What is Death in Medicine and Law?

 
A brain-dead baby was taken off life support hours after a judge decided his mother cannot force a hospital to continue treating a legally dead child.

His heartbeat and breathing, maintained by machines for nearly three weeks, soon ceased Tuesday night.

The 2-month-old baby, Isaac Lopez, was declared brain dead July 2, days after police allege his father beat his head into the bathtub. Brain death, meaning no functioning brain cells remain, is medically and legally the same as death by cardiac arrest.

But the child's mother, Iveth Yaneth Garcia-Menchaca, filed suit, asking a judge to forbid Kosair Children's Hospital here from removing the ventilator and feeding tube. She argued that only a child's parents, not the hospital, have the right to make decisions about his medical treatment.

Jefferson County Circuit Judge Judith McDonald-Burkman sided with the hospital Tuesday, finding that the boy is legally dead, and no parental right survives.

"There are no treatment decisions for Isaac's parents or anyone else to make," the judge wrote. "His condition is irreversible. That will never change."

A committee at Harvard Medical School concluded in 1968 that brain death signals the end of a life, as final as death by cardiac arrest. That finding was reiterated in 1981 by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and has been accepted universally, in medicine and in law.

Kentucky law recognizes two definitions of death, the judge wrote. The first is "irreversible cessation of spontaneous respiration and circulation." The second is "total and irreversible cessation of all brain function, including the brain stem and that such determination is made by at least two licensed physicians."

Four doctors at Kosair concluded through a series of neurological tests that every part of Isaac's brain had shut down: Both the upper brain, which controls thought and voluntary movement, and the brain stem, the stalk of neural tissue that connects the spinal cord to the brain and controls involuntary actions like breathing and reflex.

Isaac did not respond to pain. He did not gag or cough or blink when provoked. He did not wheeze for breath when carbon dioxide levels increased in his blood, as any human with even a partially functional brain stem would do.

"The Kentucky Legislature has made a policy decision, based on scientific medical evidence, of when life ends," McDonald-Burkman wrote in her decision. "There is no authority to suggest the parent of a legally dead child can override the Legislature's definition of death."

Excerpt from a USA TODAY story at usat.ly/1rBkM8P