Monday, February 05, 2018

Do Machines Determine Death?

Jahi McMath is legally dead in California, where a routine tonsillectomy on the thirteen-year-old girl went awry on Dec. 9, 2013 and she basically bled to death.  But she is still legally alive in New Jersey.  After refusing to let the California hospital harvest her organs, her family insisted she was still alive and moved her to New Jersey to take advantage of a law that allows them to do so.  Her case, described in a recent New Yorker article, raises serious questions about the role of technology in determining the end of human life. 

New Jersey and New York are the only states which allow families to refuse a diagnosis of brain death if it violates their religious beliefs.  This exception was made to accommodate the beliefs of Orthodox Jews, who believe that breathing indicates life.  Not so long ago, most people and governments would have said the same thing, but then medicine developed the ability to monitor brain function via electroencephalography (the EEG machine), as well as more sophisticated technologies such as MRI scans and automatic ventilator machines. 

These changes were reflected in a 1981 report written by a Presidential commission entitled Defining Death:  Medical, Legal, and Ethical Issues.  Modern ventilator machines can keep the rest of a human body functioning even after the brain is destroyed —for a time, anyway.  But the ability to detect brain function with EEGs, plus the increasing popularity of organ transplants (which stand a better chance of success if the organ is harvested from a donor whose systems are still functioning) led to a redefinition of death as cessation of activity in the whole brain.  Definitions are one thing, but decisions made under stressful actual conditions are another, especially in gray areas such as Jahi's.

In New Jersey, Jahi underwent a tracheotomy and had a feeding tube inserted.  Although she is still dependent on a ventilator, an MRI by a New Jersey brain researcher showed that parts of her cerebrum were intact.  The cerebrum is considered to be the seat of higher mental activity.  And there are videos showing that she can occasionally respond accurately to her mother's request to move certain fingers, as well as heart-rate changes when she hears familiar voices.  Because the legal limits on malpractice damages are capped at $250,000 but only if the victim dies, Jahi's parents are suing the State of California to bring about a trial in which a jury will determine whether Jahi is dead or alive in that state.

I find it fitting that the legal system in at least two states defers to religious beliefs on matters of death, because in doing so the law acknowledges that it doesn't perhaps know everything there is to know about this subject.  In dealing with death, we have to base our actions on some theory of what it involves.  And there are two distinctly different current narratives.

The first version is the secular narrative.  Human life is for purposes we can't discern and came about for reasons we can't figure out.  Human life on the whole is good, but utilitarian considerations of the greatest good for the greatest number tell us that if we use the criterion of brain death rather than more traditional definitions of death, organ transplants can benefit other people more.  And I see this point of view.  My brother-in-law is now doing very well, freed of the drudgery of thrice-weekly dialysis treatments, because he received a kidney transplant from a brain-dead accident victim last August.  And if Kansas hadn't been using the modern definition of brain death on the donor, doctors would not have been able to harvest that kidney.

The second version is the religious narrative, and because I'm most familiar with it, I'll give the Christian version.  God created the heavens, the earth, and all that is in them.  He created humans with the ability to sin, which they unfortunately took advantage of, and death entered the world.  But believers in Jesus Christ have overcome death and will rise with him at the general resurrection.  A person's spirit uses the brain, but brains are not necessary in order for a person to exist.  Angels and God Himself are personal beings, but they are not encumbered by brains.  There are testimonies from dozens, if not hundreds, of people who have had near-death experiences in which they have visited Heaven, and then returned to their bodies, some of whom probably met the criteria for brain death in the interim.  And if surgeons had started harvesting organs before they came back, well, that would have been the end of that.

There are both present and future reasons why Jahi's parents don't want her taken off the machinery that keeps her going.  One is the simple human desire to have your child with you.  We know each other through our bodies, and in a real sense, we are our bodies. To let a loved one's body cease to live and fall victim to decay is a final parting from that body which we have known and loved. 

The second reason is prospective:  the hope that Jahi might recover.  Medical science tells us that this is very unlikely in Jahi's case.  But broadly similar cases have resulted in the eventual recovery of the person involved.  In the magazine article's photo of Jahi on her bed in New Jersey, she is covered with a blanket that reads "I Believe in Miracles—Mark 11:24"  The reference is to the words of Jesus:  "Therefore I say unto you, What things soever ye desire, when ye pray, believe that ye receive them, and ye shall have them." I'm not going to presume to interpret that passage here, but the point is that the Christian virtue of hope sometimes leads people to do things that look ridiculous, wasteful, or even sacreligious to less hopeful people.

I don't know how Jahi's situation will end up.  But that is the point.  Sometimes even the best and most advanced technology won't tell us everything we want to know.  And in such cases, faith may be a better guide than technical expertise.

Sources:  The article by Rachel Aviv, "The Death Debate" appeared on pp. 30-41 of the Feb. 5, 2018 issue of The New Yorker.  I also referred to Wikipedia articles on brain death and Jahi McMath.

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