Truly Reconciling the Case of Jahi McMath

Abstract

This article clarifies some issues raised by Dr. Ariane Lewis in her recent "Current Opinion/Arguments" article on the case of Jahi McMath. Review of case materials. Jahi's case most likely represents an instance of global ischemic penumbra (GIP) mimicking brain death (BD), with intracranial blood flow too low to support neuronal function or to be detected by radionuclide scan but sufficient to prevent widespread necrosis. Her MRI scan 9 months after the ischemic insult showed gross preservation of cortical and internal structures, incompatible with there ever having been a period of completely absent blood flow. Regarding Jahi's alleged intermittent responsiveness, the set of videos, unsystematic as they are, constitutes convincing evidence that her movements in seeming response to command are not of spinal cord origin and are indeed voluntary responses, placing her in the category of minimally conscious state (MCS). In the absence of serial examinations by experts in MCS, the benefit of the doubt should be given. Unfortunately, her death on June 22, 2018, 4½ years after the diagnosis of BD, precludes such examinations. During those 4½ years, Jahi underwent menarche, with three documented menstrual periods, and ongoing pubertal development. Her case is an important example of false-positive diagnosis of BD, demonstrating the inability of current diagnostic standards to distinguish true BD from potentially reversible brain nonfunction due to GIP. The incidence of such mimicry is impossible to determine, because in most cases a BD diagnosis becomes a self-fulfilling prophecy.

Are All Brain Death Controversies on The Internet Fake Medical News?

“…3 This premise, however, has been disproven. 3,4,6 We agree with Sochet and Nakagawa 7 that building trust with patients demands providing accurate information. We also concur with their position that "trust is not built by blatantly ignoring alternative theories."…”

“…Jones et al overlooked serious contemporary scientific, legal, ethical, and philosophical challenges to these national guidelines, 3 which, if had been considered, undermine the authors' implied claim of the "accuracy" of the national guidelines as a reference source. These challenges can be summarized as follows: (1) nonequivalency of brain death with biological death 3,4 ; (2) emergence of neuroscience research in disorders of consciousness refuting the premise that behavioral unresponsiveness equates to irreversible loss of capacity for consciousness 3 ; (3) deviation of the neurologic diagnostic criteria (based on the brainstem function) from wholebrain function 5,6 ; and (4) noncompliance with the US legal standard in the Uniform Determination of Death Act, which mandates the cessation of the whole-brain function. 3 Sochet and Nakagawa 7 attributed misinformation about brain death on the Internet to "simple error, unfamiliarity, individual misperception or confusion, or lack of context," as well as "sensationalism" and "‛fake news'."…”

The Case of Jahi McMath: A Neurologist's View

“…This is the range called the “ischemic penumbra,” well known in the stroke field and hypothesized by Cicero Coimbra to occur globally as a mathematical necessity during the progression from normal to no flow in the pathogenesis of brain death . Jahi's case may be the first indirect confirmation of Coimbra's hypothesis . False positivity of the brain death diagnostic criteria and of “confirmatory” blood flow tests is not unprecedented .…”

The challenge of brain death for the sanctity of life ethic

“…Shewmon believes that Jahi was probably in a minimally conscious state, as a result of a condition known as global ischemic penumbra, in which intracranial blood flow is too low to support synaptic function, but is just sufficient to prevent the death of the cells. At present, the standard tests for blood flow used to diagnose brain death are not sensitive enough to distinguish this low level of blood flow from no flow at all (Shewmon, 2018).…”