As I write this post, there is debate swirling around 13-year-old Jahi McMath in a children’s hospital in California. She has been declared brain dead following complications from a “routine” tonsillectomy. The hospital’s position is that she should be removed from the ventilator that is currently breathing for her and allowed to exit this life peacefully. Her parents by all accounts are “expecting a miracle” even though all of the medical professionals and a judge have declared Jahi brain dead. Jahi’s mother has been quoted as saying if her daughter’s heart would stop, then they would consider her dead; since her heart is still beating, they consider her still alive. The gist as I understand it is that the parents have requested that the hospital perform two surgeries: a tracheostomy and a feeding tube placement so that Jahi’s body can be kept alive and moved to a nursing facility. The hospital is refusing to perform surgical procedures “on a corpse” and hold the position that brain dead means permanently lifeless with no recoverable options.
In this situation, we can clearly see struggles between hearts and brains. Not necessarily the physiological structures and functions of these two organs, but rather the characteristics assigned by human beings to their relevance in our lives. If one’s perspective is heart-based (emotions) like family members, one may assume that life remains or is paramount and, like Jahi’s parents, might hold out hope for a miracle. If perspective shifts to a brain’s reasoning and logic, one might agree with the hospital caring for Jahi and avoid doing further harm to a brain-dead little girl.
Regardless of which side one agrees with, there can be no overlooking the fact that emotions (heart) and reason/logic (brain) rarely operate in unison in times of medical crisis. Loved ones unprepared for a medical crisis will most often voice concerns or directives from the emotional arena while professional care providers are likely to be working from the reason/logic arena. Although families do not want to hear words like “medically futile”, they may nonetheless need to be said in the spirit of shared, informed decision-making. Healthcare providers have an obligation to provide care but that obligation ceases when the options for care are deemed to offer no medical benefit for the patient.
Several important lessons may come from Jahi’s case:
- Surgical procedures, even if very commonly performed, should never be considered routine.
- Patients and families should fully understand and prepare for possible complications regardless of the percentage of risk.
- It is never too early to have conversations about scenarios like this with family members, including children.
- We need to employ both hearts and brains in determining healthcare choices and treatment options, long before medical crises occur.
Caring Choices is ready to help you and your family prepare for decision-making during a medical crisis. The key is early conversations in times of health when emotions and reason are both fully engaged.
(c) 2013 Caring Choices