Bioethics is concerned with questions about basic human values such as the rights to

life and health, and the rightness or wrongness of certain developments in healthcare
institutions, life technology, medicine, the health professions and about society's
responsibility for the life and health of its members.

ALANO VS LOGMAO (GR NO. 175540 APRIL 7, 2014)

Facts: At around 9:50pm of March 1, 1988, Arnelito Logmao then 18 y/o, was brought to
the East Avenue Medical Center (EAMC) in Quezon City by two sidewalk vendors, who
allegedly saw the former fall from the overpass near the Farmer’s Market in Cubao,
Quezon City. The patient’s data sheet identified the patient as Angelito Lugmoso of Boni
Ave., Mandaluyong. However, the clinical abstract prepared by Dr. Paterno F. Cabrera,
the surgical resident on-duty at the emergency room of EAMC, stated the patient is
Angelito Logmao. Dr. Cabrera reported that Logmao was drowsy with alcoholic breath,
was conscious and coherent; that the skull x-ray showed no fracture; that at around
4:30am of March 2, 1988, Logmao developed generalized seizures and was managed
by the neuro-surgeon resident on-duty; that the condition of Logmao progressively
deteriorated and he was intubated and ambu-bagging support was provided; that
admission to the ICU and mechanical ventilation support became necessary, but there
was no vacancy at the ICU and all the ventilation units were being used by other
patients; that a resident physician of NKTI, who was rotating at EAMC, suggested that
Logmao be transferred to NKTI; and that after arrangements were made, Logamo was
transferred to NKTI at 10:10am. At the NKTI, the name Angelito Logmao was recorded
as Angelito Lugmoso. Lugmoso was immediately attended to and given the necessary
medical treatment. As Lugmoso had no relatives around, Jennifer Misa, transplant
coordinator was asked to locate his family by enlisting police and media assistance. Dr.
Enrique Ona, chairman of the Department of Surgery, observed that severity of the brain
injury of Lugmoso manifested symptoms of brain death. He requested the laboratory
section to conduct tissue typing and tissue cross-matching examination, so that should
Lugmoso expire despite the necessary care and medical management and he would be
found to be a suitable organ donor and his family would consent to organ donation, the
organs thus donated could be detached and transplanted promptly to any compatible
beneficiary. The identity of Lugmoso was verified by Misa from EAMC and she was
furnished the patient’s data sheet. She then contacted several radio and television
stations to request for air time for the purpose of locating the family of Angelito Lugmoso
of Boni Ave., Mandaluyong who was confined at NKTI with severe head injury after
allegedly falling from the Cubao overpass, as well as police station no. 5 Eastern Police
District. Lugmoso was pronounced brain dead on March 3, 1988 7:00am. Two hours
later, Dr. Ona was informed that EEG recording exhibited a flat tracing thereby
confirming his brain death. He was found to be a suitable donor of the heart, kidneys,
pancreas, and liver, and after the extensive search, no relatives were found. Dr. Ona
then requested the removal of the specific organs of Lugmoso from the herein
petitioners, Dr. Alano, the director of NKTI who thereafter issued a memorandum stating
that only after the requirements of RA 349 as amended by PD 856 was complied, they
can remove the specified organs of Lugmoso. Lugmoso’s remains was brought at La
 Funeraria Oro. A press release made by NKTI announcing a double organ transplant led
to the findings of the relatives of Lugmoso.

Issue: Whether or not the removal of Lugmoso’s organs were valid.

• Held: Yes. The internal organs of the deceased were removed only after he had been
declared brain dead; thus the emotional pain suffered by respondent due to the death of
her son cannot be in any way be attributed to petitioner. Neither can the court find
evidence or second to show that respondent’s emotional suffering at the sight of the
pitful state in which she found her son’s lifeless body be categorically attributed to
petitioner’s conduct.

Thus, there can be no cavil that petitioners employed reasonable means to disseminate
notifications intended to reach the relatives of the deceased. The only question that
remains pertains to the sufficiency of time allotted for notices to reach the relatives of the
deceased.

If respondent failed to immediately receive notice of her son’s death because the notices
did not properly state the name or identity of the deceased, fault cannot be laid at
petitioner’s door. The trial and appellate courts found that it was the EAMC, who
recorded the wrong information regarding the deceased’s identity to NKTI. The NKTI
could not have obtained the information about his name from the patient, because as
found by the lower courts, the deceased was already unconscious by the time he was
brought to NKTI.

