Engineering Ethics Blog: Do Machines Determine Death?

Jahi McMath is legally dead in California, where a routine
tonsillectomy on the thirteen-year-old girl went awry on Dec. 9, 2013 and she
basically bled to death.  But she
is still legally alive in New Jersey.  After refusing to let the California hospital harvest her
organs, her family insisted she was still alive and moved her to New Jersey to
take advantage of a law that allows them to do so.  Her case, described in a recent New Yorker article, raises serious questions about the role of
technology in determining the end of human life. 

New Jersey and New York are the only states which allow
families to refuse a diagnosis of brain death if it violates their religious
beliefs.  This exception was made
to accommodate the beliefs of Orthodox Jews, who believe that breathing
indicates life.  Not so long ago,
most people and governments would have said the same thing, but then medicine
developed the ability to monitor brain function via electroencephalography (the
EEG machine), as well as more sophisticated technologies such as MRI scans and
automatic ventilator machines. 

These changes were reflected in a 1981 report written by a
Presidential commission entitled Defining
Death:  Medical, Legal, and Ethical
.  Modern ventilator
machines can keep the rest of a human body functioning even after the brain is
destroyed —for a time, anyway.  But
the ability to detect brain function with EEGs, plus the increasing popularity
of organ transplants (which stand a better chance of success if the organ is
harvested from a donor whose systems are still functioning) led to a
redefinition of death as cessation of activity in the whole brain.  Definitions are one thing, but
decisions made under stressful actual conditions are another, especially in
gray areas such as Jahi’s.

In New Jersey, Jahi underwent a tracheotomy and had a
feeding tube inserted.  Although
she is still dependent on a ventilator, an MRI by a New Jersey brain researcher
showed that parts of her cerebrum were intact.  The cerebrum is considered to be the seat of higher mental
activity.  And there are videos
showing that she can occasionally respond accurately to her mother’s request to
move certain fingers, as well as heart-rate changes when she hears familiar
voices.  Because the legal limits
on malpractice damages are capped at $250,000 but only if the victim dies,
Jahi’s parents are suing the State of California to bring about a trial in
which a jury will determine whether Jahi is dead or alive in that state.

I find it fitting that the legal system in at least two
states defers to religious beliefs on matters of death, because in doing so the
law acknowledges that it doesn’t perhaps know everything there is to know about
this subject.  In dealing with
death, we have to base our actions on some theory of what it involves.  And there are two distinctly different
current narratives.

The first version is the secular narrative.  Human life is for purposes we can’t
discern and came about for reasons we can’t figure out.  Human life on the whole is good, but
utilitarian considerations of the greatest good for the greatest number tell us
that if we use the criterion of brain death rather than more traditional
definitions of death, organ transplants can benefit other people more.  And I see this point of view.  My brother-in-law is now doing very
well, freed of the drudgery of thrice-weekly dialysis treatments, because he
received a kidney transplant from a brain-dead accident victim last
August.  And if Kansas hadn’t been
using the modern definition of brain death on the donor, doctors would not have
been able to harvest that kidney.

The second version is the religious narrative, and because
I’m most familiar with it, I’ll give the Christian version.  God created the heavens, the earth, and
all that is in them.  He created
humans with the ability to sin, which they unfortunately took advantage of, and
death entered the world.  But
believers in Jesus Christ have overcome death and will rise with him at the
general resurrection.  A person’s
spirit uses the brain, but brains are not necessary in order for a person to
exist.  Angels and God Himself are
personal beings, but they are not encumbered by brains.  There are testimonies from dozens, if
not hundreds, of people who have had near-death experiences in which they have
visited Heaven, and then returned to their bodies, some of whom probably met
the criteria for brain death in the interim.  And if surgeons had started harvesting organs before they
came back, well, that would have been the end of that.

There are both present and future reasons why Jahi’s parents
don’t want her taken off the machinery that keeps her going.  One is the simple human desire to have
your child with you.  We know each
other through our bodies, and in a real sense, we are our bodies. To let a loved one’s body cease to live and fall
victim to decay is a final parting from that body which we have known and

The second reason is prospective:  the hope that Jahi might recover.  Medical science tells us that this is very unlikely in
Jahi’s case.  But broadly similar
cases have resulted in the eventual recovery of the person involved.  In the magazine article’s photo of Jahi
on her bed in New Jersey, she is covered with a blanket that reads “I
Believe in Miracles—Mark 11:24” 
The reference is to the words of Jesus:  “Therefore I say unto you, What things soever ye desire,
when ye pray, believe that ye receive them, and ye shall have them.” I’m
not going to presume to interpret that passage here, but the point is that the
Christian virtue of hope sometimes leads people to do things that look
ridiculous, wasteful, or even sacreligious to less hopeful people.

I don’t know how Jahi’s situation will end up.  But that is the point.  Sometimes even the best and most
advanced technology won’t tell us everything we want to know.  And in such cases, faith may be a
better guide than technical expertise.

Sources:  The article by Rachel Aviv, “The
Death Debate” appeared on pp. 30-41 of the Feb. 5, 2018 issue of The New Yorker.  I also referred to Wikipedia articles
on brain death and Jahi McMath.

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