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Monday, December 30, 2013

Court Order Keeping California Teenager On Ventilator Expires Today

This undated photo provided by the McMath family and Omari Sealey shows Jahi McMath. McMath remains on life support at Children's Hospital Oakland after doctors declared her brain dead, following a supposedly routine tonsillectomy. (Courtesy of McMath Family and Omari Sealey via AP)

Jahi McMath remains on life support at Children’s Hospital Oakland after doctors declared her brain dead. (Courtesy of McMath Family and Omari Sealey via AP)

Time is running out for the family of a California teenager who was declared brain dead after a routine tonsillectomy went awry.

Three weeks ago, 13-year-old Jahi McMath went into Children’s Hospital & Research Center Oakland to get her tonsils removed to treat her sleep apnea. But soon after the surgery, McMath began to bleed profusely and went into cardiac arrest.

Doctors at the hospital declared her brain dead a few days later. A court order that had kept the 13-year-old on a ventilator ends today at 5 p.m. PST.

The McMath family is trying to get another facility to care for the 13-year-old so she can remain on a ventilator.

George Annas, a medical ethicist and professor of health law and bioethics at Boston University, tells Here & Now’s Robin Young that usually doctors declare someone dead when the heart stops beating and cannot be restarted. In McMath’s case however, doctors determined death when McMath’s brain completely stopped functioning.

“We keep talking about her being on life support,” Annas said. “She’s not on life support. She’s on a mechanical ventilator that is usually used to support life, but in this case it’s used to pump air into a corpse.”

Guest

  • George Annas, a medical ethicist and professor of health law and bioethics at Boston University.

Transcript

ROBIN YOUNG, HOST:

Well, time is running out for the family of a California teenager who was declared brain dead after a routine tonsillectomy gone terribly wrong. Three weeks ago, 13-year-old Jahi McMath went into Children's Hospital in Oakland to get her tonsils removed to treat her sleep apnea. Soon after, she began to bleed profusely and went into cardiac arrest. She was declared brain dead a few days later.

Now a court has ordered that the hospital can take her off life support at 5 p.m. California time. But Jahi's family says their child is still alive, and they're trying to get another facility to take her. Medical ethicist George Annas, professor of health law and bioethics at Boston University, is here to take a look at some of the ethical questions as that 5 p.m. deadline draws near.

And George, this is a very sad case, but it's not a new case, is it?

GEORGE ANNAS: No, sad I think is the right word for it. It's very similar to the Jesica Santillan case we had a number of years ago, a little girl who went in for a heart-lung transplant, had the wrong blood type, was given another heart-lung transplant and then died. And her parents wanted her maintained on the ventilator, as well, because they simply didn't trust the doctors who had done that to her.

YOUNG: Well, in this case you feel for the family because they're already seeing what they perceive as a botched surgery. We don't know yet what happened there. And now this must seem like the same hospital damaging their daughter twice. What do you think, though, of the diagnosis of brain death? I'm hearing from ethicist Art Caplan, your colleague, that it's actually - the strict test for determining if someone's brain dead are even more error-free than let's say just pronouncing death because of a heart attack.

ANNAS: Well, this is death, and that's the key issue here, and doctors get to declare death. Usually it's when your heart stops beating and can't be restarted, but it can also be if you're on a ventilator, if your breathing is being done by a machine, then your heart's not going to stop. Your heart doesn't need the brain to breathe - brain to be - so in that case we use total cessation of all functions of the entire brain, and then you're dead.

And once death is declared, unless you're an organ donor, the machine to be turned off because it cannot do anyone any earthly good after that.

YOUNG: Well so she has been declared brain dead, and it's interesting because in reading some of the articles, people are tripping over their words. There was a facility that was going to take her in California, but then somebody issued a statement from Children's Hospital, where she is, saying we're not sure how to transport the deceased.

So, you know, already Children's Hospital is talking about her as being deceased. This other facility that said they might take her said that they couldn't because of the relationship with their doctors who refuse to treat people who have been declared brain dead.

