The Case of Jahi McMath
Despite these many cases, however, the controversy about the meaning of brain death did not rise to the level of public awareness until the celebrated case of Jahi McMath. McMath was 13 years old at the time she was admitted to Oakland Children’s Hospital in 2013 for complex pharyngeal surgery. Shortly after surgery, she developed a postoperative hemorrhage, which led to a cardiac arrest. Although she was successfully resuscitated, she suffered severe brain hypoxia and was
pronounced brain-dead 3 days later. Her family refused to
accept the diagnosis of brain death and initiated legal proceedings.
This resulted in McMath being transported to New Jersey, the only state that allows patients and families to categorically opt out of the determination of death by neurologic criteria. There,
she remained biologically alive (heart-beating) for almost 5 years, mostly at home, with occasional hospitalizations. During that time, she had a ventilator to breathe for her, she was fed through a gastrostomy tube, and she received supplemental hormones. Over those years, her body continued to grow and develop, and she began having menses. In 2018, she developed liver failure. Her family declined further interventions, and
she died biologically from a cardiac arrest. She currently has 2 legally valid death certificates; in California, she died on December 12, 2013, and in New Jersey, she died on June 22, 2018.
There are many lessons that can be drawn from the case of Jahi McMath, not least of which are the ways that race and class impact medical care and may threaten the trust that should exist between patients, families, and their care providers. In terms of how we define death, however, the McMath case is significant because it clearly brought public attention to the fact that the diagnosis of brain death is not synonymous with biological death.
Given the significance of the case, one might wonder why there are not more cases like Jahi McMath. Several reasons can be offered. First, the diagnosis of brain death is almost always a self-fulfilling prophecy because it is quickly followed by either
organ donation or ventilator withdrawal. Second, few families insist on continuing life support in the face of such a severe brain injury and a poor prognosis. Third, even those who do object to the diagnosis are typically overridden
because brain death is recognized as legal death in every state.