Washington D.C., Jan 4, 2014 / 06:03 am
The "tragic" case of teenage girl Jahi McMath – now at the center of a legal controversy over brain death – shows the need to determine the facts before making ethical conclusions, says a bioethicist.
"The difficulty of these cases have to be recognized, especially in terms of the human suffering of the families," John Di Camillo of the National Catholic Bioethics Center in Washington, D.C. told CNA Jan. 2.
"It's not something that's simply a clear-cut, back-and-white case that we can, from the outside, say we know what's going on. Because we don't," he added.
"It's all in the details of the medical facts. We have to defer to reason when we see that the facts have been clarified, and then we can use those as our starting point for our ethical reflection."
Jahi McMath, age 13, underwent a complex tonsil removal surgery at Children's Hospital Oakland on Dec 9 to treat her sleep apnea. After the surgery, she appeared fine but then underwent cardiac arrest, lost oxygen to her brain and had extensive hemorrhaging, the Los Angeles Times reports. She was first declared brain dead on Dec. 12.
Five physicians, two at Children's Hospital Oakland and three independent doctors requested by the family, have declared the girl to be brain dead. The doctors have said the girl is unable to breathe on her own and other tests show that there is no blood flow to her brain and no signs of electrical activity. She is presently on a ventilator.
A federal court order has barred the hospital from removing life support systems until Jan. 7, ABC News reports. McMath's family hopes to transfer her to a long-term care facility where she can stay on life support.
The family's lawyer has asked Children's Hospital Oakland to perform a tracheotomy and insert a feeding tube, procedures necessary before any transfer.
The hospital had said it "does not believe that performing surgical procedures on the body of a deceased person is an appropriate medical practice." It said transferring the girl would require the approval of the coroner, as she is considered legally dead.
The hospital added, however, that it continues to support McMath's family "in this time of grief and loss over her death."
On Jan. 3 the girl's family and the hospital reached an agreement to allow a team to transfer her to another facility, the Los Angeles Times reports. But a judge has refused the family's request to have a doctor perform the procedures required for the move. The girl's mother will take full responsibility for her during the transfer. It is not yet known what facility will receive the girl.
Di Camillo stressed the need to know the facts of Jahi McMath's case before making a moral judgment.
"Before even getting to the ethical considerations, the medical facts are an absolute priority," he said. "If we have a medically clear and confirmed determination of death by these neurological criteria, then we're dealing with a situation where the body is actually the corpse of the deceased of this young girl."
"If we're dealing with a case where the person is in fact brain damaged but still alive, then we have a whole different set of ethical criteria because we're talking about a living human being who is worthy of full respect and full treatment."
He said Catholic teaching holds that "full brain death" criteria are legitimate indicators that the patient has died. However, he also warned about "misleading language" which uses the term "brain death" to describe those who are brain damaged or in states of reduced consciousness where a patient may still have brain stem function.
Patients deserve proportionate care that offers a reasonable hope of benefiting them without imposing an "excessive burden," he said.
Catholic ethics do not support the mentality of "life at all costs," but rather promotes life "within reason and within the context of one's circumstances, possibilities, pain, suffering." The bioethicist said there is a basic obligation to protect life "within the limits of reason and the limits of that proportionality"
Di Camillo again noted that appropriate treatment depends on the facts of the case. Life support systems are sometimes ordinary means of treatment and sometimes disproportionate.
"It's not an absolute. It has to be determined on a case-by-case basis, in light of the facts," he said.
Jahi McMath's situation has prompted comparisons to Terri Schiavo, a Florida woman who suffered severe brain damage in 1990, lived in a persistent vegetative state for years, and died of starvation in March 2005 after a contentious legal battle. Her parents wanted doctors to provide her nutrition and hydration, while her husband did not.
Di Camillo said such a comparison is "difficult" because it is known that Schiavo was in a persistent vegetative state and "clearly not brain dead."
Schiavo "could not satisfy any of the criteria for brain death as far as I understand it," the bioethicist said, while McMath's status is "the very question at issue."
The Terri Schiavo Life & Hope Network, founded by Schiavo's parents, brother and sister, said Dec. 31 it has been overseeing the effort by several groups to transfer the teen girl out of the Oakland hospital.
The network says McMath's case draws attention to hospital corporations' "vested financial interest in discontinuing life."