The Jahi McMath case involved a teenage girl who was declared brain
dead in California following surgery in 2013 at age 13. This led to a bioethical debate
engendered by her family's rejection of the medicolegal findings of death in the case, and their
efforts to maintain her body using mechanical ventilation and other measures. Her parents
considered these measures to constitute life support, while her doctors considered this to be
futile treatment of a deceased person.[3][4][5][6][7][8] In October 2014, the McMath family attorney
made the unprecedented request that Jahi McMath's brain death declaration be overturned. The
attorney later withdrew this request, saying he wanted time for the court-appointed medical
expert and his own medical experts to confer.[9][10][11][12][13] In March 2015, McMath's family filed
a malpractice lawsuit against Children's Hospital Oakland and against the surgeon who
performed McMath's surgery, indicating they were prepared to argue as part of the lawsuit that
McMath is not dead, but profoundly disabled.[14] The family lawyer stated that a preliminary
second death certificate was issued on June 22, 2018, listing extensive bleeding relating to liver
failure as the cause of death.[

The surgery and outcome

On Dec. 9, 2013, the 13-year-old McMath entered Children’s Hospital and Research Center in
Oakland, California, for what should have been a routine tonsillectomy. The young girl was,
according to her mother’s account, frightened that something would go wrong. Her mother
reassured McMath that she would be okay.
 McMath’s post-surgical complications began about an hour after her surgery. A nurse provided
a bin to catch the blood that McMath had begun spitting up. Although the nurses indicated to the
family that some post-surgical bleeding was normal, two hours later, McMath’s blood filled two
plastic bins and the bandages packing her nose were saturated with blood. Her hospital gown
was also covered in blood.

According to the family, four and a half hours passed before a physician saw her, despite the
family’s repeated pleas for intervention. The hospital has maintained that they can not discuss
Jahi’s case in detail because of privacy laws. Bleeding complications, though rare, can
occur after tonsillectomy because tonsils are near arteries.

As a result of the immense blood loss, McMath’s heart stopped and her brain was deprived of
oxygen. Three days later, on Dec. 12, 2013, the medical staff at Children’s Hospital declared
McMath brain dead. Hospital personnel encouraged the family to withdraw life support and
donate her organs.

McMath’s family refused to accept the diagnosis, and a court battle to keep McMath on life
support ensued.

A judge in California initially ruled that McMath could remain on life support until Jan. 7, 2014.
However, the Alameda County coroner issued a death certificateanyway.

JAHI MCMATH’S CASE

This case led to a bioethical debate, which is still open, since her family refused the medical
conclusion of brain death. They made countless efforts to keep her daughter, Jahi, alive using
mechanical ventilation and other treatments.

The complex topics going through this case and going through our consciences are:

1. 1. The Definition of Vital Support and Futile Care

Her parents considered these medical treatments to be a vital support, meanwhile her doctors
considered this a futile treatment for “a death person”.

This case has prompted some commentator to debate over the futility of life support in these
cases, because it would be considered as a “life support for a death” and a futile care therapy.

2. Religious belief
The McMath family’s solicitor said: “There would have been no legal battle if Jahi had her tonsil
surgery in New Jersey”, referring to a New Jersey state law that allows religious objection to the
declaration of death based on neurological criteria.

3.Change of the Law on the Determination of Cerebral Death

Other perplexities were raised to include explanations on how the American law deals with brain
death conditions and if Jahi’s case can change current laws and practices.

4. Organ donation
The public uncertainties over the differences between “brain death” and “cardiac death”
conditions raised during this case, led some clinicians to express concerns on how this case
could influence the recovery of live organs from brain dead patients. This represents the largest
source of supply in use.

Jahi’s History

2013

9 December 2013
According to court documents Jahi Kelis McMath, a 13-year-old girl, is hospitalised into the
paediatric unit of the “Benioff Children’s Hospital” in Oakland-California on 9 December 2013 for
an adenotonsillectomy, uvulopalatopharyngoplasty and submucous resection of bilateral lower
turbinate’s.

It is hoped that these surgeries would improve Jahi’s airflow during night time sleep, as she
suffers from obstructive sleep apnoea.
Jahi appears to be very worried and does not want to undergo this surgery. Her mother,
Latasha “Nailah” Winkfiled, persuades her to trust Dr. Rosen, the surgeon, telling her that he
was an expert and had done this kind of operation many times.

The surgery lasts four hours and at about 7.00pm Jahi come out conscious from the operating
theatre. The nurses give her an ice lolly when she is in the recovery room.

About an hour later, Jahi begins to cough up blood and a nurse gives the family a container to
collect it. However, at 9.00pm the bleeding also spread to her nose.

Nailah calls her mother, Sandra, who has been a nurse for 30 years. When she arrives, the
container was already filled with up to 200ml of blood. She immediately told the nurses that this
didn’t look to be normal.

A nurse writes in her notes that the doctors on duty were “warned several times during the shift”
that Jahi is bleeding.

Another nurse writes that the doctors were “aware of this post-operative bleeding” but tells her
that “there will be no immediate intervention of the ENT team or Surgery”.

Dr. Rosen leaves the hospital for the day. In his medical records, he writes that Jahi’s right
carotid artery appeared abnormally close to the pharynx. This is a congenital condition that
could potentially increase the risk of haemorrhage. Though the nurses responsible for her
recovery seem unaware of her conditions and don’t mention it in their notes.

Jahi’s grandmother, Sandra, sees a doctor in a opposite room asking why he is not visiting her
granddaughter.

The doctor ignored her and instead tells a nurse not to change Jahi’s clothes so that he could
observe how much blood she has lost and to spray the “Afrin” in her nose.
At 12:30 am., Sandra sees on Jahi’s monitor that her oxygen saturation levels dropped down to
seventy-nine percent.

She screams to the medical staff and several nurses and doctors rush to Jahi and start working
to intubate her.

