The sad case of 13-year-old Jahi McMath, who suffered brain death after complications from a botched tonsillectomy, has renewed the debate over brain death and whether her family has the right to keep her on feeding tubes and ventilators when there is no hope of recovery. Michael Byrne discusses how resistant people are to the idea that a brain-dead person is really, truly dead:
[D]eath is not obvious, or necessarily obvious. In fact, you can very neatly be dead and alive at the same time, in a sense. If, for example, if all of your brain dies except some of the autonomous stuff in the brain stem, you can go on breathing and “living” while having forever forfeited the ability to have a thought, let alone interface with the world. This is post-death. Faux-life. People confuse post-death with life because not only do you still have the body there in front of you, but it does stuff. The body reacts to its environment just the same. This doesn’t mean, however, the brain is enlisted in the activity because the body does plenty of things reflexively without ever bothering with the brain, like shrink from pain or heat. So post-death can sometimes even do a pretty decent impression of life, though you really need to be properly alive to feed yourself or, indeed, have thoughts.
The truly frightening thing in the case of Jahi McMath is that it’s not thoughts that seem to matter to the family. “I believe in God, and I believe that if he wanted her dead, he would have taken her already,” Nailah Winkfield, the girl’s mother, told the New York Times. “Her heart is beating, her blood is flowing. She moves when I go near her and talk to her. That’s not a dead person.” It’s a lower standard for life than it might first seem.
Surgeon Soumitra Eachempati explains how attitudes like Winkfield’s result in a shortage of transplantable organs:
The best chance for a successful organ transplant comes from either a living donor or from organs belonging to an individual declared deceased by brain death. Living donors can only surrender a kidney—and in relatively few cases—a portion of their liver. The patient declared cardiac dead has organs that are sub-optimal due to loss of blood flow to the organs. Most of the successful transplanted organs in the world are from patients declared brain dead.
Organs from brain death represent the overwhelming resource for the livers, hearts, lungs, and pancreases transplanted in the world to victims of such diseases as congestive heart failure, pulmonary hypertension, cystic fibrosis, and diabetes. The major limiting factor precluding donation of these potentially harvestable life-saving organs is refusal of organ donation by families of patients declared to be deceased by brain death criteria. Importantly, organ donation rates vary by country, race, and ethnicity.
Different studies have tried to ascertain why families would refuse the donation of organs even though the demise of their loved one is both imminent and irreversible. Some families may not consider organ donations for religious reasons while others may have misperceptions as to how the body of their loved ones will be handled. Others still simply lack consensus among family members to make a decision in a timely manner. The most common factor, as is the case with the McMath family, is refusal to accept the criterion of brain death as finality for their loved one. In the case of Jahi McMath, the late child’s heart is reportedly spontaneously beating as her organs are being kept alive by a ventilator and other circulatory support. Her mother has said she hopes for a “miracle” and that she is not convinced her child is dead because the heart is beating. Her words and actions clearly indicate that she recognizes cardiac death as finality but not brain death despite the fact that both are clinically and legally recognized as such.
The Dish 