Every parent identifies with Nailah Winkfield's desperate search for a miracle for her 13-year-old daughter, Jahi McMath, who was declared brain dead after a tonsillectomy that went horribly wrong Dec. 9. The family's pain is all the more heart-wrenching as the tragedy has unfolded over Christmas, the season of hope for so many.



People do come out of comas and even, more rarely, out of a persistent vegetative state. Sometimes it happens long after most loved ones have lost hope, and it can seem like a miracle.

Rev. Harold Mayberry, left, reads a statement for the family of 13-year-old patient Jahi McMath during a press conference outside Children's Hospital Oakland on Sunday, Dec. 22, 2013, in Oakland, Calif. (D. ROSS CAMERON)

But there is no recovery from brain death. Ever.

Once all functions within the brain and the brain stem cease, the condition is irreversible.

Under California law, derived from the Uniform Determination of Death Act used by most states, patients in this condition are legally dead. Machines can keep lungs and hearts pumping, which gives loved ones the illusion of life. But it is an illusion.


Keeping a patient on life support in an intensive care unit bed costs, at a minimum, $2,000-$4,000 per day and can run much higher depending on the patient's condition, into hundreds of thousands a year. Nurses and doctors must maintain care around the clock, warding off bed sores and other conditions that come from being confined to a hospital bed for days, months or even years.


It may seem cold to say it, but doing this for a patient who is legally dead takes up the time of medical professionals and sophisticated equipment that otherwise could be available to ICU patients who have real hope of recovering from devastating injuries or diseases.

Since the beginning of civilization, doctors, scientists and religious leaders have struggled to define when a person is dead. Like the question of when personhood begins, determining death is not straightforward.

The ancient Egyptians may have been the first to focus on the beating of the heart, believing that only when it stopped was a person dead. For centuries afterward, breathing and response to stimulation sometimes were considered tests, in addition to heartbeat.


Doctors have been refining the tests for brain death ever since, as medical knowledge about the functions of the body and brain expands. But it is clear that brain activity, once fully ended, does not return.

The tragedy of Jahi McMath shows that many people are still uncomfortable equating the death of the brain with death itself, when machines can keep lungs and hearts going.

But as widely respected medical ethicist Arthur Caplan wrote last week, "Once brain death is declared, doctors have the right to stop treatments including life-support. ... No matter what the family might say, death is a clear line beyond which treatment need not and should not continue."

We know death can occur from any surgery, but that is cold comfort when a child dies from having her tonsils out. Who does not wish that Jahi could somehow come back to life? The tragedy has touched the hearts of millions.
