Ethicists criticize treatment of brain-dead patients comments (4)
January 23, 2014
Many doctors are questioning continued medical procedures on a 13-year-old California girl declared brain-dead in early December 2013, calling interventions to provide nutrition to a dead body wrong and unethical.
Jahi McMath was pronounced dead by the coroner’s office after suffering rare complications from a Dec. 9 tonsillectomy. Her parents, unwilling to disconnect Jahi from machines that keep her heart beating artificially, have transferred her from an Oakland hospital to an unnamed facility. The McMath family lawyer announced Jan. 8 that Jahi’s new doctors had inserted a tube in her throat and another tube to provide nutrition to her stomach.
Many people don’t understand the differences between a coma, persistent vegetative state and brain death, said Arthur Caplan, head of the division of bioethics at NYU Langone Medical Center in New York City. By moving the lungs up and down, a ventilator can “give the appearance of life,” Caplan said.
But in fact, “brain death” is no different than any other sort of death: A brain-dead person is no longer alive. The term simply describes how the death was determined.
According to the Uniform Determination of Death Act, adopted by most states, death is defined as “irreversible cessation of circulatory and respiratory functions” or “irreversible cessation of all functions of the entire brain, including the brain stem.”
Some of the differences between states of consciousness and brain death are:
Brain death: These patients are no longer alive. There has been an irreversible cessation of all activity in both the brain and the brain stem. Reflexes that go through the spinal cord may persist even in a brain-dead state.
Coma: These patients are alive, but in a state of eyes-closed, depressed consciousness from which they cannot be aroused. Coma is distinguished from brain death by the presence of brain stem responses, spontaneous breathing or nonpurposeful motor responses. Coma has three possible outcomes: progression to brain death, recovery of consciousness or evolution to a state of chronically depressed consciousness, such as a vegetative state or minimally conscious state.
Vegetative state: Patients in vegetative states are alive but have severely impaired consciousness, although their eyes may open spontaneously. The eye opening may give the impression of consciousness, but there is no awareness of the environment. These patients do not acknowledge the examiner; they do not attend or track objects that are presented to them; their movements are nonpurposeful; they do not speak.
Minimally conscious state: These patients are alive, with a severe alteration in consciousness with intermittent but inconsistent behaviors suggesting awareness. Minimally conscious patients may occasionally have purposeful movements, and they may track motions with their eyes or speak.
Editor’s Note — Robert Stevens, associate professor of neuroscience/critical care at Johns Hopkins University School of Medicine, was a source for this story.