- - Sunday, January 5, 2014

Whole brain death is defined as irreversible cessation of all functions of the entire brain, including the brain stem. Six doctors concur that Jahi’s condition fits the criteria set forth by a nationally accepted 1968 Harvard Medical School committee that defined legal death to be “whole brain death.” The hospital now wishes to disconnect the ventilator. Her parents’ object, holding that Jahi shows signs of consciousness and that they are hoping for a miracle. A court order was issued preventing the hospital from removing the ventilator until Jan. 7, allowing the family time to arrange to move their daughter to a facility in New York.

A respirator is all that keeps alive 13-year-old Jahi McMath at Children’s Hospital in Oakland, Calif. Jahi suffered heavy bleeding, cardiac arrest and “whole brain death” on Dec. 12 after complications from a tonsillectomy.

Whole brain death is defined as irreversible cessation of all functions of the entire brain, including the brain stem. Six doctors concur that Jahi’s condition fits the criteria set forth by a nationally accepted 1968 Harvard Medical School committee that defined legal death to be “whole brain death.” The hospital now wishes to disconnect the ventilator. Her parents object, holding that Jahi shows signs of consciousness and that they are hoping for a miracle. A court order was issued preventing the hospital from removing the ventilator until Jan. 7, allowing the family time to arrange to move their daughter to a facility in New York.

In cases involving children, “end-of-life decisions” are always difficult. Many years ago, I would annually speak to the medical staff at Children’s Hospital in Philadelphia. I would always encourage them to go the extra mile to save the life of a child. However, this does not mean that we should be foolhardy, hoping against hope.

Ethicists use the terms “proportionate” and “disproportionate” means in determining required lifesaving measures. In the former category, this would mean ordinary medical care, including feeding, hydration and hygiene. In the latter case, it would bar as unnecessary any procedure that is too costly, painful, exotic or repulsive to the patient.

Two high-profile cases can further explain proportionate and disproportionate health care in difficult cases.

Karen Ann Quinlan, a 22-year-old New Jersey woman, suffered cardiac arrest owing to drug and alcohol abuse in 1976. She lapsed into a “persistent vegetative state,” which means a state of deep unconsciousness. Her lower brain continued to function. She was immediately put on a ventilator and a feeding tube. After some months, her parents requested that the ventilator be removed, after which she continued to breathe on her own. However, the feeding tube had to remain, since to remove it would have been the equivalent of starving her to death. What followed was proportionate care — feeding, hydration and hygiene. She died of pneumonia in a nursing home nine years later.

The second case is that of Terri Schiavo, a 26-year-old Florida woman, who suffered cardiac arrest in 1990 and was declared to be in a persistent vegetative state. She was put on life-support. Like Quinlan, she continued to breathe on her own once the ventilator was removed. She also remained connected to a feeding tube.

After eight years, her husband petitioned to have the tube removed. A court battle ensued between him and her parents and the state of New Jersey, opposing his decision. Since a spouse is legally recognized as next of kin, his wish prevailed. His contention was that “she would not want life-prolonging measures” had to be taken at face value. Ethically, had she in some way expressed this publicly prior to falling into a persistent vegetative state, the tube could have been removed without the court and ethics battle that ensued. Schiavo lingered on for a few weeks and died from a lack of sustenance, which is deemed to be proportionate care.

The McMath case, however, even goes beyond “disproportionate” means, since Jahi is currently being kept alive artificially with no hope for recovery. Since the brain stem, which controls the involuntary muscle system, is dead, her heart will stop once she is removed from the ventilator. This being the case, the hospital has no further obligation to keep her circulatory system going, since medical intervention is now futile.

To keep a body alive is to deny the natural dying process and to delay the inevitable. This in no way can be construed as a “right-to-life case” since the medical and legal community both accept Jahi’s condition as irreversible — not comatose, but dead. Nor can it be put forward that halting care would constitute a violation of her religious freedom. Since religious morality is reasonable, it accepts the proportionate-disproportionate delineation. To hold out for a miracle is to tempt God. It will also lead to expending, unnecessarily, scarce health care dollars, which in itself would be immoral.

With the above considerations in mind, disconnecting Jahi from the ventilator is the best solution to this tragic case.

The Rev. Michael P. Orsi is a research fellow in law and religion at Ave Maria School of Law in Naples, Fla.