“Brain Death,” “Dead,” and Parental Denial-The Case of Jahi McMath—ERRATUM

AbstractWho decides when a child is dead? The story of Jahi McMath has brought this question into focus for pediatric intensivists, ethicists, and the American public. In this article, we address this question by arguing that medical professionals do not have an obligation to acquiesce when families insist upon postmortem therapies. To do so may harm the dignity of the child by subjecting him or her to procedures that objectify the body, damage the child's reputation, and violate his or her privacy. Applying this answer to the real world of pediatric intensive care, we suggest practices meant to preserve the dignity of the child while accepting that the family is struggling to understand the tragedy. Muddled communication or an unyielding attitude will fail to help the family understand and cope with the death of their young loved one. Clear and honest communication—in conjunction with an empathetic disposition—can improve pre- and postmortem care for both patient and family.

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Jahi McMath and the Ethics of the Brain Death Standard

Bangladesh Journal of Bioethics ◽

10.3329/bioethics.v5i3.21533 ◽

2015 ◽

Vol 5 (3) ◽

pp. 18-22

Author(s):

Norman K. Swazo

Keyword(s):

Mechanical Ventilation ◽

Brain Death ◽

Nursing Care ◽

Brain Function ◽

Legal Issues ◽

Current Evidence ◽

Legal Action ◽

Jahi Mcmath ◽

The Brain

How does one account for the discrepancy between the evidence of total and irreversible brain death and the current evidence of recovered brain function? This is the question that is raised by recent legal action in the case of 13-year old Jahi McMath, certified dead on the basis of neurological criteria but maintained in mechanical ventilation and medical/nursing care since then at the insistence of the parents who claim she is alive. In this brief discussion, the medical and legal issues are reviewed. Here the argument is advanced that this is not a case that means there should be a re-evaluation of the neurological criteria for determination of brain death. Instead, this case is to be understood as the exception that proves the rule. DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21533 Bangladesh Journal of Bioethics 2014; 5(3):18-22

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The MRI of Jahi McMath and Its Implications for the Global Ischemic Penumbra Hypothesis

Journal of Child Neurology ◽

10.1177/08830738211035871 ◽

2021 ◽

pp. 088307382110358

Author(s):

D. Alan Shewmon ◽

Noriko Salamon

Keyword(s):

White Matter ◽

Brain Death ◽

Circulatory Arrest ◽

Detection Threshold ◽

Synaptic Function ◽

Structural Basis ◽

Magnetic Resonance Imaging Scan ◽

Ischemic Penumbra ◽

Brain Functions ◽

Jahi Mcmath

Jahi McMath was diagnosed brain dead on 12/12/2013 in strict accordance with both the pediatric and adult Guidelines, reinforced by 4 isoelectric electroencephalograms and a radionuclide scan showing intracranial circulatory arrest. Her magnetic resonance imaging scan 9 1/2 months later surprisingly showed gross integrity of cortex, basal ganglia, thalamus, and upper brainstem. The greatest damage was in the white matter, which was extensively demyelinated and cystic, and in the lower brainstem, most likely from partial herniation that resolved. The apparent integrity of gray matter and the ascending reticular activating system may have provided a potential structural basis for the reemergence of some limited brain functions, while the white matter and lower brainstem lesions would have caused severe motor disability, brainstem areflexia and apnea. The findings indicate that there could never have been a period of sustained intracranial circulatory arrest. Rather, at the time of brain death diagnosis, low blood flow below the detection threshold of the radionuclide scan was sufficient to maintain widespread neuronal viability, though insufficient to support synaptic function. Her case represents the first indirect confirmation of the reality and clinical relevance of global ischemic penumbra, hypothesized in 1999 as a generally unacknowledged and possibly common brain death mimic.

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More about the Determination of Death by Neurologic Criteria

10.20944/preprints202003.0014.v1 ◽

2020 ◽

Author(s):

Calixto Machado

Keyword(s):

Brain Death ◽

The United States ◽

Determination Of Death ◽

Her Family ◽

Legal Foundation ◽

The Us ◽

Jahi Mcmath ◽

Death By Neurologic Criteria ◽

Death Cases

Lewis et al. published an important and timely necessary article about the determination of death by neurological criteria, revising the Uniform Determination of Death.The acceptance of brain death (BD) has been progressively accepted beginning at the late 1950s. Nonetheless, contentious brain-death cases have recently raised new controversies about the diagnosis of BD, such as the Jahi McMath case, extensively covered by the US and international press. Jahi McMath meant a terrible tragedy for her and her family. But further than this gloomy story, the case has also raised confusion and challenging qualms about a fundamental query: how we confirm whether a person is dead or alive? Since 1981, the Uniform Determination of Death Act (UDDA) has served as the legal foundation for the medical practice of determining death. But, although death by neurologic criteria is considered legal death throughout the United States, several recent lawsuits have quizzed the rightfulness the authority of the UDDA to declare death by neurological criteria. This issue explains the importance of Lewis’s et al. paper. In this article I want to present the historical procedure for issuing a law in Cuba for the determination and certification of death. Of course, it is impossible to compare our country with USA. Cuba is a small and developing country, in which a law encompasses a national scenery, in contrast with USA, a multistate nation.

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Jahi McMath, a New Disorder of Consciousness

Revista latinoamericana de bioética ◽

10.18359/rlbi.5635 ◽

2021 ◽

Vol 21 (1) ◽

pp. 137-154

Author(s):

Calixto Machado

Keyword(s):

Eye Movements ◽

Brain Death ◽

Self Awareness ◽

Autonomic Reactivity ◽

Disorder Of Consciousness ◽

Eeg Activity ◽

Transitional State ◽

Total Absence ◽

Jahi Mcmath

In this paper, I review the case of Jahi McMath, who was diagnosed with brain death (BD). Nonetheless, ancillary tests performed nine months after the initial brain insult showed conservation of intracranial structures, EEG activity, and autonomic reactivity to the “Mother Talks” stimulus. She was clinically in an unarousable and unresponsive state, without evidence of self-awareness or awareness of the environment. However, the total absence of brainstem reflexes and partial responsiveness rejected the possibility of a coma. Jahi did not have uws because she was not in a wakefulness state and showed partial responsiveness. She could not be classified as a LIS patient either because LIS patients are wakeful and aware, and although quadriplegic, they fully or partially preserve brainstem reflexes, vertical eye movements or blinking, and respire on their own. She was not in an MCS because she did not preserve arousal and preserved awareness only partially. The CRS-R resulted in a very low score, incompatible with MCS patients. mcs patients fully or partially preserve brainstem reflexes and usually breathe on their own. MCS has always been described as a transitional state between a coma and UWS but never reported in a patient with all clinical BD findings. This case does not contradict the concept of BD but brings again the need to use ancillary tests in BD up for discussion. I concluded that Jahi represented a new disorder of consciousness, non-previously described, which I have termed “reponsive unawakefulness syndrome” (RUS).

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