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The Beginning of Death

By on January 6, 2014
Image: A photograph of 13-year-old Jahi McMath is seen on a necklace in Oakland

A confusing layer of grey space exists between the line that separates life from death.

When has a vibrant, young thirteen year-old girl truly died?  That is the great debate raging on inside the walls of the independent, free-standing Children’s Hospital Oakland after an elective tonsillectomy procedure tragically ended in brain death – and technically, an actual death as well, under California law – for Jahi McMath.

Undeniably, a death has occurred when the heart has stopped beating and cannot be revived.  However, just as the Terri Schiavo case that polarized the nation proved in 2005, controversy and confusion stands in the way and continues to fuel debate surrounding sensitive end of life issues.  Specifically, Jahi’s situation polarizes the issue of when a person’s heart is still beating while the brain has died about what to do.
So how did we get to this point and what is next?At this point Jahi’s family can either accept the shared opinion of the physicians who have declared her irreversibly brain dead or cling to their faith and strong religious beliefs for a modern day miracle.  It is an emotional and almost incomprehensible tragedy that began with tonsils being removed. It’s been reported that complications by obstructive sleep apnea led to heart attack. And then directives by nursing staff to provide direct, bedside care to their daughter.

Apparently the medical concerns about having any family member suctioning blood from their daughters throat did not herald the need for an even more urgent intervention. Bleeding after tonsillectomy procedures is relatively common and sleep apnea patients also carry a higher risk of complications with surgical procedures.

It appears that given the role the family may have played in assisting with their daughters medical care and the unfortunate outcome that resulted, that there are too many unanswered concerns and too much mistrust to allow the family to reject hope and their fundamental rights as parents and replace it with technical definitions of death. Wouldn’t millions of parents feel the same way under these circumstances?

Tonsillectomy Brain Dead GirlThe individual right of a patient – or their parent – to control medical decisions for their children is a fundamental cornerstone of the medical establishment.
The role of the physician is to care for the patient, explain the options and let the patient or next of kin decide.  However, in this case, the independent Children’s Hospital Oakland has chosen to press the issue of McMath being brain dead.
What will happen to Jahi now that there has been an agreement for her to leave Childrens Hospital remains unclear.  However, if there is one lesson to be learned from this tragedy, and there are several, it is to plan.
Discuss your wishes in advance if you are about to have surgery and prepare an Advance Directive. This document can easily be found on line and helps communicate your wishes to your loved ones and to your physician.
Image courtesy of Reuters/Stephen Lam
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Dr. Moshe Lewis MD, MPH, MBA is currently on the Volunteer Clinical Faculty of UCSF. Dr. Lewis specializes in the non-surgical management of musculoskeletal and neurological injuries and diseases.  His focus of care is pain relief, regaining flexibility, and building strength with the goal of getting people back to work and enjoying healthy, productive lives.

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