and not breathing. She had been there at least an hour, and neither his attempts nor those of emergency-room personnel could revive her. At John Peter Smith Hospital, in Fort Worth, her heart stopped beating, multiple times. The family, in accordance with her wishes, told the staff not to make further resuscitation attempts, but was informed that the hospital could not comply: she was fourteen weeks pregnant, and Texas law forbids withdrawing or withholding life support from a pregnant woman until the fetus is viable and can be delivered. Later, according to Erick Muñoz, doctors told him his wife was brain-dead, but would be kept on the machines for at least another twelve weeks.
Our sense that a body is not dead until it is still and cold may be uninformed and unscientific, but so is our sense that the sun moves across the sky from east to west, and most of us live our lives as if this were the case. Of course, you can’t plan a rocket trip to the moon based on that understanding of heavenly movement, and you can’t harvest organs from a body based on our instinctual understanding of death. The concept of brain death has its uses; organ transplants save many lives. But it has its limits, too, as these cases show, chief among them the fact that it is a concept dreamed up by humans in their quest to overcome suffering, one that can have difficulty standing up to the power of love and the implacable mysteries of death.Gary Greenberg is a practicing psychotherapist and the author of “The Book of Woe: The DSM and the Unmaking of Psychiatry.”...more at linkhttp://www.newyorker.com/online/blogs/e ... death.html