The medical debate over a 13-year-old California girl placed on a ventilator after being declared brain-dead has raised a difficult question for doctors, and patient advocates, LiveScience reports: How much of the body will keep on working with the help of technology, and for how long, after a brain-dead person is not legally alive?
Jahi McMath of Oakland, was declared brain-dead last month after experiencing a rare complication from tonsil surgery. Her family has fought to keep her on a ventilator, but a judge has ordered that the machine be turned off next week.
A person is considered brain-dead when he or she no longer has any neurological activity in the brain or brain stem. Doctors perform tests to determine whether someone is brain-dead, noted Diana Greene-Chandos, M.D., an assistant professor of neurological surgery and neurology at Ohio State University Wexner Medical Center.
In the United States, a person is legally dead if he or she permanently loses all brain activity (brain death) or all breathing and circulatory. In Jahi's case, three doctors have concluded that she is brain-dead. But the heart's electrical system can keep the organ beating for a short time after a person becomes brain-dead, Dr. Greene-Chandos said. But without a ventilator to keep blood and oxygen moving, the heart would stop beating, usually within an hour.
With just a ventilator, some biological processes can continue for about a week.
Kenneth Goodman, director of the Bioethics Program at the University of Miami, told LiveScience that such functions do not mean the person is alive.
"If you're brain-dead, you're dead, but [with technology], we can make the body do some of the things it used to do when you were alive," Goodman said.
Without the brain, the body does not secrete hormones needed to keep gastric, kidney, and immune functions working for more than about a week. Normal blood pressure often cannot be maintained without blood-pressure medications in a brain-dead person, Dr. Greene-Chandos added. A brain-dead person also cannot maintain his or her own body temperature, so the body is kept warm with blankets, a high room temperature and, sometimes, warm IV fluids.
Doctors sometimes provide support if the organs of the person will be used for donation, or if the family needs more time to say good-bye, Dr. Greene-Chandos said.
If all of the criteria for brain death are met, "then it's pretty clear that there's nothing left, and we're supporting the body," Greene-Chandos said, adding that Jahi's case is tragic and, as a mother, she is heartbroken for the family.
Terri Schiavo's family, who fought to keep their brain-damaged daughter on life support for 15 years, has reportedly said they are trying to help move Jahi to another facility for long-term support. Unlike Jahi, Schiavo was not brain dead, but in a vegetative state in which she had some brain activity.