Sandra heard a doctor say, “Oh, shit, her heart stopped.”

It takes two and a half hours to restore Jahi’s heartbeat and stabilise her breathing.

Sandra says that when she saw dr. Rosen the morning after, he looked like he was crying.

So, between the 9 December 2013, the same day of surgery, and the 10, Jahi suffers from
a massive loss of blood and has subsequent cardiac arrest.
According to the medical team who were caring her, the loss of blood circulation caused
the death of the whole brain.

On 12 December 2013, the the medical team declare her brain was death.
The family is informed that she is legally dead and that consequently any life support treatment
will be withdrawn.

The family refuses to accept the medical declaration of death according to neurological criteria
stating that Jahi is not dead. They start a legal proceeding in an attempt to request the hospital
to continue life treatments.

On 20 December 2013, Jahi’s family files a lawsuit in the High Court of Alameda County,
asking the court that the Oakland Children’s Hospital keeps Jahi in life support treatments.
On 23 December 2013, in a preliminary court hearing, Judge Evelio Grillo appoints Paul
Graham Fisher, M.D., as head of the Child Neurology unit at Stanford University School of
Medicine to provide an independent medical opinion regarding the declaration of her brain death
condition.
Jahi’s family also asks dr. Paul A. Byrne [1], M.D., to make a separate medical report.
Dr. Fisher examines Jahi and confirms the diagnosis of brain death, reporting that there is no
activity on her electroencephalogram (EEG), no blood stream into her brain and that she is
unable to breathe on her own when removed from mechanical ventilation. These evidences are
standard clinical signs of a totally brain death condition.

On 24 December 2013, Mr. Justice Grillo concludes that Jahi is legally dead, basing his
decision on the medical evidences showed by the medical team at the Oakland Children’s
Hospital and the independent opinion of the expert dr. Paul Fisher.
Grillo tells the family: “This was very, very heart-breaking for you, no one anywhere in
the world would want this to happen to anyone else”.
Mr. justice requests the hospital to continue mechanical ventilation until 30 December 2013.

The hospital solicitor, mr. Doug Straus says he would like to try to stop intravenous fluids and to
remove Jahi from the breathing machine on 30 December by 5 pm. Though the medical team
would like to negotiate with the family the option to remove Jahi from ventilation even earlier, if
the family agrees.

On 30December 2013, the family appeals the decision to the second district of the California
Court of Appeals and the US Court for the Northern District of California, requesting the hospital
to continue life support treatments until other ways can be arranged by the family to guarantee
the right care of the girl.
Jahi’s mother claims that applying the Uniform Determination of Death Act [2]in this case is in
violation of constitutional rights and privacy and, since Jahi’s heart is still beating, she can still
be considered alive.
Mr. Byrne declares in court that he saw Jahi moving at the hospital and so he considers her still
alive.

The hospital states that it would be immoral and “grotesque” to require the hospital and its
medical team to provide further medical treatments to a corpse and claims that Byrne is “a
crusader with an ideological bias”. It also complains that he is not a neurologist and he is not
licensed to practice in the state of California.

The hospital declares that the movements are due to Lazarus’s signs [3]and that they are not
rare in cases of brain death patients.
After the hospital and Jahi’s family engaged in scheduled talks, an agreement was reached.

The agreement reached allows the hospital to call a transfer team to enter the facility and
relocate Jahi body. The full medical responsibility and the responsibility for the relocation will
fall, from now on, solely on Jahi’s mother.

Jahi’s ventilation equipment must be removed and connected into the transport team’s
equipment along with those of the other devices. The girl’s body must pass from the hospital
gurney to a new one. Even her medical records, medications and a status report must be
delivered back, and the hospital must interrupt any relations with her.

The family’s request of a tracheotomy and a feeding tube installed by the hospital is denied by
the court.

2014
On 3 January 2014, the coroner’s office issues an official death certificate for Jahi with
the date of death of 12 December 2013.
The death certificate is incomplete and as the cause of death is under investigation.
Therefore, an autopsy is required.

On 5 January 2014, the Children’s Hospital releases Jahi’s body to the coroner of the county of
Alameda.
After receiving custody of the body from the paediatric hospital, the coroner releases the body to
her mother’s custody. The mother she is warned of all related risks for a possible cardiac arrest
during Jahi’s transfer. The transfer team is made up of 2 simple nurses.

“A short time ago, Jahi McMath’s body was released by the Children’s Hospital & Research
Centre in Oakland to the coroner”, mr. Durand writes in a statement. “The coroner has then
released her body to the custody of the mother, Latasha Winkfield, as per court order, for an
unknown destination. Our hearts are with the family while suffering from this sad situation and
we wish them a conclusion in peace.”

The family Solicitor Mr. Christopher Dolan along with Uncle Sealey, do not release any details
about her care during the late-night press conference. They say that Jahi will be connected to a
feeding tube and a tracheotomy will be applied by Monday morning.

