Jahi McMath was a thirteen-year-old girl who was declared

brain dead Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...

California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...

following surgery in 2013. This led to a

bioethical Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, m ...

debate engendered by her family's rejection of the medicolegal findings of death in the case, and their efforts to maintain her body using

mechanical ventilation Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...

and other measures. Her parents considered these measures to constitute life support, while her doctors considered this to be futile treatment of a deceased person. In October 2014, the McMath family attorney made the unprecedented request that Jahi McMath's brain death declaration be overturned. The attorney later withdrew this request, saying he wanted time for the court-appointed medical expert and his own medical experts to confer. In March 2015, McMath's family filed a malpractice lawsuit against Children's Hospital Oakland and against the surgeon who performed McMath's surgery, indicating they were prepared to argue as part of the lawsuit that McMath was not dead, but profoundly disabled. The family lawyer stated that a preliminary second death certificate was issued on June 22, 2018, listing extensive bleeding relating to liver failure as the cause of death.

Background

According to court documents, McMath was admitted to

Children's Hospital Oakland UCSF Benioff Children's Hospital Oakland formerly known as Children's Hospital Oakland, is a pediatric acute care hospital located in Oakland, California. The hospital has 191 beds and is affiliated with the UCSF School of Medicine. The hospital pr ...

on December 9, 2013, for an adenotonsillectomy,

uvulopalatopharyngoplasty Uvulopalatopharyngoplasty (also known by the abbreviations UPPP and UP3) is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. This could be because of sleep issues. Tissues which may typically be remov ...

and submucous resection of bilateral inferior

turbinates In anatomy, a nasal concha (), plural conchae (), also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like ...

. It was hoped these procedures would provide improved airflow during her sleep at night. The hospital described these procedures as complicated. The family described the surgery as a routine

tonsillectomy Tonsillectomy is a list of surgical procedures, surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep ...

in media reports. After the surgeries were performed, McMath was conscious and according to her mother, Latasha "Nailah" Winkfield, asked for a popsicle while in the recovery room. On December 9, 2013, McMath suffered massive blood loss and consequent

cardiac arrest Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and poss ...

. According to McMath's doctors at Children's Hospital Oakland, the loss of blood circulation caused whole brain death. On December 12, 2013, her doctors declared her brain-dead. Her family was informed that she was

legally dead ''Legally Dead'' is a 1923 American drama film directed by William Parke and written by Harvey Gates. The film stars Milton Sills, Margaret Campbell, Claire Adams, Eddie Sturgis, Faye O'Neill, and Charles A. Stevenson. The film was released ...

, and that as a result, life support systems would be discontinued. Her family refused to accept the medical declaration of death by neurological criteria, said that McMath was not dead, and initiated legal proceedings in an effort to require the hospital to continue treatment.

Legal action

On December 20, 2013, McMath's family filed a lawsuit in Alameda County Superior Court, petitioning the court to require Children's Hospital Oakland to keep McMath on life support. In a pretrial conference on December 23, Judge Evelio Grillo appointed Paul Graham Fisher, the chief of Child Neurology at Stanford University School of Medicine, to provide an independent medical opinion regarding the declaration of brain death. McMath's family also requested to have Paul A. Byrne conduct a separate evaluation. Byrne, a

neonatologist Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practised in neonatal intensive care units (NICUs). The ...

, has campaigned against the medical consensus of accepting brain death as

death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...

. The court denied that request. Fisher examined McMath and affirmed the diagnosis of brain death, reporting that she had no activity on an

electroencephalogram Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...

, no blood flow to the brain and did not breathe when removed from

, all of which are standard clinical indications of total brain death. On December 24, 2013, Judge Grillo ruled that McMath was legally dead, basing his decision on the medical evidence presented by physicians from Children's Hospital Oakland and from independent expert Paul Fisher, but ruled to require the hospital to continue mechanical ventilation until December 30, 2013, later extending this order until January 7, 2014. Grillo told the family "This has been very, very hard on you. No one anywhere would wish this to happen to anyone." On December 30, 2013, the family appealed the decision to the Second District,

California Courts of Appeal The California Courts of Appeal are the state intermediate appellate courts in the U.S. state of California. The state is geographically divided along county lines into six appellate districts.

and the United States District Court for the Northern District of California, calling for the hospital to continue life support measures until other arrangements could be made by the family for the girl's care. McMath's mother argued that applying the

Uniform Determination of Death Act The Uniform Determination of Death Act (UDDA) is a model state law that was approved for the United States in 1981 by the National Conference of Commissioners on Uniform State Laws, in cooperation with the American Medical Association, the America ...

to the case was a violation of constitutional religious and privacy rights and that because Jahi's heart was still beating, she was still alive. Byrne stated in court documents that he witnessed McMath moving in the hospital and that he considered her to be alive. The hospital stated that it would be unethical and "grotesque" to require the hospital and its doctors to provide further medical care to a dead body and said that Byrne was "a crusader with an ideology-based bias" The hospital also said that

Lazarus sign The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies). The phenome ...

s are not uncommon in cases of brain death. After the hospital and McMath's family engaged in settlement talks, an agreement was facilitated in which McMath could be released from Children's Hospital, with the ventilator and her intravenous fluid lines, to the custody of her mother, but the United States District Court for the Northern District of California denied the family's petition to require hospital staff to perform a

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...

and insert a

feeding tube Eating (also known as consuming) is the ingestion of food, typically to provide a heterotrophic organism with energy and to allow for growth. Animals and other heterotrophs must eat in order to survive — carnivores eat other animals, herbi ...

