There has always been a very fine-line differentiating the role of religion and law in America, an especially true statement with regard to medicine. Rulings relating to abortion and contraception are almost never free of controversy, and in many instances, religious groups are the main influence on whether such laws are passed or not. The moment of death is not excluded from the controversy. Although it is widely presumed that the difference between life and death should be a clearly defined topic that is universally agreed upon, two recent cases that occurred in American hospitals demonstrate that this is far from reality.
Brain death is the irreversible end of brain activity due to death of the cerebral neurons which follows loss of oxygen in brain tissue. The blurred lines between life and death are due to the use of life support machines or ventilators. Traditionally, death is defined as the moment that the heart has stopped beating. This prevents oxygen from being delivered to the organs, which results in a loss of function. A ventilator allows air to flow in and out of a patient’s lungs keeping the heart beating, and supplying vital organs with oxygen.
Ventilators are also used in patients with brain damage. In a normally functioning body, respiration and heart beat are automatic functions. However, in a patient with brain damage, this automatic signaling system is impaired. The patient is hooked up to a ventilator to guarantee that oxygen is sent throughout the body so there is no further damage to other organs. In such a case, there is hope that the patient’s brain will recover and the other organs will still be working properly.
Unfortunately, this is not always the case. When the damaged brain fails to make a recovery and the brain as a whole stops to function, the person is considered to be brain dead. Although brain death is considered legal death, uncertainty lies in the fact that the heart keeps beating. Some argue that if a person is breathing, they should be considered alive even though their brain is not working, as this fits in well with the traditional view of death. Much doubt and speculation shrouds this legal definition and patients’ families always have their own opinions regarding the status of their loved one. Interestingly, patients classified as brain-dead can have their organs removed for organ donation.
A brain-dead individual has no clinical evidence of brain function upon examination, which includes no response to pain and no cranial nerve reflexes. In order to properly classify brain death, physicians must distinguish between brain death and states that may mimic brain death such as barbiturate overdose, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma, or chronic vegetative states. In a situation of brain death, brain electrical activity can stop completely, or drop so low that it is undetectable with medical equipment. Therefore, an EEG graph will be completely horizontal, a line that can be present during deep anesthesia or cardiac arrest. In the United States, a flat EEG test is not required to certify death, although it has confirmatory value. Legal criteria vary, but in general they require neurological examinations by two different physicians. Some medical dictionaries define brain death as cerebral death, or death of the cerebrum, while other definitions include the brainstem. The following two recent cases are the perfect demonstration of the confusion that surrounds a unanimous definition for brain death.
The first case is as follows: Jahi McMath, a thirteen year-old girl went in for a routine tonsillectomy. Of course, as with any surgical procedure, there are risks involved. Jahi suffered from complications which caused her brain to stop functioning. Doctors had her put on a ventilator, so although she was brain dead, she was still breathing. The hospital declared Jahi dead, issued her death certificate, and wanted to remove her from the ventilator. Her family strongly objected, as they were saw that Jahi was still breathing, hence she was still “alive”. They believed that Jahi would recover if given the proper treatment. However, doctors refused to give her treatment as she was a dead patient. The family took this to court and fought to keep Jahi on the ventilator. They found a treatment center that specializes in recovery from brain injuries and would accept Jahi and treat her. After a long struggle, Jahi (legally considered a dead body) was allowed to be moved from the hospital to this specialized center, where she currently is being treated.
The second case involved a pregnant woman in Texas, Marlise Muñoz; who suffered from a blood clot and collapsed in her home in the fourteenth week of her pregnancy. She was rushed to the hospital and put on a ventilator. She was later declared brain dead, but Texas law requires hospitals to do all they can to protect a fetus, so the woman was kept on life support. Unlike Jahi McMath’s family, Muñoz’s family had accepted the fact that she was dead and wanted her to be taken off of the ventilator. The hospital refused, as their best interest was to save the fetus, and they claimed they would be breaking Texas law by taking her off of the ventilator. After much debate, the hospital finally took her off of the ventilator and let the fetus “die” when it was 22 weeks into the gestation period
What do we learn from these two cases? As seamlessly stated in a recent New York Times article, “A prolonged heartbeat has created the perception of life for Jahi’s family, while for Ms. Muñoz’s relatives it represents a denial of the right to die.” The main consideration in this hotly contended topic is who has the right to regulate the decision between life and death? Some would call it unfair or even unconstitutional for state and federal law to go against a family’s religious and cultural beliefs, but it is also not proper if a family’s beliefs go against a legitimate law. Even with the endeavored sensitivity of American law and the attempted separation of religion and government, we will still inevitably encounter struggles within the law concerning such matters. So, will there ever be a solution? I guess we have to wait until our next life to find out.