Her mother, Nailah Winkfield, is by her side, as they are the “highly skilled workers of the
intensive care unit “, Dolan says:

“This family knows that the odds are all against them. They also know that they don’t
need anything less than a miracle. However, what this family only wanted was another
opportunity. This is not just for girl named Jahi McMath. This case also applies to every
parent being able to have the right to make a choice for their own child and not an
hospital that choose for them” he concludes.
Dolan also refuses to indicate where Jahi has been moved and says that his silence is intended
to protect Jahi’s privacy and the privacy of other the other patients on the facility.
The Court documents show that “Life & Hope of Terry Schiavo” network worked hard to move
her in a protected facility in the State of New York, and that Medway Air Ambulance based in
Georgia would have provided the transportation.

The court documents say that the approximate cost of Jahi transportation was around $ 32,000;
Jahi McMath’s website at gofundme.com reports that $ 47,842 has been collected so far in just
10 days.

Only during the flight, the family realise that they are going to New Jersey, the only other state
along New York, to allow Orthodox Jews to be accommodated by law. Some of them believe,
citing the Talmud, that the presence of breath means presence of life.

Jahi arrives at the hospital after more than 3 weeks of not receiving proper nutrition.
In March 2014, the “Life & Hope of Terry Schiavo” network, recognise the McMath family effort
with an annual award. The award recognises “the unconditional love they have for Jahi and their
courage as they continue to fight for their daughter against the overwhelming adversities”.
Jahi’s mother claims to be honoured to receive the award claiming for her daughter to be “still
asleep” and making it clear that she does not use the phrase “brain dead” when referring to her.

Meanwhile, Jahi’s condition begins to stabilise. Her skin becomes more elastic, her limbs and
face swell and her blood pressure stabilise.

In their progress notes, the medical team simply write “Status quo”.

No rehabilitation facility will accept her as a patient, therefore she will stay in the hospital’s
intensive care unit with her treatments covered by the Medicaid insurance.

Nailah says that the cost of care is around one hundred and fifty thousand dollars a week.
According to the 1991 New Jersey Statute on Death, insurance providers can’t deny coverage
due to “personal religious beliefs regarding the application of neurological criteria of death
declaration.”

Alan Weisbard, the executive chief of the bioethics commission who drafted the law, says: “I
thought that our position could have been of humble, rather than certainty”.

Previously, Weisbard assisted the legal assistant of the President for the Death and, like Wikler,
felt uneasy regarding the result.

He says: “I think that people who have conceived deep and conceptual thinking about the brain
death condition are people with a high IQ, who tremendously evaluate their cognitive abilities –
people who believe that the ability to think, plan and act in the world is what makes life
meaningful. Though there is a different tradition that points much more towards the body”.

Weisbard, a religious Jew, says that he doesn’t think that “minority communities should be
forced into a definition of death that violates their belief structures and practices and their
primary senses.”

In June 2014, some media report that Jahi was transferred to the Saint Peter’s University
Hospital in New Brunswick, New Jersey, in the paediatric intensive care unit where patients
receive assistance 24/7.
According to the website, the Saint Peter’s University Hospital is part of a non-profit healthcare
system funded by the Roman Catholic diocese of Metuchen, NJ.

Philip Hartman, a spokesman for the San Peter’s Healthcare System, says he is unable to
confirm the presence of Jahi, as his hospital’s policy restrict the release of patient names to the
public.

Jahi’s family’s solicitor, Christopher Dolan, is also firmly convinced that he too can’t reveal
where Jahi is located: “No, I cannot confirm anything in relation to where Jahi is,” he says.
However, Dolan, reassures that Jahi’s conditions improved to the point that the family is
considering moving her out from the hospital.

Dolan declared: “I would say this is an event I see potentially possible”. “Thanks to Jahi’s
improvement, she may need a lower level of support now”.

Still according to media, Jahi was in hospital until August 2014, after which she is transferred to
an apartment still in New Jersey.

In July 2014Jahi has her first period.

At the end of August 2014, Jahi is discharged from the hospital but still diagnosed with a “brain
death” condition. She moves to an apartment rented by her parents.
The nurses, paid by Medicaid insurance, aid 24/7.

Every four hours, Nailah helps them to turn her daughter’s body.
One of Jahi’s closest nurses writes a note on the wall in her bedroom: “During your turn, interact
with her” she writes. “She can hear you! Speak clearly, slowly, slowly”. She adds: “Nobody
knows whether she is able to comprehend, but only your voice or your comforting touch could
help”.

Not long after the family moved, two detectives and a patrol officer show up at the apartment.
The Franklin Township Police Detective has received an anonymous warning that there was a
corpse in the house.

Nailah led the investigators into Jahi’s room and shows them her ventilator.

The policemen concluded that there is no criminal activity and they left. Though, the nurse on
duty is shocked and leave the house.
Nailah is harassed for months by e-mail and Facebook messages that accuse her of child
abuse or exploitation of her daughter for money. A stranger launched a petition on Change.org
to “prevent New Jersey state from paying for the care of corpses with taxpayer’s’ money”; the
petition says that Nailah bought a “Michael Kors” bag and an expensive wine. This accusation
was made based on Instagram pictures.

Nailah’s solicitor, Dolan, says: “They think she’s just a black lady who sucks in public
resources.”

