Our newspaper has been covering two tragic situations in the last month, that warrant some reflection in light of my previous series on dying and death. The first involves a fourteen-year-old girl Jahi McMath, who died after sudden complications from surgery to remove her tonsils and repair sinuses. I—and the state of California—say she died, because in the course of this medical emergency, her brain ceased all function to the point of “brain-death.” This is not a permanent vegetative state but the complete stoppage of all neurological activity in all areas of the brain. The complicating factor was that she was still on a ventilator, which kept her breathing and her heart beating. Her parents, based on generally stated religious beliefs, do not believe she is “dead” as long as she has a heartbeat, so in their view she is not deceased. They took the hospital to court to keep her on life-support, and finally settled the issue by moving Jahi to a care facility that had agreed to maintain this support in hopes of a medical reversal. The attorney representing the family is hoping to pursue the case in court in order to secure for parents, rather than hospital or state, the right to determine when death has occurred in their minor children.
The second case involves a Texas woman Marlise Munoz who, fourteen weeks pregnant, apparently collapse at home, possibly due to a blood clot, and has never regained consciousness. She was declared brain-dead, but in this case it was the hospital that kept her on life support, against the family’s wishes, because of a Texas law requiring it to protect the unborn child she carried. Both the hospital and the family agree on basic facts of the case, that the mother is dead and that the fetus is not viable outside the womb. Nevertheless, the hospital sees itself complying with a law that prohibits withdrawal of life-sustaining treatment from a pregnant patient. There is another detail—irrelevant to the presenting case, in my view—that the fetus is “distinctly abnormal.” Would a “perfectly normal” fetus change the equation at all? I think not, but I am getting ahead of myself.
These cases push the envelope of bioethics. One, fueled by unspeakable parental grief, and the other by misapplied pro-life law, each tugs at the heartstrings and move us to consider the conditions under which we deem a person dead. Here’s what I think on the matter:
While I have only the most profound compassion for the feelings of family and friends, and cannot imagine the anguish these situations are causing them, I seriously wonder what kind of counsel they are getting about life and death. It seems to me that the fundamental, undergirding problem here is the denial of death and a failure to accept tragedy at face value. Both cases represent “bargaining” (the stage of grief) to the nth degree. Jahi’s case is cloaked in religious freedom issues, based on a belief that life ends not when the brain ceases to function but when the heart stops. Marlise’s case is carried by a pro-life ideology I doubt would be supported even by our most stalwart pro-life churches (the Roman Catholics, for instance). These are “heroic measures” which are not only unjustified, but terribly misguided about life and death and the existence of tragedy.
Does it seem as though our culture is finding it harder and harder to accept tragedy as a part of life? People die. They die suddenly because of accident or error. They die young. They die pregnant, so two die. A nation that has buried thousands of people because of mass tragedies—911, Oklahoma City, Sandy Hook—finds it difficult in individual cases to accept a definition of death because it can be trumped by the use of life-support machines. This goes right back to the denial of death, about which I have been commenting in the last week or two.
Let’s be clear about some things: miracles are possible and in fact happen (perhaps more in Africa than here in the States). God is able to raise the dead, and keeping a teenager on a ventilator is not required for God to do what God is capable of doing. But God has not resurrected Jahi, so when is it time to give up and accept the tragedy of what has happened? And what do parents think they are doing in the best interest of their child, when in fact they are begrudging her transition from this life to the next? I said “begrudged” rather than “prevented,” because I think Jahi is dead and her soul has left her body to be with the Lord. Meanwhile, her parents as people of faith are unhappy about that? It is so unspeakably sad, a tragedy upon a tragedy, that these parents cannot acknowledge a passage that sets their daughter free from the trials and sickness of this life and sets them free to remember her and move on.
In the Texas situation, while I am very sympathetic to the desire to protect pre-born human life, in this case the state is not obligated to prolong the functioning of a dead mother’s organs in order to nurture a fetus to the point of viability. If she had been eight months pregnant, I would consider that course of action more justifiable, but fourteen weeks? I shudder to think of the implications, macabre and machine-driven. True tragedies cannot be reversed, only owned. Marlise’s family is willing to own theirs; the state must recognize the folly of its position and let her and her baby go.
God, please use these faithful words to apply healing balm to all who will receive it and also to ring out biblical truth to a world so needy for it. In Jesus’ Name, Amen.
Amen.
I see very little difference in how many Christians approach death vs the most fearful agnostics – I see it all the time with friends dealing with their parents. ” Please pray for my 95 year old mother’s second brain cancer surgery.” Really? This was excellent Mary!
Mary, I am kind of surprised at where you came out on the case of the brain dead pregnant woman.
All of the arguments that I have heard to support abortion rights are predicated on two secular arguments. One, that a woman has a greater right over her own body than her unborn child has, and two, a sort of secular version of the age old question of when does the soul enter the body; only replace ‘soul’ with “person-hood”. An unborn child does not become a “person” until they satisfy some arbitrary set of requirements, and a non-person doesn’t have any rights.
The notion of person-hood is most often attached, perhaps informally, to brain function. More brain function more person, less brain function less person, and no brain function equals no person. That is the main reason for writing someone off as “dead” when the brain stops working. An unborn child whose brain is not yet functioning is, likewise, not (yet, or fully) a person.
As you said, we used to define “death” around the functioning of the heart. We haven’t with any other organ of the body. The biological fact is that the brain is “just” another organ. The body can potentially be kept alive even if the brain is dead, the difference being that removing life support from a brain dead body does not “kill” the person.
(The question might be “why keep their body alive” and the answer might be “to harvest their other organs”, or “to bring an unborn child to term”)
Since the mother’s brain is dead and therefore “she” is dead, she no longer can contest with her unborn child for the rights over her own body. We should, as you say, accept the fact of her death even though the biological machinery of her body still functions. The only justification against trying to keep her body alive, to bring her child to term, is that even though she is no longer a person, her child is also not a person. So other considerations take precedence: The wishes of the family, or the prior wishes of the deceased to not have their life artificially prolonged in the advent of unconsciousness with no hope of regaining consciousness, or other versions of DNRs. But if the unborn child is a person, then the argument gets turned on its head.
My surprise is this: I think your argument in favor of letting the baby ‘go’ is in essence exactly the same argument that supports abortion rights.
I also think that a sound secular ethical argument could have been made based on the medical principle of “do no harm”. Keeping the mother’s body alive would do her no harm, but removing life support would do harm to the child. As long as there is hope that the child could be brought to term, keeping the mother’s body alive is justified.
I do understand your concern with the excessive denial of death in our culture. We kill people in the movies by the dozens, but in “real life”, death is not something we accept. And because we don’t, we also fail to fully accept life. My sense is that it is precisely the inability to let her go, to accept that the body they saw was no longer their loved one, that it was that denial that prevented her loved ones from embracing the possibility of using her body to save the child’s life.
(And I do hope they are not eves-dropping on my insensitivity to their tragedy as if I had any right to speak of it. But we do need to talk about it to learn and understand the ethics of our own lives)
Jodie