The Jahi McMath Case

My very first nursing job was working in an adult ICU. This was over twenty years ago. Even then, there was discussion of futile care and the withdraw of medical support in cases where further medical intervention would not constitute recovery for the patient.

The Jahi McMath case is an interesting one. In case you're unfamiliar with the story, she is a 13 y/o girl who suffered bleeding after a tonsillectomy (and removal of other things), arrested and suffered irreversible brain death after her cardiac arrest. These have been widely reported. One of the reasons I had Dr. Mabry post about tonsillectomies is that bleeding is a known (though low) risk of the procedure due to the location of the tonsils by a major artery. Even though the risk is low-- it can and does happen. I've cared for post-tonsillectomy patients that did require blood transfusion after surgery.

Though this case is tragic and I grieve for the family-- it also doesn't necessarily mean the hospital did something wrong though one blogger states, "Children’s Hospital faces serious malpractice questions about its care of Jahi." Let's let the courts iron that issue out. I know from personal experience that a patient's death in a hospital does not automatically mean malpractice occurred. However, I don't think this is a commonly held public opinion- particularly when a child has died.

What's interesting about this case is what has transpired after she was declared brain dead. Brain death is considered legal death-- even above cardiac death because we resuscitate people from cardiac arrest all the time. In fact, in his book Proof of Heaven, neurosurgeon Eben Alexander discusses this very difference.

How do we know a patient is brain dead? I did a three-part series on this very issue that you can read here, here and here. These tests were done on Jahi and it was determined by multiple medical experts that she'd suffered whole brain death-- so not even her brainstem had bloodflow. Whole brain death is considered legal death. It cannot be reversed.

Think of what the brain controls--- everything. It is the computer hard drive of your body. If it has died-- it is no longer signaling the production of hormones that control vital body functions. If the brain isn't doing this-- then we as medical providers have to administer medications that will do this. Because of this, the whole body begins to decompose and the heart will eventually stop beating.

Because brain death has occurred-- the care provided to her is futile-- because she has no hope of recovery. What comes in to play is who pays for her medical bills because the family insisted she be transferred to another medical facility due to the fact the hospital refused to provide further medical care. The coroner has issued a death certificate. There are news reports that after transfer from the hospital her body is in a state of decline. 

Likely, the family is going to be responsible for the medical bills after she was legally declared dead. This will easily add up to hundreds of thousands of dollars. So, what is fair? To burden this family with medical bills when their daughter will not recover from this tragedy?

There has been criticism of the hospital. One such article outlines that hospital staff began to use terms like "the body". Though it may seem cruel, I know exactly why they did this.

It was in hopes of trying to get the family to accept that Jahi was no longer with her body. That her spirit had gone on so they could discontinue the very expensive medical care keeping her body alive.

I'm a pro-life girl but what I know from 20+ years in nursing is that whole brain death (which is different from living in a vegetative state where there is still brainstem function) is death and the care being provided for Jahi is sadly not going to bring about any sort of recovery.  Personally, I think it is giving false hope and a large medical expense to boot.

I am continuing to pray for this family.

What do you think? Should hospitals be required to continue to provide care when a patient has been declared brain dead by multiple medical experts? Who should pay those bills if the family cannot pay if it's the family's decision to continue medical care?