In September 2014, a month after Jahi was discharged, the International Brain Research
Foundation, a group of neuroscience experts supporting innovative research, economically
contribute for Jahi to have an MRI scan at the “Rutgers New Jersey Medical School”.
The MRI scan is made on 26 September 2014.
Dr. Calixto Machado, president of the Cuban Society of Clinical Neurophysiology, flies to New
Jersey to analyse the scan.
Machado published over two hundred articles on conscience disorders and organizes a
symposium every four year that attracts the world’s leading brain death experts.

He says: “Everyone was talking about Jahi -Jahi this, Jahi that … – but nobody knew her
neurological picture”.

The fact that Jahi started menstruation – a process triggered by the hypothalamus, near the
front of the brain – suggests that not all of her neurological functions has stopped.

Dolan sits next to Machado in the hospital while looking at two computer screens showing
images of Jahi’s head and the top of her spine.

In rare events in which brain-dead patients are sustained by a ventilator, neurologists

have reported a phenomenon called “respiratory brain”: the brain liquefies.
Machado says that if Jahi’s original diagnosis is correct, and if she has not had a cerebral blood
flown for nine months, he expects to see a small tissue structure in her cranial cavity with only
fluid and disorganized membranes.

During the scans, Machado observes that Jahi’s brain stem is almost destroyed.

The nerve fibres that connect the left and right hemispheres of the brain are barely
recognizable.

But large areas of her brain, which trigger consciousness, language and voluntary movements,
are structurally intact.

Dolan shouts: “She has a brain!”

Machado also performed a test that measures the interaction between sympathetic and
parasympathetic nervous systems, a relationship that regulates the states of excitation and rest.

He used three experimental conditions, one of which he calls “The mother speaks to the
patient”.

Nailah stayed closed by her daughter without touching her.

“Hey, Jahi, I’m here” she says. “I love you. Everyone is so proud of you”.

Machado notes that Jahi’s heart rate changes in response to her mother’s voice.

“This cannot be found in a brain-dead patient” he wrote.

On October 2014, three days after the scans, Dolan presents a report from Machado to the
Alameda County Coroner’s office and asks him to rescind Jahi’s death certificate, so that she
can return to California to seek treatment from Nailah.
The coroner and the county public health department rejected the request: “Any opportunity to
overturn the Court’s statement that Jahi McMath is brain dead has long since expired” their
lawyers wrote.

Paul Fisher, MD, an independent expert appointed by the court, who confirmed Jahi’s diagnosis
of brain death in December 2013, states that the new evidences presented don’t refute his
previous determination of brain death.

The Oakland Children’s Hospital continues to sustain that the original diagnosis of brain death is
correct and that the videos don’t meet the diagnostic criteria for brain death condition.

At the end of 2014, Dr. Alan Shewmon [4], who has just retired as head of the neurology
department at Olive View-U.C.L.A. Medical Center, read Machado’s report and begin to wonder
if Jahi has a condition, for the first time proposed by the Brazilian neurologist C. G. Coimbra,
called “ischemic penumbra”. Coimbra hypothesises that this brain state can lead to a
misdiagnosis of brain death in patients whose cerebral blood flow has decreased enough to not
be detected by standard tests. If blood still flows into parts of the brain, however slowly, then in
theory some degree of recovery should be possible.
Shewmon flies to New Jersey and visits Jahi in her flat.

He pulls a desk chair by her bed and, with a notebook in his hand, observed her for six
consecutive hours.

Jahi did not respond to his instructions to move her limbs, a fact that Shewmon didn’t find
particularly revealing.
He analysed the videos that Nailah recorded and which suggested, according to her, that Jahi
was in a minimally conscious state. This is a condition in which patients are either partially or
intermittently aware of themselves and the environment around them.

He writes that her condition “creates a particular challenge to be refuted or verified because the
probability that Jahi is in a “reactive” state during a random exam is very minimal”.

After Shewmon left, Nailah records more videos by following Shewmon’s instructions of not
touching her daughter during filming and to preferably starting the video outside Jahi’s room.

At the end, Shewmon analyses 49 videos containing 193 commands and 668 body movements.

He wrote that movements occur “faster after the command than what would have been
expected if they were random events” and that “there is a very strong correspondence between
the part of the body required to move and the part of the body that actually moves. This cannot
reasonably be explained by chance”.

He also noted that movements “don’t compare to any kind of reflection” and that, in a video, Jahi
seemed to show a complex level of linguistic comprehension”.

Nailah asks her: “When you get angry with someone, what finger you should move?” and two
seconds later, Jahi flexes her left middle finger, then bent her pinkie finger. “Not that” Nailah
says. Four seconds later, Jahi moves again the middle finger.

2015

In March 2015, Jahi’s family files a lawsuit for negligence against the Children’s Hospital in
Oakland and the surgeon who performed Jahi’s intervention, Dr. Frederick Rosen, stating they
are ready to discuss that Jahi is not dead as a part of the hearing.
McMath’s family, together with Bruce Brusavich, the solicitor who followed the lawsuit for
negligence, declared that they were prepared to claim that Jahi is not brain dead.

The prosecution claims that the surgeon advised a high-risk surgery instead of using a CPAP
(continuous positive airway pressure) machine, which is usually preferable, especially for
children.

