Jahi's family remained inconsolable and on Jan. 6 moved jahi to another medical facility. The unknown medical facility is now being criticized by the medical community for first misleading the public and confusing the definition of death, and secondly for giving useless maintenance treatment to jahi, giving her family futile hope, and will also incur huge medical expenses for her family as insurance companies will not pay for the medical bills of a person who is already dead.
Why does it cause so much controversy even if a person is dead or not?
It stems from the fact that the public and the medical community have different concepts of death.
When the average person mentions death, the overwhelming impression is bound to be that the heart stops beating and breathing and the body temperature drops. However, a person, even if he appears to be alive, with a heartbeat and breathing, may still be medically defined as dead.
Because, medically, death is not characterized by cardiac and respiratory arrest as the ultimate pointer, but by brain death.
The general public is used to confusing the terms "coma," "vegetative state," and "brain death. But in medicine, the terms have very different meanings.
A coma is a broad term that refers to a prolonged state of unconsciousness caused by a variety of reasons. On the outside, a comatose patient looks like he or she is asleep. But it usually doesn't last more than a few weeks, and the patient can either return to full consciousness or, unfortunately, pass into a vegetative state.
The vegetative state usually means that the patient has lost most of their cognitive abilities, but their brain is still working and there is brainwave activity. A recent study found that patients in a vegetative state may still be able to tell the difference between a loved one and a stranger. Such people are unable to talk and are unresponsive to the outside world. A few will eventually recover; the vast majority will not regain normal consciousness.
But both states are different from brain death.
The concept of brain death was first introduced in the United States in 1995 when the president enacted the Uniform Death Determination Act (UDDA), which stipulates that death can be determined by the presence of one of these two conditions:
1. Irreversible loss of respiratory and cardiac function. Or
2. Irreversible cessation of all functions of the entire brain, including the brain stem.
The controversy over this Jahi thing lies in this second one.
The human brain is, in layman's terms, divided into an upper half and a lower half. The lower brain connects the upper spinal cord to the upper brain and manages our body's voluntary breathing, heartbeat, reflexes, body temperature and sleep cycle. The upper half of the brain manages our various actions, perceptions, sensations such as seeing, hearing, movement and so on.
Brain death means that both the upper and lower halves of the brain no longer function. Our body's overall command doesn't work anymore. But, even though the Commander-in-Chief doesn't work, there are times when the General below it still works on its own, so sometimes, the heartbeat and breathing will still be there with the help of medical facilities. In this way, it looks as if it is still alive.
Ordinary people would have a hard time understanding and accepting this. But once the brain is dead, the heartbeat and breathing will eventually stop unless medical intervention maintains the breathing and heartbeat. A ventilator can make it appear that a brain-dead person is still breathing, but in fact, once the ventilator is removed, spontaneous breathing cannot occur. The heartbeat usually doesn't last more than 72 hours after brain death, but it can be maintained even longer with the right intervention.
The term brain death, because of the ambiguity it can bring, has been the subject of much recent discussion among ethics experts about whether it should be changed. That's because when ordinary people hear the word brain death, they think it's just brain death and that the person is still alive. The term "life-support equipment", which is usually used to maintain breathing after brain death, is also very misleading. Because it implies that there is still life.
In 2010, the American Academy of Neurology updated its guidelines for brain death in adults, requiring all U.S. doctors to check a ****load of 25 indicators before declaring brain death. Only when all 25 indicators are met can a patient be declared dead.
The full name of the guideline is "Evidence-Based Guideline Update: How Adults Decide to Die". What are the key components?
1. Loss of consciousness that is irreversible and of known etiology.
2. Neuroimaging consistent with loss of consciousness.
3. Central nervous system medications no longer work.
4. There is no severe acid-base balance, electrolyte abnormalities, or endocrine abnormalities.
5, normal body temperature or mild hypothermia (this involves a medical emergency principle called "no man is dead until he is warm and dead, meaning that extreme hypothermia can not be judged as death).
6, no spontaneous breathing.
7. Systolic blood pressure is greater than 100 mm Hg.
8. Pupil light reflex disappears.
9, Corneal reflex disappeared.
10, disappearance of spontaneous respiration after stopping the ventilator.
The following means of examination are necessary only if clinical diagnosis cannot be accomplished or if respiratory tests are inconclusive. Only one negative is required to declare death:
Cerebral hemogram.
Electroencephalography.
Transcranial Doppler ultrasound.
Seeing this, you should understand that although there may still be a breathing heartbeat, brain death is the gold standard for determining death. If you are brain dead, you are dead.
(Note: This article is reprinted from the author's Sohu blog)