Jahi McMath Has Died. Again.

The family of Jahi McMath released news that their daughter has passed away. If you don't remember who Jahi was, she was the adolescent who suffered anoxic brain death after complications from a tonsillectomy and uvulectomy for sleep apnea in 2013. She suffered her second death last week after complications from an abdominal surgery.

Multiple doctors declared the child brain dead five years ago yet the family refused to accept the diagnosis. Even though there was no blood flow to the brain, the family pointed to such findings as twitching of the fingers and toes. Most doctors would say those are spinal reflexes that has nothing to do with brain activity but they found a sympathetic judge who kept the child on a ventilator in the hospital until they found another facility in New Jersey willing to take this "patient".

This case had huge implications for the anesthesia community. For years afterwards, the ASA's CME material repeatedly emphasized the active ingredients in the metabolism of narcotics and how to be extra careful sedating obese young patients in recovery. In all the years before the McMath case, they never discussed this issue once. 

Thanks to the Jahi McMath media circus, at least there was tremendous educational opportunity for physicians. She did not die twice in vain.

Feeding The Fantasy

Remember that sad and sordid story a few months ago about Jahi McMath? She was the 13 year old girl who died from an anoxic brain injury after surgery to treat her sleep apnea. She was pronounced brain dead by multiple pediatric neurologists last December. However a sympathetic judge sided with the family who believed she will one day wake up from the catastrophic surgical complication. The judge allowed the the family to keep the body on a ventilator and let them move her to an undisclosed location.

Apparently this fantasy has not played itself out yet. Yesterday, Jahi's mother, Nailah Winkfield, told a local TV station that Jahi was "still sleeping." Says Ms. Winkfield, "She is blossoming into a teenager before my eyes." Never mind that the poor girl's brain is now a protein mush while her internal organs slowly and inevitably shut down. The only thing keeping her heart pumping is the ventilator that is forcing air into the lungs.

What is really disturbing to me is that Ms. Winkfield was actually being "honored" for her delusional attempts to save Jahi by the Terri Schiavo Life & Hope Network in Philadelphia. They wanted to praise the family for "protecting the dignity of a loved one against overwhelming odds." Says Bobby Schindler, Terri's younger brother, "Jahi's family persevered through extreme pressure from doctors, media, and public opinion to enable their child a chance to be properly cared for."

Is there any worse way to dishonor the memories of Terri Schiavo? I guess the people who run this network don't recognize the difference between persistent vegetative state and brain death. When somebody is in a persistent vegetative state, which is what Terri was in, their brain is still alive. It's just in a coma but can have a very slim chance of waking up. Brain death means dead.

You would think that after her family struggled through years of heartbreak and legal fighting to keep her alive, they would understand the difference between brain death and persistent vegetative state. Apparently they didn't learn anything despite years of legal arguments about the medical definitions of life, death, and PVS. To equate Jahi's condition, and her family's fantasies, to Terri's medical state is the ultimate affront to her memory and cause.

Misguided Judicial Sympathy

The ghoulish circus surrounding the tragic death of Jahi McMath continues. Alameda County Judge Evelio Grillo has ordered Children's Hospital Oakland to keep her on a ventilator for another week while the family attempts to find a facility that will receive the brain dead girl following complications from a tonsillectomy last week.

I don't know what Judge Grillo is trying to accomplish by prolonging this agony. Multiple physicians, including a court appointed neurologist from Stanford University, have declared Jahi brain dead. Very specific and universally accepted guidelines have been developed over the years to help doctors decide without a doubt when patients are dead. These rules were made to prevent this very type of madness that can occur when grieving families refuse to let loved ones go and doctors are afraid to step up and make the decision for the good of the deceased.

Judge Grillo has taken it upon himself to overturn decades of medical ethics teaching and ruled to keep a human body hooked up to machines despite the unanimous consensus of doctors that Jahi is never going to recover her neurologic functions. Does he think he is doing her family a favor by keeping their daughter on a machine? How can this family ever have closure and grieve properly when they see their child involuntarily twitch to the touch and continue to have a pulse that the machines are providing for her?

What do the actions of Judge Grillo say to doctors all over the country about how their medical decisions can be overturned at the whim of the family and a single non medically trained person wearing a black robe? This is the reason doctors are so leery of stopping treatments for the terminally ill, or in this case deceased, even though all hope of recovery is lost. We are the ones who are at the patients' bedsides every day and are in the best position to decide the best course of action. But because of legal actions like the ones being made by Judge Grillo, any disgruntled family member can make a simple call to a lawyer and effectively make a law judge the patient's caregiver despite having little to no knowledge of medicine. I also find it extremely ironic that the courts will allow a family to keep a dead patient alive on a machine yet at the same time have no difficulty declaring the killing of living fetuses as a constitutional right.

In the meantime the McMath family is trying to find a nursing home that will accept Jahi once she has a gastrostomy tube and a tracheostomy. I don't blame the hospital or its doctors for refusing to perform either of those procedures. It is ethically unacceptible to perform these surgical procedures on a deceased patient. The best thing the family can do is accept the tragedy that has beset them and donate her organs to others who will truly survive with their daughter's gifts. Only then can they come to peace with her fate. After that they can call their medical malpractice lawyer for issues that the courts really are supposed to adjudicate.