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Brain Death: Making the Distinctions Print E-mail
By Matthew Hanley   
Wednesday, 22 January 2014

Hundreds of thousands of people will be marching around the country today to protest the wholesale slaughter of life in the womb. Catholics and others have kept that fight alive, to good effect, for decades. But as a faith that values both faith and reason, Catholicism makes careful distinctions on other life issues as well.

Most people, for instance, are not familiar with what, specifically, constitutes brain death. It is not the most pleasant of topics to ponder. And, thank God, few of us have a pressing reason to do so. But the tragic case of a 13-year-old Oakland girl, Jahi McMath, has brought it to national attention – and reinforced the need to speak as considerately as we do clearly.

Here’s a quick review of Jahi’s case: she went in for an elective operation to remove her tonsils in order to alleviate her sleep apnea.  Shortly afterwards, she experienced profuse bleeding, followed by cardiac arrest and brain damage.  This catastrophic outcome is highly uncommon following such a procedure. Doctors determined a couple days later that she was brain dead. 

Incidentally, another young girl suffered devastating neurological damage following a similar surgery at the same hospital two years ago but did not die; the family obtained a $4.4 million settlement.

No one is privy to what precisely went wrong in Jahi McMath’s case. From the succession of media accounts, it seems evident there has been friction between the family and the hospital – and subsequently between their respective attorneys and spokesmen. The family’s insistence that she be maintained on the ventilator has ignited widespread discussion.

But is this – as some portrayed the Terri Schiavo case – a touchstone in the contest between the culture of life and the culture of death, Round Two? In a move that may well add to confusion in this matter, the Terri Schiavo Foundation recently announced its support of Jahi McMath. By support I do not mean expressing solidarity with the grieving family (which, of course, they have), but deeming Jahi, as her family insists, to be alive.

Let us recall, in order to make the most important distinction, that Schiavo was never brain dead. Schiavo was in what has long been called a “persistent vegetative state.” Her brain destruction was not complete. She was able to breathe spontaneously on her own, a clear sign that the brain stem is intact. It was never a debate over whether she was dead; she was never considered to be.

Schiavo’s condition is now beginning to be referred to as Unresponsive Wakefulness Syndrome. The recent change of terminology is not a vacuous nod to political correctness; it is both more respectful of the patient’s inherent dignity and more accurate.

In fact, one of the most fascinating discoveries in recent neuroscience is that some patients in Schiavo’s condition have greater capacities and awareness of their surroundings than previously presumed.

A 2013 study published in JAMA Neurology, for example, demonstrated the effectiveness of a brain scanning technique (fMRI) in detecting conscious awareness and even the capacity to communicate in some patients who are otherwise (i.e. behaviorally) non-responsive.


        Jahi McMath

These kinds of findings provide further validation to what had already been widely accepted as obvious: such patients, despite claims of some scholars who want to classify them as dead, are clearly alive.

By contrast, those who meet the neurological criteria for death have irreversibly lost the critical functions of the entire brain. They have lost the so-called “higher” brain functions and are unable to maintain their own autonomic, vegetative functions. That all those capacities have been irreversibly lost is taken as the sign that death, rather than a seriously debilitating injury, has occurred.

The controversy in Schiavo’s case revolved around whether or not artificial nutrition and hydration could be withdrawn, and who was entitled to make that decision.  Jahi McMath, by contrast, has undergone six separate neurological exams, each of which confirmed the diagnosis of brain death.

It’s not difficult to understand why Jahi’s mother said she could accept her death if her heart stopped beating – easy to sympathize. It’s harder to wrap one’s mind around the accomplishments and limits of modern technology. While Jahi’s case went to court, a man in France received the first completely artificial heart – (more) radical proof that one’s own heart is not necessary for life to persist. The same cannot be said for the brain.

At last report, Jahi had been admitted to an undisclosed facility in New York. According to one news story, Jahi “has been welcomed with open arms by a Catholic organization that believes the right-to-life.” [sic]

This reference may also raise some confusion, in that it might imply that the Catholic right-to-life mentality precludes the legitimacy of physicians determining that death has occurred. Pius XII specified back in the 1950s that physicians are the ones with the requisite competence to make such determinations.

