"What Does It Mean to Die?"

That's the question asked by the New Yorker in a sad, poignant article.  Here's an excerpt.

Two days later, Jahi was declared brain-dead. With the help of a ventilator, she was breathing, but her pupils did not react to light, she did not have a gag reflex, and her eyes remained still when ice water was dripped in each ear. She was briefly disconnected from the ventilator, as a test, but her lungs filled with carbon dioxide. On an EEG test, no brain-wave activity could be seen.

Like all states, California follows a version of the 1981 Uniform Determination of Death Act, which says that someone who has sustained the “irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” California law requires that hospitals permit “a reasonably brief period of accommodation” before disconnecting a ventilator—long enough to allow family to gather, but not so long that hospitals neglect the “needs of other patients and prospective patients in urgent need of care.”

. . .

Over the next few days, a social worker repeatedly urged Jahi’s family to make a plan for taking her off the ventilator. She also recommended that they consider donating her organs. “We were, like, ‘Nah,’ ” Marvin said. “ ‘First, tell us what happened to her.’ ” The family asked for Jahi’s medical records, but they weren’t allowed to see them while she was still in the hospital. Nailah didn’t understand how Jahi could be dead when her skin was still warm and soft and she occasionally moved her arms, ankles, and hips. The doctors said that the movement was only a spinal reflex, described in the medical literature as “a Lazarus sign.”

. . .

A week after the surgery, Sealey called a personal-injury lawyer, Christopher Dolan, and told him, “They’re going to kill my niece.” Dolan agreed to take on the case pro bono, though he had no experience with legal issues involving the end of life ... He wrote a cease-and-desist order: if doctors unplugged Jahi’s ventilator, he said, they would violate her and her family’s civil rights. Sealey taped the note to Jahi’s bed and oxygen monitor.

In a petition to the Alameda County Superior Court, Dolan requested that a physician unaffiliated with the hospital examine Jahi. He wrote that the hospital had a conflict of interest, because if its doctors were found guilty of malpractice they could “drastically reduce their liability by terminating Jahi’s life.” In cases of wrongful death, California places a cap of two hundred and fifty thousand dollars on damages for pain and suffering. But there is no limit on the amount that can be recovered when a patient is still alive.

. . .

On December 19th, ten days after the surgery, David Durand, the hospital’s senior vice-president and chief medical officer, held a meeting with the family ... When they persisted, Durand asked, “What is it that you don’t understand?” According to Jahi’s mother, stepfather, grandmother, brother, and Dolan, who took notes, Durand pounded his fist on the table, saying, “She’s dead, dead, dead.” (Durand denies pounding his fist or repeating the word.)

There's more at the link.  Highly recommended reading.

As a pastor and chaplain, I've seen enough of this sort of dilemma to understand both sides of the picture.  Families naturally want to keep hope - and the patient - alive as long as possible.  Hospitals want to avoid needless expense, and free up a bed (and, perhaps, specialized life support technology) for patients who desperately need it.  On the other hand, I've been present at meetings where hospital and medical staff undoubtedly pressured families to sign off on the termination of life support, particularly in cases where organ donation was an option.  I got the very strong impression that they were more interested in harvesting the patient's organs than in keeping him/her alive.  I'm not alone in that, either;  other chaplains and pastors with whom I've spoken have told me of hospitals asking them to persuade the family to "let go" and allow the patient to die, so that others may be helped.  They've even gone so far as to invoke Christian charity as a reason for doing so.

This also raised the question of so-called "living wills" or "advance healthcare directives".  In them, one specifies whether one does, or does not, wish to be resuscitated, or provided with life-enhancing or -extending treatment, under various circumstances.  These are supposed to be binding, but I've seen hospitals disregard them almost at will if it suits them to do so.  I've also seen relatives refuse to allow them to be implemented, often due to arguments over inheritances, over which they wish to reach agreement with other relatives before they allow the sick person to die.  It's a messy, mercenary business, and I hate it . . . but it's a reality most of us may one day face.

This is a terribly complex, thorny issue, and there are no easy answers.  There probably never will be.  However, it behooves all of us to be aware of it . . . because one day, we might well be the patient in that hospital bed, and our families may be arguing with the hospital over whether we should live or die.  That's not a comforting thought.

Peter