Wednesday, January 8, 2014

Brain death is all over the news these days and it's making me crazy. A dead teen is being kept breathing on a ventilator in some private, undisclosed location because her family refused to accept that she's dead and a dead woman is being kept breathing on a ventilator in a Texas hospital against her family's wishes because the fetus inside her still has a heartbeat. Both are dead. Both should already have been buried, cremated, memorialized, whatever by now.

First, there's Jahi McMath. Again, to be clear, she's dead. 6 doctors have agreed, with absolutely no disagreement, except from the girl's mother (understandably anguished) who says her daughter feels warm and has a heartbeat, so she's not dead. Because that's a scientifically sound basis for determining life and death. The circus surrounding that case has been well-document. Just this evening, her family's lawyer informed the world that Jahi is "improving" after being moved and fitted with a feeding tube.

Side note: I have to wonder about the medical professional who put in the feeding tube, which is a surgical procedure. I have some recent personal experience with this. My family had to go through a lot of discussions regarding that feeding tube, and mine was for a person who was unquestionably alive, aware, not comatose, etc. There's a reason why all of the medical professionals at the Oakland hospital (and apparently at reputable rehab facilities contacted by the family) refused to insert a feeding tube into a dead person.

So, anyway. Girl dead, family refusing to accept this fact, death certificate issued, and yet somehow the county coroner has released the girl's body to her mother's custody so that the mother can maintain the very macabre fantasy that her daughter is still alive.

Then there's Marlise Munoz, the dead Texas mother whose body is now being used as an incubator against her and her family's wishes just because the tragedy of her sudden, unexpected death happened to be compounded by the fact that she was 14 weeks pregnant at the time the embolism killed her. I have not seen any indication that there is any question about whether she is in fact brain dead, so I am operating under the assumption that neurologists who have examined her agree with that assessment. This woman's family sought to cease artificial respiration, but the hospital refused, citing a Texas law that prohibits the removal of life support from a terminal patient if she is pregnant.

It's disgusting.

Both cases are being treated like they raise so many thorny legal and ethical questions, but here's the thing: they don't.

Brain dead is dead. Yes, there are anecdotal examples of doctors not following the protocol correctly before declaring brain death. That is not the same thing as saying brain death isn't final and irreversible. So, yes, a family like Jahi's should be allowed to make sure the assessment is correct. Perhaps even to the point of being able to go to court to get a court-appointed outside doctor to give a second opinion. But they shouldn't be allowed to take private custody of dead bodies. We have laws about disposal of bodies for a reason, because it's a public health issue. And it's frankly just gross to think of a body being animated in some creepy simulation of life to assuage the grief of a family in denial.

Meanwhile, a family like Marlise Munoz's should not be forced to know that their loved one's body is similarly being artificially animated in the vain hope that enough semblance of life can be faked for long enough to turn a nonviable fetus into a live infant. For crying out loud, we have no idea what the lack of oxygen that killed Marlise's brain did to the fetus, but it can't be good. And how can it possibly be developing in any good way inside a body that has no brain function, the key to all bodily systems working. But somehow, the hospital insists that the law in Texas requires them to keep up this charade until they can try a C-section at some point, undoubtedly a point way too early for ideal, safe delivery.

Side note: I question the hospital's interpretation of the law. The statute prohibits taking a terminal patient off life support (which is despicable enough, but that'd be the subject of a different rant). But if a person is dead, that patient is no longer terminal, right? And when a respirator is the only thing maintaining any illusion of life, it's not life support. Were I representing this woman's family, I would most strenuously argue that this law applies to women in comas or in persistent vegetative states, women who have at least minimal brain stem function, but does not, and indeed cannot, apply to women who are, as Marlise Munoz is, dead.

What these two cases show is that we as a culture have some seriously messed-up ideas about how to respect life. We don't respect life by allowing people to pretend that the state that Jahi McMath and Marlise Munoz are in right now is life. It isn't, for either of them. It's a cruel hoax. We also don't respect life by forcing Marlise's pregnancy to continue in this sorry state, when we have no idea what sort of pain and suffering will result. Is it even possible that a live infant can come out of this mess? If so, what sort of developmental issues will it be born with?

Respecting life would be letting nature take its course. Both of these individuals are dead. They shouldn't be used as incubators for a mother's denial or for a fetus. Dead is dead.

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