37 Muerte cerebral

Brain death can be defined in a simple way as the permanent loss of cerebral and brainstem functions. However, this definition does not really cover all the ethical, philosophical or even neurological aspects related to the brain death. This can be a topic, not only for those cases with extensive media coverage, but for all the cases found daily around the world.

Mrs Marlise Munoz, a 14 week pregnant, collapsed into her kitchen floor kitchen last November. The 33-years-old woman was founded by her husband an hour before. It appeared that she suffered from a pulmonary embolism.  Despite of the paramedics’ best efforts, Mrs Munoz was declared brain dead the next day. Even that her husband said she did not want to be kept on life-support in such a situation and he wanted the hospital to let her go, the hospital refused to disconnect her from the machines keeping her alive. The law in Texas prohibits ceasing life-support while a person is pregnant.

The teenager, Jahi McMath, was declared brain dead after complications from a tonsillectomy at Children’s hospital in Oakland. In this case, it was not the hospital, but the family instead who opposed to disconnect her from live support.

Both cases have an important similitude; according with the law and medical literature, both, McMath and Munoz died in the moment they were declared brain dead. Under the Uniform Determination of Death Act (UDDA), approved by the United States in 1981, an individual is dead, not only when has sustained irreversible cessation of circulatory and respiratory functions, also who has sustained irreversible cessation of all functions of the entire brain, including the brain stem.

However, most people in the United States do not equate these two concepts as the law does. Numerous surveys have found that most population thinks that a declared brain dead person is still alive. Also, a proportion of this people think that a person with brain death is able to hear. This shows the absolute general misunderstanding about brain function and brain death implications. This misunderstanding is even more surprising as surveys among professional medical practitioners revealed that only 38% of respondents fully understand the medical and legal criteria for declaring a patient death.

Although the debate about brain death, around the world, continues among experts and non-experts it is important to establish as a basic fact: brain death is in effect the death of the individual. In order to declare a brain death diagnosis, it is needed the total and irreversible cessation of all neurological functions. So, brain death is not a partial death, it is a fully and irreversible death. Considering “alive” a brain death patient connected to live support machines, is like considering “alive” a body without a head. If it would be possible to maintain the vital functions of a decapitated body through machinery, would it be considered alive?

It is important to remember that we are talking about real humans. It is only natural for people to have different personal and religious believes that might contradict what has been established by legal and medical research; respect is fundamental. Both situations presented in this article are very tragic and we send our condolences to the families of Marlise Munos and Jahi McMath.