New experiments raise important questions on what it means to die.
On December 9, 2013, 13-year-old Jahi McMath was checked in to Oakland Children’s Hospital in California for a routine tonsillectomy. She had sleep apnea and her parents believed that having her tonsils removed would improve her life, her sleep, and her relationships with her classmates. Each year, more than half a million people in the United States get this procedure. The vast majority have no complications. McMath was not so fortunate. About an hour after waking from the surgery, she started spitting up blood. In the middle of the night, her oxygen-saturation levels plummeted. Medical staff started working frantically to intubate her, but McMath’s heart stopped. As Rachel Aviv reported in a chilling 2018 New Yorker story, it would take several more hours to restore her heartbeat and breathing.
Two days later, doctors declared McMath brain-dead. But with her body still warm and her skin still soft, her family disagreed. They fought in court to keep her on a ventilator. Eventually they raised enough money through a GoFundMe campaign to airlift McMath to New Jersey, one of the only states that allows families to refuse a death declaration on the basis of their religious beliefs. Nourished through a feeding tube and supplied with supplemental hormones, McMath’s body continued to grow and develop—and even began menstruating.
In 2018, Jahi’s family’s attorney announced that she had died of complications from liver failure. Only then, five years after the tonsil surgery, “were all parties in mutual agreement that Jahi had in fact died,” says Michele Goodwin, chancellor’s professor and director of the Center for Biotechnology and Global Health Policy at UC Irvine School of Law. “It was quite the controversial case.”
And it’s not the only such case. Over the last 70 or so years, declaring death has gotten progressively messier. Scientific advances such as ventilators and life support have made it harder and harder to find the line between being a person and being a body. Now, mind-blowing experiments in pigs, and the development of a souped-up life-support system called OrganEx, are reinvigorating a decades-old debate about how our lives end. While OrganEx is not yet available for use in humans, it was able to reverse some of the cellular changes associated with death in pigs. What does that mean? In studies, when pigs were hooked up to the system after being dead for an hour, they looked lifelike, their hearts restarted, and they even moved. But were the pigs still dead? And if a treatment like that ever makes it to humans, what happens to the next Jahi McMath?
THE DEAD CONTINUE TO LIVE
The technology that kept Jahi McMath looking alive for five years is one of the first threats to death as we know it, the modern ventilator. Ventilators, which started appearing in hospitals in the 1950s, save lives by pushing air into a patient’s lungs when the person no longer can breathe on their own. Their invention also created an ethical dilemma: If bodies could breathe indefinitely without recovering or decaying, when were doctors legally allowed to pronounce them “deceased?”
In 1968, a committee of experts met at Harvard Medical School to discuss the matter. The existing criteria for determining death were based on the ways people had died for centuries. When breathing stopped and a person had no pulse, they were no longer alive. Now, the group proposed adding a second criterion, the absence of brain activity. It made sense: The brain holds power over other organs, and controls breathing. There wasn’t, and still isn’t, a way to fix a nonfunctional brain.
The timing of this decision wasn’t coincidental. Just one year prior, in 1967, doctors had performed the first heart transplant. In addition to relieving the burden of prolonged, meaningless treatment, the new brain-based approach to defining death could also ward off controversy over when doctors could retrieve transplant organs. If an organ donor’s brain was dead, their organs were fair game.
A legal entity called the Uniform Law Commission, which is charged with clarifying and stabilizing complicated laws across the country, formalized the brain-death criterion in 1980. Most U.S. states have since adopted it. According to this law, a person is dead if they meet one of two conditions: “irreversible cessation of circulatory and respiratory functions” or “irreversible cessation of all functions of the entire brain, including the brain stem.” Over time, brain death became the more popular definition of biological death, and doctors codified this view in a 2019 position statement by the American Academy of Neurology. Ninety-three percent of the organization’s surveyed members agreed that brain death is the equivalent of circulatory death.
Yet there have been rare cases, most conspicuously Jahi McMath’s, where medical interventions have successfully maintained a person for years after their brain no longer worked. “[Jahi] indeed went through puberty,” says Alex Capron, an expert in health policy and medical ethics at the University of Southern California Gould School of Law and Keck School of Medicine. If that’s true, and some endocrine functions can persist without brain activity, there’s room for critics to argue that the current standards are incomplete. And that was before scientists started trying to reverse the dying process in pigs.
Read More – A Groundbreaking Scientific Discovery Shows That We Can Reverse Death
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