It also claims that the surgeon did notice an abnormal artery in Jahi’s throat and that he did not
inform the nurses that this would have put the girl at an increased risk of serious bleeding.

Indeed, a nurse provided the family with a suction device to remove her blood, causing the
starting of the strong bleeding meanwhile another nurse suggested to not use it because it
would have removed blood clots which were essential for her life.

Jahi bled from 7:30pm to 12:35am of the next day and lost more than 2 litres of blood.

Dr. Rosen was never present during these events.

After several hours, another doctor arrived and stated: “[swearing], her heart has stopped” and
began the cardiac massage manoeuvres for about 30 minutes.

The cardiac arrest lasted more than two hours, leaving Jahi severely brain damaged and
dependent on life support.

The family also claims that the hospital manager told them “she had suffered significant
brain damage” and that he then placed her on the list of organ donors as they were
arranging to end her life support.
There was also a chaotic emotional scene at the hospital where he banged his fists on
the table and said “What do you not understand? She’s dead, dead, dead.”
The hospital insists that dead people don’t have the possibility to take legal actions.

“The prosecutors are preserving Jahi’s body from her natural post-mortem course”, the
hospital’s solicitor wrote. “It would be against to the public policy to consider doctors
accountable for the unnecessary medical interventions on a dead person”.

After this, the hospital appoints its own medical experts team for further opinions.

Thomas Nakagawa, who wrote the 2011 guidelines for pediatric brain death, states that the only
criteria accepted for brain death are those established by the guidelines themselves.

MRI scans, heart rate analysis, movement videos and menstruations are not relevant to these
criteria.

Sanford Schneider, a professor of pediatrics at the University of California, Irvine, used to refer
to Jahi as a “dead body” and tells the court that “she cannot respond to verbal commands
because she doesn’t have a brain mechanism to hear the sound”. This conclusion was based
on a test that measured Jahi’s brain wave activity in response to several noises.

Schneider wrote: “There is absolutely no medical chance that J McMath has recovered or,
sooner or later, will recover from death.”

Dolan says he is going to make a request to Alex Padilla, the Secretary of State of California,
asking him to rescind the death certificate so that the family can return to Oakland and receive
assistance for their daughter. If this would not work, he will then sue the State to bring Jahi back
home.

The case of medical negligence is independent of the legal effort to have Jahi declared alive in
California. The first trial can go on regardless of the success of this last effort.
Note: if the hospital and the medical team are considered responsible for Jahi’s injuries, the
amount of the damage compensation would be drastically higher if she is considered alive as
the total will also include the costs incurred for treatments after the declaration of death.

Dolan shows video recordings of Jahi and: the statements of Dr. Machado, the witnesses of
three New Jersey consultant who has examined her and the advice of Dr. Shewmon, who
concludes that Jahi met the requirements of brain death at the time of his diagnosis in 2013, but
not anymore.

He wrote: “Over time, her brain has recovered the ability to generate electrical activity, in
parallel with the recovery of the ability to respond to commands”.

He describes her as “an extremely disabled but very alive girl”.

Jahi’s family believes that she is capable of a wider range of thoughts than she can express, an
idea that Shewmon has also considered: “Given the evidence of intermittent reactivity”, he wrote
in a statement addressing the court, “we all should be willing to remain agnostic about her inner
state of mind during periods of non-responsiveness, rather than automatically equating it with
unconsciousness”.

Progress in neuroimaging led some clinicians to consider the possibility that a significant
number of patients deemed to be in a vegetative state – those who don’t demonstrate a clear
awareness of their environment and do not do intentional movements – are misdiagnosed; they
can be periodically conscious and capable of a certain level of communication.

Dolan also provides the signed statements of Dr. Charles J. Prestigiacomo, director of
cerebrovascular and endovascular neurosurgery at the University Hospital of Newark and
president of the neurological surgery department of Rutgers, who claims that Jahi is not brain
dead.
Prestigiacomo wrote in his statement, after reviewing the tests conducted at the university
hospital, the following: “The brain structure shown in the MRI scan is not consistent with a nine-
month dead brain patient’s MRI scan,”. Furthermore, he adds that Jahi has a “very significant
brain injury but she does not meet the criteria for brain death patients.”

In October 2015, a judge rules that Jahi’s family can provide proofs to determine whether she is
dead or alive. If dead, the case will be a cause for death caused by a medical intervention with a
$250,000 damage compensation limit meanwhile, if alive, the damage could potentially reach
many millions of dollars.

This will be a significant sentence: “… even though a California court has already declared Jahi
dead (in 2013), this can now be re-discussed. On the other hand, this is a decision only upon
the made request. If the first request for change (expected at the beginning of November) can
produce sufficient evidences, then Jahi has yet to offer further evidences to support them.
However, it seems that the request for change is very well detailed”, says T.M. Pope, bioethicist
and professor of law.