It’s not be widely known that the Church has reflected on brain death carefully over the past several decades. Each time she has weighed in on the matter, it has been in support of the legitimacy of this means of determining that human death has occurred.

One commonly expressed lamentation following the Schiavo case was that a teaching opportunity had been missed.  This might explain – in part – why basic distinctions remain overlooked, although some may simply prefer to overlook them.

One guest on CNN lumped McMath in with Schiavo, implying that they were both dead – muddled thinking, to put it mildly. His reason for doing so was to dismiss all life-affirming activism – whether for McMath or Schiavo or anyone else – as ultimately a manifestation of anti-abortion politics, which he presumably regards as unreasoned nonsense.

The need to oppose the ongoing abuses characteristic of the culture of death – and for vigilance against yet further abuses – is obvious and cannot be understated.  But our means of opposition is to shine the light of truth, expressed in charity. That light of truth is also necessary in discerning and accepting when a tragic death has actually occurred.

 
Matthew Hanley is senior fellow with the National Catholic Bioethics Center. With Jokin de Irala, M.D., he is the author of Affirming Love, Avoiding AIDS: What Africa Can Teach the West, which recently won a best-book award from the Catholic Press Association. The opinions expressed here are Mr. Hanleys and not those of the NCBC. 
 
 
The Catholic Thing is a forum for intelligent Catholic commentary. Opinions expressed by writers are solely their own.

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Comments (5)Add Comment
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written by Jack,CT, January 22, 2014
Thanks,
I will never forget both cases!
The removal of "Food" from Terri and the Poor Mom
in California,I prayed in both cases and as you
have seemed layed out well,tragic events and Allowing
a culture of daeath is shameful.

I have educated many new people into nursing and the topic
of "Ethics" and "Advanced Direcives" is rarely if ever
discussed in cases of children.
I will simply say I worked in a Catholic Hospital for a
long time as my allegiance to the truth was far more
important then a "couple of bucks"!

Oh,Please allow me to say please pray for the "Little
Sisters" fighting the fight aganst "Abortifcation drugs"
and there employees.Many of us Catholics work in Catholic
facilitys so as to AVOID these issues.
God Bless Both souls and may the lord be charitable
to there souls and all those in this situation,Amen


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written by Chris in Maryland, January 22, 2014
Thank you Dr. Hanley, for this essay, and your dedication to reasoning in truth.

The cult of abortion and our other abominations, demand that all men live in darkness, and pretend that there is no truth, and no recourse to the truth, because the truth is such a horrible to be judged by.
0
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written by Peter, MT, January 22, 2014
Thank you Matthew Hanley for your clear reasoning and evident charity in the handling of this vitally important issue and heartbreaking tragedy. This is why I read TCT everyday. Thank you for your work at NCBC.
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written by petebrown, January 22, 2014
A very nice piece Matt! Reminds me of an article I read by Daniel Sulmasy warning that "witnessing for life" should not fall into the trap that St. Basil warns about here:

"Whatever requires an undue amount of thought or trouble or involves a large expenditure of effort and causes our whole life to revolve, as it were, around solicitude for the flesh must be avoided by Christians".
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written by Carol J Burt, February 24, 2014
Actually the Church states that there must be RIGOROUS uniform scientific criteria,and a moral certitude of death.Bl John Paul 2 during his last year of life asked that the issue of brain death be reexamined.There was a conference on FEb 4-5 2005 where the members of the council convened by the Academy REJECTED "brain death" as true death.The academy called this conference a "preliminary" one and rejected the findings though JP2 ordered the results turned over to the Congregation for the Doctrine of the Faith. I can find none of these documents on the official Vatican site.

If even one person wakes up,wriggles,tenses abdominal muscles,gasps etc,you have to wonder how accurate the apnea tests are.It is my understanding that the purpose of the tests is to not only see if one can breath unaided but to get the CO2 level up to at least 60 which is LETHAL.Jahis reached 73.3 durin g Dr Fishers apnea test.

I have very serious reservations about the concept of BD especially in light of people who were declared BD(yes a misdiagnosis) but survived.

Jahis hypothalamus regained function in early January,and it is known that a certain portion of people diagnosed as BD have retained some function.The hypothalamus is considered part of the brain.That alone would invalidate the diagnosis as it requires complete and total loss of the entire brain function and it must be IRREVERSIBLE

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