Tuesday, December 31, 2013

Life support for the dead

The sad, sad story of Jahi McMath, the California girl who died as a result of complications following routine surgery just underscores how little people understand what it means to be dead. Thirty or more years ago, every state in the US adopted some version of 'brain death' recommended by the AMA and the National Conference of Commissioners on Uniform State Laws to compliment the older notion of cardiac death. In both cases, the cessation of cardiac function and brain function are criteria for death---the end of a person's life, the cessation of self-sustaining biological activity. Brain death criteria were adopted once it became clear that artificial resuscitation can keep a heart functioning for some days following death. That a heart continues to beat while supported by machines does not indicate continuing organic life any more than electrical stimulation of the arm of a corpse to make it move indicates anything except technological tricks you can do with dead bodies.

I am not surprised that Jahi's grieving family, angered by what it perceives as incompetence and deceit on the part of the hospital where Jahi died, rejects the conclusion that Jahi is dead. What does surprise me is the continuing insistence from a California judge that the corpse be maintained on 'life support', despite the conclusions from his own outside expert that Jahi is dead.
An independent physician named by Alameda County Superior Court Judge Evelio Grillo last week corroborated the determination that Jahi is legally dead, saying that testing showed no blood flow to the brain, no ability to breathe without the ventilator and no sign of electrical activity in her brain.
Jahi's uncle, Omari Sealey, told reporters late in Monday afternoon that the family has now contracted with the New York facility and arranged for medical transport. But Singer said documentation indicating that the facility will accept the girl appears "faulty."
Meanwhile, experts in medical and legal ethics have said that the hospital must remain steadfast in its refusal to perform any procedures on what is legally considered to be a corpse.
“I think they have to be adamant that they will not begin any new technology on a corpse,” said Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center. “If they don’t, I think it’s disrespectful to the dead in a fundamental way, and it opens the floodgates for other people to say, 'Oh, you don’t really know when we’re dead, do you? So please make more efforts for my loved ones.'"
The attorney representing Jahi's family told local media Monday that he knows he has been widely criticized by some for stoking a false sense of hope, but maintained that he was fighting "for the right of parents to direct the healthcare of their child and for them to make the choice.''
Once someone is dead, there is no such thing as health care, so the attorney's claim makes no sense. The parents do have the right to make funeral arrangements for their child, but these arrangements should not include continuing medical abuse of a corpse.

No parent wants to put her child in the ground, but even sustained on a ventilator, Jahi's heart will stop beating, probably in the next few days. I hope that will given her parents peace.



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