On 24 October 2015Jahi turns 15 and a series of photos posted on his Facebook page show
that her body apparently has not yet deteriorated as it usually happens in a situation of a brain
death patience.
In November 2015, in the paper script presented to the court, these points were presented:
30. Since the Certificate of Death was issued, Jahi has been examined by a physician
licensed to practice in the State of California who is an experienced paediatric neurologist with
triple Board Certifications in Paediatrics, Neurology (with special competence in Child
Neurology), and Electroencephalography. The physician has a minor specialty in “brain death”
and had published and lectured extensively on the topic, both nationally and internationally. This
physician has personally examined Jahi and has reviewed several medical records and studies
performed on her, including an MRI/MRA done at Rutgers University Medical Centre on 26
September 2014. This medical consultant also examined 22 videotapes of Jahi responding to
specific requests to respond and move…
31. The female period involves hormonal interaction between the hypothalamus (part of the brain),
the pituitary gland, and the ovaries. Other aspects of pubertal development also require
hypothalamic function. Corpses do not menstruate. Neither do corpses undergo sexual
maturation. There is no precedent in the medical literature of a brain-dead body developing the
onset of menarche and thelarche.
32. Based upon the paediatric neurologist’s evaluation of Jahi, Jahi no longer fulfils the standard
“brain death” criteria due to her ability to specifically respond to stimuli. The distinction between
random cord-originating movements and true responses to command is extremely important for
the diagnosis of “brain death” patience. Jahi is capable of intermittently respond intentionally to
a verbal command.
33. In the opinion of the paediatric neurologist who has examined Jahi, having spent hours with her
and having reviewed numerous videotapes of her, she has proven that Jahi has not followed the
trajectory of imminent total body deterioration and collapsed that was predicted back in
December 2013, based on the brain death diagnosis of. Her brain is alive in the
neuropathological sense and it is not necrotic. Currently, Jahi does not fulfil California’s statutory
definition of death, which requires the irreversible absence of all brain function. This is because
she exhibits hypothalamic function and intermittent responsiveness to verbal commands.

2016
In January 2016, according to the family’s solicitor: “Jahi’s family pleads a federal lawsuit for
obtaining a revocation of the death certificate, after they failed an attempt to do so at as tate
level”.
The current doctor of Jahi, Dr. Alieta Eck, makes a statement to the court request affirming that
she believes the teenager is alive. This after having treated her for months. “While Jahi McMath
has suffered a severe and significant brain injury and looks like a person who has suffered
severe brain trauma with signs and features of serious brain damage, Jahi McMath is not dead,”
says Eck. “She is showing signs of brain functions”

In October 2016, Jahi’s family publishes a video in which it can be seen a machine to measure
the breathing, with the mother encouraging Jahi to breathe without mechanical assistance.
According to the evidences, she takes fourteen or fifteen breaths in a minute. If this results to be
true, Jahi is not dead. This evidence means that she is able to hear and at least her brainstem
has a continuous function.
2017
In court, after viewing 49 videos of Jahi, Dr. Alan Shewmon declares that she is technically
alive. This was recorded in a court document made on 29 June 2017, stating that the girl
performs movement commands and shows other evidence of life.
He testified: “The observed movements can be impulses of the spinal cord but not all. There is a
very strong correspondence between the stimulated part of the body and the part of the body
that she can move. This can’t reasonably be explained by chance. Considering that several
tests have shown these videos to be fully genuine, these images should make us raise all our
head. Jahi McMath is a living, severely disabled, young woman who currently doesn’t meet
either the standard diagnostic guidelines for brain death or the statutory definition of California
death. At least, in the matter of life against death, the convincing evidences [in video] of the
ability to respond to commands and the puberty justifies the benefit of the doubt”.

The full testimony of Shewmon is available here:

http://www.thaddeuspope.com/images/Winkfield_v_Rosen_Declaration_Shewmon_06-29-
17_.pdf
The judge therefore is reluctant to remain at the conclusions made in 2013.

In a potential advance regarding the decision, he determines that Nailah could try to prove that
Jahi is alive in a medical malpractice case and a jury will be called to decide.

June 22, 2018 – Jahi Dies

Jahi’s life support was removed on 22 June 2018, after four and a half years of her initial
diagnosis of brain death.

Her second, and at the same time first, death certificate – released in New Jersey – defines her
cause of death as bleeding due to liver failure and notes that Jahi suffered from an anoxic brain
injury for 4 years.
Nailah declares to be “devastated by the loss of her daughter who had shown enormous
strength and courage”.

Furthermore, she declares: “Jahi forced the world to rethink about the topic of brain death. The
University of Harvard recently held a symposium in which the case of Jahi was discussed in
detail. Doctors and researchers presented papers and lectures agreeing that Jahi was not brain
dead. Instead they presented proof of a new level of consciousness. ”