Transfer

On January 5, 2014, Children's Hospital released McMath to the Alameda County coroner. The coroner's office had issued an official

death certificate A death certificate is either a legal document issued by a medical practitioner which states when a person died, or a document issued by a government civil registration office, that declares the date, location and cause of a person's death, as ...

for McMath on January 3, 2014, with the date of death listed as December 12, 2013. The death certificate was incomplete, pending an autopsy to determine cause of death. After receiving custody of McMath from Children's Hospital, the Coroner then released her to the custody of her mother, who was warned of and assumed all risk regarding cardiac arrest during the transfer. The family moved the girl to an undisclosed location where a

was performed and a

was inserted.

Commentary

This case has prompted some commentators to discuss the futility of life support in such cases and even refer to it as "death support". Other questions that have been raised include how California law treats brain death and whether McMath's case could change existing laws and practices. McMath's attorney, Christopher Dolan said, "There would have been no legal battle if Jahi had had her tonsils out in New Jersey”, referring to a

New Jersey New Jersey is a state in the Mid-Atlantic and Northeastern regions of the United States. It is bordered on the north and east by the state of New York; on the east, southeast, and south by the Atlantic Ocean; on the west by the Delaware ...

state law allowing religious objection to a declaration of death on the basis of neurological criteria. Public confusion surrounding differences between brain death and cardiac death raised by this case led some doctors to voice concern about how the case could affect live organ recovery from brain dead patients. The impact of this case on medical negligence awards in California has also been discussed, as there is no compensation limit if the patient is alive, while compensation is capped at $250,000 if the patient has died.

Aftermath

In March 2014, the Terri Schiavo Life and Hope Network awarded McMath's family an annual award. The award recognizes "the unconditional love they have for Jahi, and their courage as they continue the fight for their daughter against overwhelming odds." McMath's mother stated she was honored to receive the award and referred to her daughter as “still asleep,” clarifying that she does not use the phrase "brain dead" to refer to her daughter. According to media reports, McMath was at a

Catholic The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...

hospital in New Jersey until August 2014, after which she was moved to a New Jersey apartment. In October 2014, McMath's attorney, Christopher Dolan, held a press conference where he said that recent medical tests had detected blood flow and electrical activity in McMath's brain and where he released videos which he said showed the girl moving on command. At that time, Dolan also filed documents asking that the Alameda County Superior Court reverse their finding of brain death in the case. Paul Fisher, M.D., the court-appointed independent expert who had confirmed McMath's diagnosis of brain death in December 2013, said that the new evidence presented did not refute his earlier determination of brain death. Dolan then withdrew the petition for the October 2014 court hearing and requested that the involved doctors collaborate, stating that "with an open and transparent dialogue between health care professionals, only one conclusion can remain: that Jahi McMath is not brain dead." In March 2015, McMath's family filed a malpractice lawsuit against Children's Hospital Oakland and Frederick Rosen, the surgeon who performed McMath's surgery. The lawsuit alleges that the surgeon noted an abnormal artery in McMath's throat but did not notify the nurses that this placed the girl at increased risk for serious hemorrhaging. Additionally, the lawsuit alleges that McMath bled from approximately 7:30 p.m. to 12:35 a.m., that a doctor said “ xpletive her heart stopped” when he arrived hours after the family said they requested a doctor, and that the family was given conflicting information from nurses regarding how to care for McMath's bleeding. The family also claims that the hospital pressured them to donate McMath's organs. McMath's family and Bruce Brusavich, the family's malpractice attorney, have indicated that they are prepared to argue that McMath is not brain dead, so that the California state limit of $250,000 on medical malpractice lawsuits involving children who die does not apply in her case. After viewing over four dozen independent videos of McMath, Alan Shewmon, a UCLA pediatric neurologist, declared her technically alive in a June 29, 2017, court filing, stating that the girl follows movement commands and exhibits other proof of life. Children's Hospital Oakland maintained that the original diagnosis of brain death was correct and that the videos do not meet the diagnostic criteria for brain death. Dolan issued a statement in June 2018 that McMath had died on June 22, 2018. She was having internal bleeding due to kidney and liver failure, so her doctors removed her from life support, allowing her heart to stop. Dolan stated that he intends to continue his '' pro bono'' case to have McMath's California death certificate revoked and her date of death established as June 22, 2018. However, on February 1, 2019, the case to revoke McMath's original death certificate was voluntarily dismissed by the plaintiffs.

References

External links

Areas of persisting controversy in brain death

Jahi McMath videos released
October 3, 2014 * {{DEFAULTSORT:Jahi McMath case 2013 in California Medical controversies in the United States History of Oakland, California Healthcare in the San Francisco Bay Area Child deaths 2013 controversies in the United States