Two struggles with brain death: One to keep support, one to let the patient go
Two cases show the struggle that hospitals and families still can have with the definition of death, and the legal fights that might ensue.
In a highly publicized case, 13-year-old Jahi McMath was admitted to Children’s Hospital Oakland (CA) on Dec. 9, 2013, for an adenotonsillectomy, uvulopalatopharyngoplasty, and a submucous resection of bilateral inferior turbinates, all intended to improve her breathing and sleep. She suffered bleeding and cardiac arrest while in recovery, and blood flow to the brain was lost for an undisclosed period of time. Court records show that on Dec. 12, 2013 she was declared brain-dead by doctors at the hospital. Her family was informed that, because her brain had died, she was legally dead and life support systems would be removed.
The family refused to accept that conclusion and petitioned Alameda County Superior Court Judge Evelio Grillo, JD, to order an independent second opinion. Paul Graham Fisher, MD, the chief of child neurology at Stanford University School of Medicine, was appointed by the court and he reaffirmed the diagnosis of brain death.
McMath’s mother claimed that declaring McMath dead under the Uniform Determination of Death Act violated her freedom of religion and privacy. The Alameda County Superior Court granted an extension to keep McMath on a ventilator until Jan. 7, 2014, but refused the family attorney’s request for hospital staff to insert tracheostomy and feeding tubes.
On Jan. 5, 2014, Children’s Hospital released McMath’s body to the Alameda County coroner, which then released her body to the custody of her mother. The family has since issued statements saying McMath is on life support at an undisclosed facility.
Marlise Muñoz was a pregnant 33-year-old paramedic in Fort Worth, TX, who died from a suspected pulmonary embolism on Nov. 26, 2013. Her husband, also a paramedic, relayed that Muñoz did not want life support in such an instance, but the hospital refused to terminate it and cited a Texas law that limits the application of advance directives in pregnant patients.
The Muñoz family filed suit in state court and argued that the law did not apply because the patient already was dead, and that the fetus had suffered from oxygen deprivation and was suspected to be non-viable. On Jan. 24, 2014, Judge R. H. Wallace Jr., JD, ruled that the hospital must disconnect life support for Muñoz by Jan. 27. While not ruling on the constitutionality of the state law, Wallace found that the law did not apply to deceased patients such as Muñoz.
Muñoz was disconnected from life support on Jan. 26, 2014.