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What's Up With Jahi McMath

In January of this year, I wrote this about the Jahi McMath case:

This cannot and will not go on indefinitely. It is not true that a dead body can be sustained forever by a ventilator. Eventually, usually fairly rapidly, the heart stops functioning and cardiac arrest occurs, despite full ventilator life support.

My own opinion is that the longer it takes for that to happen, the more questionable was the original diagnosis. My empirical faith in zombies that live for years with literally zero brain function, including zero brain-stem function, etc., is at an extremely low ebb.

It's nine months later, which is a long time in terms of alleged total brain death. Not only has Jahi McMath not suffered cardiac arrest, her family and several doctors claim the following:

--She has undergone menarche (the onset of menstruation).
--She has electrical activity in her brain.
--She has blood flow to her brain.
--Her upper brain has large areas of structural preservation.

And, most controversial of all,

--She moves her foot and hand on command.

Concerning the last of these, I want to be cautious. We don't know much about the data set from which the videos have been taken, and it took a while in the foot movement video before Jahi's foot moved as her mother coaxed. These claims of responsiveness could be based upon cherry-picked data, though one doctor engaged by the family says, "There is a consistency to it"--meaning, a consistency in her responses to verbal commands.

However, it's important to remember that a great many patients do not fulfill the alleged requirements of complete and total cessation of all brain function but are also not responsive. The responsiveness claim is, in a sense, icing on the cake. Even if it doesn't hold up, that doesn't mean that Jahi still fulfills the clinical requirements of "total brain death."

Even a brief googling turns up clear evidence that the brain is crucially involved in the onset of puberty, which in girls of course is accompanied by the beginning of periods. As far as I can tell, if Jahi's hypothalamus were not working, she could not have gone through this change. I have mentioned before that other patients diagnosed as having suffered total brain death manifest evidence of hypothalamic function. This is a particularly dramatic case thereof, and I think we should all be getting a little bit tired of being told something on the order of, "Oh, when we said cessation of function of all working parts of the brain, of course we didn't mean that part. Who cares about the hypothalamus, anyway?"

Blood flow is also important. The claim we are all supposed to believe is that a truly totally brain-dead patient is like a corpse with its head cut off and that the body is merely being kept metabolizing by the use of a ventilator. This is not supposed to be just a metaphor but a valid biological comparison, which is why blood flow tests are used if one is attempting to be rigorous in diagnosing "total brain death." If Jahi has consistent blood flow to her brain, then it is not surprising that she has large areas of structurally working brain tissue.

As for the EEG, I note that one specialist, Arthur Caplan. sneers that it is irrelevant, saying, "I can get electrical measurements out of Jell-O.". But what a strange thing: This page lists the absence of EEG activity as one of the tests for brain death. This page goes into excruciating detail about how to test carefully for the absence of EEG activity in trying to diagnose total brain death. Here's a scholarly paper that doesn't seem to share Dr. Caplan's disdain for the relevance of EEG measurements. In fact, Dr. Caplan appears to be very much in the minority in this disdain, as EEG is widely used in this area. Though I am a layman, it certainly looks to me as though, if Jahi has EEG activity in her brain now, she does not now meet the criteria for "total brain death." Hence, her earlier condition was not, in fact, irreversible.

The exact legal proceedings relevant in this case are unclear. This story says that a judge has allowed a hearing in California on the question of whether Jahi is dead or alive. Judge Grillo, who is apparently allowing the re-hearing, expressed some uncertainty as to whether his court has jurisdiction for such a reconsideration of the conclusion that Jahi is dead. I know that there have been cases in which person is "presumed" dead (because he had disappeared) and then has later shown back up alive. There must be precedents for dealing with such cases, but as far as I know a hearing has never been held to reverse a death declaration issued on the grounds of total brain death. It is not surprising that Judge Grillo is uncertain how to proceed in the face of alleged new evidence.

If indeed Jahi does not now meet the clinical criteria for "total brain death," this should be a very big deal indeed in the medico-legal world, and all the more so since a genuine effort was made here to apply those criteria rigorously.

We need to follow all of this, gruesome though it may sound, for many reasons, not the least of which is the rather important question of whether Jahi herself is dead or alive! Lurking in the background of all of this, though not (thankfully) relevant to Jahi's own case, is the entire issue of organ transplant. As I have repeatedly pointed out, virtually no vital organ transplant can be done from a truly cold, dead corpse. (Kidneys are a little more resilient than other vital organs, but even there doctors are leery of transplanting kidneys that have had a chance to sit around for even an hour and approach room temperature.) Hence, vital organ transplant is done from "corpses" that are hooked up to ventilators and breathing. I won't go into all the details I have gone into before on this matter, but the point is that "total brain death" is extremely important as a medico-legal category for the entire enterprise of vital organ transplant. If we have good reason to question a) whether such a thing ever actually occurs while there is a heartbeat and/or b) whether such a thing can ever be reliably diagnosed, then vital organ transplant should be in big trouble, for ethical reasons.

I don't know what will happen in Jahi McMath's case, but I'm becoming more and more convinced that for her, at least, "clinically brain dead is dead" has just turned out to be false.

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