Jahi MacMath, brain-dead teenager, is released to her mother

Jahi McMath, the 13-year-old girl at the center of a emotional legal battle that has spun out to include three courts, was released from the Children’s Hospital Oakland to her mother on Sunday night.

Jahi McMath, the 13-year-old girl at the center of a sensitive battle over what constitutes death, was released from the Children’s Hospital in Oakland, Calif., to her mother on Sunday night. The brain-dead teenager is expected to be transferred to a long-term care facility, though her exact whereabouts were not released.

“She is safely out of Children's,” tweeted Christopher Dolan, the family’s attorney, on Sunday night.

Jahi, a California resident, was declared brain-dead on Dec. 12, after complications arose from tonsil surgery three days earlier. After declaring Jahi dead, the hospital sought to have the teenager removed from the ventilator. Jahi’s heart, though, was still beating. To her parents, who cite Christian beliefs, their daughter was still alive.

The tense standoff between the hospital and Jahi’s family has since spun out to include three courts, the Terri Schiavo Life & Hope Network, and multiple long-term care facilities. It has also become more than a fight over Jahi’s fate, unfolding into a broader struggle on the legal definition of death.

The Jahi’s family lawyer, Mr. Dolan, has told the press that Jahi could recover from her injuries with time and proper care, telling CNN that “her brain needs time to heal.” The Terri Schiavo Life & Hope Network, founded in the memory of Terri Schiavo, the woman whose husband had her removed from life support against the wishes of her parents, has also said that Jahi “is a living person,” since she has “a beating heart, circulation and respiration, the ability to metabolize nutrition and more.”

But bioethicists have rejected such statements as confusing the definition of death and as purveying false hope for brain-dead patients.

“Just as there are questions about where life begins,” says Robert Klitzman, a bioethicist at Columbia University, “there are questions about the definition of death.”

In defining death, those questions are a result of technology that keeps the heart beating even while the brain is entirely silent, says Dr. Klitzman. In cases where the person's death was especially unexpected, as was Jahi's death, that heartbeat can furnish a grieving family's hope that the loved one is not, in fact, dead, he says. Still, despite the controversy, there is “clear medical consensus” that total brain death constitutes death, even if the heart has not stopped, he says.

That unambiguous definition is also the one used in the 1981 Uniform Declaration of Death Act, a draft law that most states have adopted, including California. Since Dec. 12, three courts have issued rulings consistent with state law and agreeing with the hospital that Jahi is dead. Multiple doctors, including a court-appointed pediatric neurologist, were called upon to assess Jahi’s condition and testified before the courts that the teenager is brain-dead.

Still, on Dec. 20, an Alameda County Superior Court judge issued a restraining order that delayed Jahi’s removal from the hospital ventilator until at least Jan. 7.  Before being released to her mother, Jahi was transferred first through the Alameda County coroner's office, which on Friday issued a death certificate for her, with Dec. 12 as the "well-publicized" death date, according to a spokesman.

The stay of removal gave the family more time to identify a long-term care facility willing to take Jahi and care for her as a living person, as opposed to removing her to her a funeral home. But finding such a facility was expected to be a substantial challenge, as any facility that accepted Jahi would have to be willing to accept as a living person what the county was listing a dead body. 

Moreover, the hospital refused to insert a feeding tube to help transport Jahi to a new center, arguing that to do so would be a violation of the practice of medicine, since the institution considers Jahi a dead body. One nursing home in California rescinded its offer to take Jahi after the hospital made this announcement.

The family’s lawyer did not name the facility to which Jahi is being moved, citing death threats the family has received during the high-profile case. But the New Beginnings Community Center in Medford, N.Y., an institute that houses and offers care for patients with traumatic brain injuries, had in letters to the court volunteered itself as a potential caregiver.

“This child has been defined as a deceased person yet she has all the functional attributes of a living person despite her brain injury,” said the center, in a statement on the Jahi case. “We do encourage every citizen to take the time to educate themselves more clearly on the issues of what brain death is and what it is not.”

Jahi left the hospital in an ambulance accompanied by a critical care team and attached to a ventilator, but without a feeding tube, CNN reported.