ANNAS: They refuse to treat corpses, that's exactly correct, because they can't benefit them and medicine is done to try to benefit the patient, and once you're dead, you're dead. But you're absolutely right. It's the language we use. We just can't get over it. We keep talking about her being on life support. She's not on life support. She's on a mechanical ventilator that is usually used to support life, but in this case it's used to pump air into a corpse.

YOUNG: Yeah. So what are the family's options going forward? We were hearing early reports that there might be a New York hospital that might take her.

ANNAS: I just cannot imagine any hospital taking her, especially not with the publicity here. She's dead. She's really dead. And the courts recognized it. It shouldn't have gotten to court, but having gone to court a judge gets to make that call with the medical advice he got from his expert witness, from another physician.

I mean, that's all you can expect of a hospital, I think, is to give the family the option to get a second opinion. But once you have that second opinion, two physicians using traditional brain death criteria to declare death, that's the end. It's very sad. The only question after that is whether there's going to be organ donation, as well. I don't think that's a question in this case because I don't - but I don't know.

YOUNG: Well again, the family might be thinking they made a mistake the first time, potentially, with the tonsillectomy. They might be making a mistake now. You're saying that there is criteria for declaring someone brain dead. But just clarify.

ANNAS: And it's not controversial.

YOUNG: It's not at all controversial within the medical world. But clarify those for people listening and who might be saying, well, wait a second, what about the person who wakes up after six months and just further underscore why this is different.

ANNAS: Right, I mean, the other thing that we've seen giant controversies over, Karen Quinlan, Terry Schiavo, Nancy Cruzan were all young women in what we call a permanent vegetative state. They're not dead because their brain stem still functions, and you know that because they can breathe on their own. They don't need a machine to breathe.

And so, you know, even there we had - even though - they weren't going to wake up ever. People - many people wanted to continue to treat them, and you could argue that, you know, it's at least optional because again they're not dead, they're still alive.

YOUNG: Yeah, functioning brain stem.

ANNAS: You could pray for a miracle. But by this case, we're way beyond that. They are dead. The entire brain ceased to function. They would not be breathing unless they were on that machine. And it's time to take the machine off after they're dead.

YOUNG: Well George Annas, again professor of health law and bioethics at Boston University. A court has given the go-ahead for Children's Hospital in Oakland to do just that at 5 p.m. California time. The family, though, of Jahi McMath still desperately hoping there's another option. Quite a - really a painful story. Thanks so much for helping us weigh in on it. Thank you.

ANNAS: Absolutely, thank you, Robin.

YOUNG: You're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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  • Traveler

    Please do a piece on the efects of incidents like this on staff of the institution(s) involved. As a healthcare provider, I can guarantee that there are at least a handful of people whose role in this girl’s bad outcome. They are still not sleeping at night, or are considering another field of work, or who can’t face themselves in the mirror not because of evil intent, but because they were trying to do good and something went wrong. Most healthcare news about these incidents seems to present the wounded victim of a big bad healthcare system. Please, a little mercy for the people who are doing their best to improve lives, and yet are somehow perceived in a light of bad intentions because we don’t know and can’t foresee everything. We’re human, too.

  • Pastor CSL

    I went through a similar experience with my Mom after a cardiac arrest. An EEG supposedly showed her brain dead. Yet when she was in the mood she would say a few words appropiately! She was on a respirator for 2 years. I tried to follow what I believed was her wishes. By the grace of God alone, I was able to take her from hospital to hospital before one hospital could force me to stop care. After very short stays in nursing homes. Thankfully, her care was too complicated for nursing homes, so they would send her back to a hospital. Finally, when I saw that her infections were overwhelming her body, I stopped care. When they took the respirator off, Mom said “I love you” and quietly passed away. I am an RN and Pastor. I tell my story because folks in similar circumstances should follow how God impresses them and not the supposed results of an EEG. My Mom was never brain dead; damage to her brain, yes, but brain dead, no! My prayers go with this family.

    • Vinson, AL

      Let God take care of her and her heart is beatin, she is still living and I pray to JEHOVAH God through Jesus Christ for this family Amen and for the people that don’t believe

  • it_disqus

    I was amazed that your guest had the access to this girls medical records he needed to condemn her with such absolute certainty.

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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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