Am I Right?

How to live ethically

When Are You Dead: Brain vs. Heart

Does lack of brain activity mean death?

Death has always been with us, so you would think that we could all agree on what it is. But Jahi McMath, the 13-year-old girl from California who suffered cardiac arrest after a tonsillectomy and tissue removal, challenges this assumption.

Jahi was put on a ventilator to keep her heart beating. Three days later they declared her brain dead. At this point the hospital wanted to do what medical protocol requires: removing the ventilator. It is contrary to medical practice and ethics to treat a dead body. Without discernable brain activity, Jahi was surely dead.

Her parents disagreed. As long as her heart was beating, she was alive, not dead. They cited their religious beliefs, but their reasoning really is secular, not religious. It is the straightforward notion that living is associated with a beating heart. Jahi’s heart beats, therefore she is alive. And as long as she is alive, they refuse to give up hope that somehow, miraculously perhaps, she will regain consciousness. Even if she doesn’t, they feel that being alive, no matter how compromised, is better than being dead.

Generally physicians accede to family’s wishes around end of life decisions. Whether to terminate treatment typically is a family’s decision to make. No one can demand treatment that isn’t medically indicated. So if Jahi is dead, as the coroner has specified, then no one can demand that treatment continue. In fact, medical codes of ethics specifically forbid it.

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So is Jahi dead or not? The answer is only partially a medical one. While bodily functions are matters of fact, definitions of death are socially determined. Traditionally when the heart stopped beating a person was deemed dead, at least in the Western world. In some parts of Africa, death wasn’t a singular event but involved two stages. As long as a person was in someone’s living memory, they had no yet arrived at being fully dead. 

 

Defining death as the cessation of brain functioning seems to be a better definition than heart functioning. Hearts stop and can be restarted. Cardiac arrest isn’t always fatal. But when the brain stops functioning there is no recovery.

What about patients who recover from comas or those in persistent vegetative state who in rare instances indicate some awareness of their surroundings? The difference is subtle but essential: in a vegetative state the person lacks cognitive functioning but the brain continues to perform other functions that support the body; brain death is the total end of brain activity. (Two minor caveats: the pituitary gland continues on its own for a while after the brain dies; hair and nails continue to grow.

Jahi looks alive because machines artificially nourish her body, keep the heart pumping and the blood circulating. There is nothing that she can do on her own.

If Jahi is dead, then not releasing her body is the desecration of a corpse. The dead have rights, too. But if the family defines death as no heart beat, then Jahi isn’t a corpse but a person.

Society needs to respect matters of conscience that turn on religious and philosophical convictions. There are times when society’s interests overrides such convictions. Defining death as a lack of brain activity brings with it several advantages to society—it is clearer than older definitions; it is an irreversible condition; it facilitates organ donations.

If there is something positive to be found in this most tragic situation, it is that it gets us to think about life and death. What is death? And more importantly, what does it mean to be alive, really alive?

 

 

  

Arthur Dobrin, D.S.W., teaches applied ethics at Hofstra University. He is the author, coauthor, and editor of more than twenty books.

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