(USA TODAY) -- The cases of two young women - a California teen and a pregnant Texasmother - have generated sympathy for their families, but also have leftsome doctors and bioethicists upset about their treatment.
Manydoctors are questioning continued medical procedures on a 13-year-oldgirl declared brain-dead nearly one month ago, calling interventions toprovide nutrition to a dead body unethical.
Many people around thecountry also have questioned the decision of a Texas hospital to refuseto remove a pregnant woman from a ventilator, although her husband saysshe is brain dead. Her husband has asked for his wife to be taken off abreathing machine. The hospital, John Peter Smith Hospital in ForthWorth, has not commented publicly on her condition.
The13-year-old, Jahi McMath, was pronounced dead by the coroner's office,after suffering rare complications from a Dec. 9 tonsillectomy. Herparents, unwilling to disconnect Jahi from machines that keep her heartbeating artificially, have transferred her from an Oakland hospital toan unnamed facility. The McMath family lawyer announced Wednesday thatJahi's new doctors had inserted a tube in her throat and another tube toprovide nutrition to her stomach.
Many people don't understandthe differences between a coma, persistent vegetative state and braindeath, says Arthur Caplan, head of the division of bioethics at NYULangone Medical Center in New York City. By moving the lungs up anddown, a ventilator can "give the appearance of life," Caplan says.
Butin fact, "brain death" is no different than any other sort of death: Abrain-dead person is no longer alive. The term simply describes how thedeath was determined, says Laurence McCullough, a professor at theCenter for Medical Ethics and Health Policy at Baylor College ofMedicine in Houston.
Accordingto the Uniform Determination of Death Act, adopted by most states,death is defined as "irreversible cessation of circulatory andrespiratory functions" or "irreversible cessation of all functions ofthe entire brain, including the brain stem."
There are no ethicalissues in the care of someone who is brain-dead, because the patient isnow a corpse, McCullough says. "Orders should have been immediatelywritten to discontinue all life support," says McCullough, who has nopersonal knowledge of Jahi's case. "The family should have been allowedto spend some time with the body if they wished. And then her bodyshould have been sent to the morgue. That is straightforward. There isno ethical debate about that."
Both Caplan and McCullough werecritical of the unnamed medical facility that agreed to put Jahi's bodyon a ventilator. "What could they be thinking?" McCullough says. "Theirthinking must be disordered, from a medical point of view. ... There is aword for this: crazy."
Caplan agrees: "You can't really feed a corpse."
McCulloughsays he worries about the emotional, spiritual and financial damagethat the parents will suffer. "Insurance doesn't pay for dead people,"McCullough says. He also worries about the psychological effect ofseeing the the girl's body, which is already said to be deteriorating,continue to break down. "Are there some living cells in the body? Notall the cells die at once. It takes time. But her body will start tobreak 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."
McCulloughsays the case of Texas mother Marlise Munoz is more complicated,because her hospital has not announced her condition. Munoz suffered anapparent blood clot in her lungs in November, when she was 14 weekspregnant.
The woman's husband, Erick Munoz, has said he's beentold his wife is brain-dead. In media reports, he's said that his wifedidn't wish to be kept alive artificially and would have wanted to betaken off a ventilator.
If Munoz is alive but unconscious,McCullough says the hospital shouldn't be blamed for taking the legallycautious approach of keeping her on life support. Texas law states that aperson may not withdraw or withhold life-sustaining treatment from apregnant patient.
If she is brain-dead, then "you have a pregnancyin a cadaver," McCullough says. "Then the law no longer applies." IfMunoz is dead, and the hospital wishes to continue ventilation to saveher fetus, that is considered a medical experiment, and should undergocareful consideration by a committee of experts, McCullough says.
"Indesperate cases, you respond with very careful thought anddeliberation," says McCullough, who chairs the fetal therapy board atTexas Children's Hospital.
Given that Munoz suffered a loss ofoxygen to her brain because of the clot, the fetus may also havesuffered grievous harm, as well, Caplan says. "You probably have a fetuswho is terribly devastated," Caplan says. "I do think the family'swishes should be honored."
At this point, Munoz's fetus is notviable, says McCullough, noting that infants are generally notconsidered viable - or able to survive with full medical support - untilthe 24th week of a 40-week pregnancy. Caplan says the Texas legislatureneeds to rewrite its law, which he describes as overly broad. As it'swritten, Caplan says, the law says "you can't have a living will if youare pregnant, even one day pregnant."
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