(USA TODAY) -- The cases of two young women - a California teen and a pregnant Texas
mother - have generated sympathy for their families, but also have left
some doctors and bioethicists upset about their treatment.
doctors are questioning continued medical procedures on a 13-year-old
girl declared brain-dead nearly one month ago, calling interventions to
provide nutrition to a dead body unethical.
Many people around the
country also have questioned the decision of a Texas hospital to refuse
to remove a pregnant woman from a ventilator, although her husband says
she is brain dead. Her husband has asked for his wife to be taken off a
breathing machine. The hospital, John Peter Smith Hospital in Forth
Worth, has not commented publicly on her condition.
13-year-old, Jahi McMath, was pronounced dead by the coroner's office,
after suffering rare complications from a Dec. 9 tonsillectomy. Her
parents, unwilling to disconnect Jahi from machines that keep her heart
beating artificially, have transferred her from an Oakland hospital to
an unnamed facility. The McMath family lawyer announced Wednesday that
Jahi's new doctors had inserted a tube in her throat and another tube to
provide nutrition to her stomach.
Many people don't understand
the differences between a coma, persistent vegetative state and brain
death, says Arthur Caplan, head of the division of bioethics at NYU
Langone Medical Center in New York City. By moving the lungs up and
down, a ventilator can "give the appearance of life," Caplan says.
in fact, "brain death" is no different than any other sort of death: A
brain-dead person is no longer alive. The term simply describes how the
death was determined, says Laurence McCullough, a professor at the
Center for Medical Ethics and Health Policy at Baylor College of
Medicine in Houston.
STORY: Experts: Brain-dead teen's victory won't set precedent
MORE: Understanding brain death vs. states of consciousness
to the Uniform Determination of Death Act, adopted by most states,
death is defined as "irreversible cessation of circulatory and
respiratory functions" or "irreversible cessation of all functions of
the entire brain, including the brain stem."
There are no ethical
issues in the care of someone who is brain-dead, because the patient is
now a corpse, McCullough says. "Orders should have been immediately
written to discontinue all life support," says McCullough, who has no
personal knowledge of Jahi's case. "The family should have been allowed
to spend some time with the body if they wished. And then her body
should have been sent to the morgue. That is straightforward. There is
no ethical debate about that."
Both Caplan and McCullough were
critical of the unnamed medical facility that agreed to put Jahi's body
on a ventilator. "What could they be thinking?" McCullough says. "Their
thinking must be disordered, from a medical point of view. ... There is a
word for this: crazy."
Caplan agrees: "You can't really feed a corpse."
says he worries about the emotional, spiritual and financial damage
that the parents will suffer. "Insurance doesn't pay for dead people,"
McCullough says. He also worries about the psychological effect of
seeing the the girl's body, which is already said to be deteriorating,
continue to break down. "Are there some living cells in the body? Not
all the cells die at once. It takes time. But her body will start to
break down and decay. It's a matter of when, not whether."
Jahi's new doctors are "trying to ventilate and otherwise treat a corpse," Caplan said. "She is going to start to decompose."
says the case of Texas mother Marlise Munoz is more complicated,
because her hospital has not announced her condition. Munoz suffered an
apparent blood clot in her lungs in November, when she was 14 weeks
The woman's husband, Erick Munoz, has said he's been
told his wife is brain-dead. In media reports, he's said that his wife
didn't wish to be kept alive artificially and would have wanted to be
taken off a ventilator.
If Munoz is alive but unconscious,
McCullough says the hospital shouldn't be blamed for taking the legally
cautious approach of keeping her on life support. Texas law states that a
person may not withdraw or withhold life-sustaining treatment from a
If she is brain-dead, then "you have a pregnancy
in a cadaver," McCullough says. "Then the law no longer applies." If
Munoz is dead, and the hospital wishes to continue ventilation to save
her fetus, that is considered a medical experiment, and should undergo
careful consideration by a committee of experts, McCullough says.
desperate cases, you respond with very careful thought and
deliberation," says McCullough, who chairs the fetal therapy board at
Texas Children's Hospital.
Given that Munoz suffered a loss of
oxygen to her brain because of the clot, the fetus may also have
suffered grievous harm, as well, Caplan says. "You probably have a fetus
who is terribly devastated," Caplan says. "I do think the family's
wishes should be honored."
At this point, Munoz's fetus is not
viable, says McCullough, noting that infants are generally not
considered viable - or able to survive with full medical support - until
the 24th week of a 40-week pregnancy. Caplan says the Texas legislature
needs to rewrite its law, which he describes as overly broad. As it's
written, Caplan says, the law says "you can't have a living will if you
are pregnant, even one day pregnant."
You may also like...
Weird Florida: A look back at some of the strangest stories of the year
Miracle Baby: Tampa toddler has 5-organ transplant
Broke Bad: Contest winner busted in synthetic drug ring
Here kitty, kitty: Lion escapes enclosure at Pasco sanctuary
Fake Cop: Man arrested 3 times for impersonating officer
Animal tragedy: Girl's miniature horse attacked by dogs
#ShortYellows: Florida quietly shortened yellow lights
Kittens shot: Officer shoots kittens in front of children
Popular photo galleries:
Faces of Meth: Devastating before and after photos of meth abusers
Trayvon Martin Shooting: Trayvon Martin crime scene photos and George Zimmerman injury photos
Hooters Winners: Winners of the 2013 Hooters swimsuit pageant
Rejected: Funny Florida license plates rejected by the DMV ***warning graphic***
Deadly sinkhole: Home collapses, man dies in giant sinkhole
Florida Sex Offenders: Look up sex offenders in any Florida neighborhood here
Restaurant Inspections: Look up inspection reports for any Florida restaurant here