Brain Death: Making the Distinctions

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’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.