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Brain-dead patients prompt new questions about end-of-life decisions

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placeholder January 20, 2014   •   VOL. 52, NO. 2   •   Oakland, CA

Nailah Winkfield, right, mother of 13-year-old Jahi McMath, who doctors declared brain dead, and Martin Winkfield, the stepfather, arrive at the U.S. District Courthouse for a settlement conference in Oakland Jan. 3.
Beck Diefenbach/Reuters, cns
Brain-dead patients prompt new
questions about end-of-life decisions

BALTIMORE — Recent conflicts in California and Texas between physicians and the families of patients considered to be brain dead have prompted new questions about end-of-life decision-making.

But the nationally publicized case of 13-year-old Jahi McMath in Oakland, and the less-well-known case of Marlise Munoz, a 33-year-old pregnant woman in Fort Worth, Texas, provide a teaching moment to help clarify Catholic teaching on the determination of death, according to the leading Catholic bioethical organization.

The cases are distinctly different, but each pits health care professionals against relatives of the brain-dead patients.

McMath's family transferred her from Children's Hospital & Research Center Oakland to an undisclosed location Jan. 5 to continue medical treatment despite the issuance of a death certificate Dec. 12. Her doctors had declared McMath brain dead following complications after routine surgery for sleep apnea.

McMath's mother, Nailah Winkfield, has said her Christian beliefs require her to remain open to the possibility that God will perform a miracle and restore her daughter to health.

Munoz, who was 14 weeks pregnant when she collapsed at home in November and was deprived of oxygen for up to an hour, is being kept on life support at John Peter Smith Hospital in Fort Worth against the wishes of her husband and parents. Hospital officials say they cannot remove her respirator because of a Texas law that prohibits doctors from withdrawing "life-sustaining treatment" from pregnant women.

But the National Catholic Bioethics Center in Philadelphia said in a Jan. 7 statement about the McMath case that nothing in Catholic teaching would contradict the determination of death by the teen's physicians, using "the rigorous application of neurological criteria."

Those criteria can include "a complete lack of blood flow to the brain, the absence of any electrical activity of the brain, the absence of cranial nerve response and the ability of the patient to breathe on her own," the statement said.

If the facts in the McMath case are being accurately reported in the media, the center's statement said, the determination of death has been made "by physicians repeatedly and rigorously applying the neurological criteria" and confirmed by an independent, court-appointed pediatric neurologist from Stanford University.

"If this is accurate, at this point there would be no moral obligation for a hospital or physician to perform any procedure on a corpse such as placing a feeding tube or trying to stabilize the bodily functions that are kept working using mechanical means," it added.

The center quoted from talks by Popes John Paul II and Pius XII, as well as the U.S, bishops' "Ethical and Religious Directives for Catholic Health Care Services," to back its conclusion. The directives, which guide ethical decision-making in Catholic health facilities, read: "The determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria."

The Munoz case in Fort Worth is complicated by several factors — her pregnancy and the inability of her unborn child to survive outside the womb; the law passed in Texas in 1989 and amended 10 years later that requires the continuation of life support for pregnant women; and federal health privacy laws that restrict any sharing of information with the media without the permission of Munoz's family, which the hospital says has not been granted.

Even if Munoz's physicians have determined her to be brain dead, there is another patient to consider, said Marie T. Hilliard, director of bioethics and public policy and a staff ethicist at the National Catholic Bioethics Center. The unborn child cannot survive without receiving oxygenated blood from his or her mother until he or she reaches at least 23 or 24 weeks of gestation, Hilliard said.

 
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