At Issue in 2 Wrenching Cases: What to Do After the Brain Dies

In one way, the cases are polar opposites: the parents of Jahi McMath in Oakland, Calif., have fought to keep their daughter connected to a ventilator, while the parents and husband of Marlise Muñoz in Fort Worth, Tex., want desperately to turn the machine off. In another way, the cases are identical: both families have been shocked to learn that a loved one was declared brain-dead — and that hospital officials defied the family’s wishes for treatment.

Their wrenching stories raise questions about how brain death is determined, and who has the right to decide how such patients are treated.

“These cases are quite different from those we’ve known in the past,” like Karen Ann Quinlan, Nancy Cruzan or Terri Schiavo, said Dr. Joseph J. Fins, director of the medical ethics division at NewYork-Presbyterian/Weill Cornell hospital. He explained: “Those patients could all breathe without a ventilator. They were in a vegetative state, not brain-dead, and that distinction makes all the difference.”

 A person who has received a brain-death diagnosis cannot breathe on his or her own and is legally dead, in all 50 states. In two states, New York and New Jersey, hospitals must take into account the family’s religious or moral views in deciding how to proceed in such cases. In all others, including California and Texas, hospitals are not required to consult the family in how to terminate care.

Doctors at Children’s Hospital in Oakland pronounced Jahi, 13, brain-dead on Dec. 12. She developed complications after surgery for sleep apnea and lost a large amount of blood. Ms. Muñoz , 33, got the diagnosis at John Peter Smith Hospital after she collapsed from a blood clot when she was 14 weeks pregnant. The hospital, citing a state law, refuses to remove the ventilator because it would harm the fetus, now in its 20th week.

The two cases are poignant in part because of a biological quirk of the body: The patients’ hearts continue to beat. Hearts have their own pacemaker, and with ventilation, the heart can continue to beat for days, even up to a week. But with more aggressive care, it can last months and longer after brain death, experts say, depending on the health of the patient and how much treatment is provided.

That ventilation saved the fetus in the Muñoz case, and probably in the nick of time, said Dr. R. Phillips Heine, director of maternal and fetal medicine at Duke University’s medical school. The diminished blood flow to the fetus when the mother collapsed — she is thought to have been passed out for about an hour before receiving care — “may lead to adverse effects over time, but we have no way to predict that,” Dr. Heine said.

A prolonged heartbeat has created the perception of life for Jahi’s family, while for Ms. Muñoz’s relatives it represents a denial of the right to die.

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At Issue in 2 Wrenching Cases: What to Do After the Brain Dies