Nailah also states: “Every day I was focused on Jahi and I was going around her. I enjoyed
seeing her every morning and kissing her for the goodnight every night. The hole on my heart
left by her passing away is enormous. My daughter died on 22 June 2018 and not on 12
December 2013. The doctors who were treating her at the time of her death declared she died
because of complications from liver failure. Nowhere there is a reference to brain death. They
recognise a previous brain injury, but don’t try to call it brain dead. The Oakland Children’s
Hospital and the doctors who were the cause of my daughter injures, allowed her to bleed so
much that it caused a traumatic brain injury. They wanted to call my daughter brain dead
because it served their purpose in trying to end her life, so she could sweep their way under the
carpet. I knew that Jahi had not died in December 2013. I’m her mother and I know my
daughter, and I was right. Jahi McMath had not died cerebrally or any other kind of death. She
was a child who deserved to be looked after and protected, not called a dead body. When she
was finally started to be treated as a human being, she then started to improve her condition. As
I told the medical team at the Children’s Hospital in Oakland, you all messed it up, you need to
make a step back and let God have some time to heal my daughter. Once away from the
Children’s Hospital and in the hands of faith-loving people that cared after her, she improved. In
December 2013, Dr. Heidi Flori of the Children’s Hospital said that Jahi’s body was
decomposing and nothing could slow or reverse his impending death. She said that no heroic
measure could change the fact that Jahi was every day dying. She didn’t know me or my
daughter. Jahi is a heroine and she fought hard. I fought with her. The doctors who cared and
did the things we asked for saved her life. People who haven’t gone through this will never
understand it. I can say that I have done all for the good of my daughter. Until she was fighting
for living, I was fighting all my life for her. During the past 4 years, Jahi hasn’t struggled. She
lived peacefully with me and my family in New Jersey. She just recently got ill, and we went to
the hospital. She has PTSD (Post Traumatic Stress Disorder) from the hospital, so this has
reported her back in time. After an exploratory surgery, Jahi began to show symptoms of
suffering. She had bleeding that they were not able to localise. Therefore, they planned another
surgery. I told Jahi that: “if you’re a tired girl, and you’re tired of all this, and you want to be with
God, I’ll give you my permission to go to God”. It was only then that I felt Jahi slipping away.
What people need to know is that I loved her enough to let her go. If she had suffered before, or
had been tired and wanted to go before, then I would have let her go. I wasn’t exploited by
anyone, I was fully aware of what people were saying, about my daughter being died in the
brain.

I knew the opposite, and I made the decisions I took on my own, like her mother, knowing that
my daughter had a very serious brain injury. The only thing I know is that she wasn’t dead. Over
the past 4 years my daughter and I have spent a lot of time together. She could hear me and
could respond to my voice by using her fingers to signal “yes” or “no”.

I knew when she had good days, bad days, if she felt pain, and anything else. Our
communication may not be like that of other people, but we have somehow communicated.
Every time I entered the room, her heart rate increased.

All of this doesn’t happen with a dead person. My daughter knew I was there and that I loved
her as well as I knew she was there and that she loved me too. This was verified by a well-
known neurologist, dr. Alan Shewmon, UCLA, who wrote an article saying that Jahi was able to
understand and respond to my voice and that she was not brain dead”.

When they told her that the paediatric hospital spokesperson, San Singer, said her emotions
had been exploited by her attorney Chris Dolan, Nailah responded: “Saying I was exploited you
are saying that I didn’t understand what was happening to my daughter and that I could not
make decisions for myself. This is a racist conclusion that has begun and keeps going on. I’m
not stupid, I was right. I’ll probably know more about medicine after these four and a half years
compared to most medical students. Dolan did only what I asked him to do and I’m glad I did.
He didn’t tell me what to do, I told him what to do as he was my solicitor. He did everything for
free.

I don’t regret having fought for my daughter’s life. This journey has been long and difficult. I left
a good paid job at the Home Depot, I cashed all my savings and sold my house and most of my
belongings to stay in New Jersey as a family. I was so stressed that sometimes I wondered if I
could make it. I could hear my daughter saying she loved me and didn’t want me to be sad. I
thought, how can I be sorry for myself when my daughter is there to take care of what she’s
been dealing with. People can say anything they want about me, but what no one will ever say
is that I gave up on my daughter. I never gave up. Nobody can say why you didn’t do this or
that, I did everything every human could do. I would do it all over again if I had to choose. I don’t
regret any of the decisions I made for my daughter. We have spent more than 4 years together.
She has just turned 17. I am grateful to the nurses and the medical team who took care of Jahi.
Although angry with the doctors who betrayed and treated her as if she was not worthy of their
care, I realised that there are also good doctors who took care of her and the life of disabled
people, not only for organ donation or to make save money to insurance companies. I thank all
the people who have prayed for us during this time and I ask you to continue to pray for me and
my daughter. Your prayers helped me to keep going and helped Jahi survive and improve.
Prayer and faith are what kept us both on the way. I have fought over the last 4 years to allow
my daughter to come home, so she could be looked after and loved by her family and friends in
her hometown.We have been deprived of this right and have lived in exile in the State of New
Jersey, which has human laws that allow people to exercise their faith and reject the legal
reasoning behind brain death that was designed to allow organs to be removed from people
who still have pulsating hearts and living bodies. It’s tragic that only now, after her death, I can
bring my daughter home.”

When asked what she hopes people have learned from the Jahi story, Nailah replied:
“I hope people have learned that they have the right to defend their loved ones and
refuse the race to end their lives. I hope they have learned not to disconnect their people
just because some doctors think it’s the best thing to do. The best thing for us was to
fight and as a result Jahi had another four years knowing that her family loved and
valued her, and that she fought for her. “

Omari Sealey, Jahi’s uncle, who fought for her survival said: “Jahi may have moved away from
his body but her name, soul and spirit will be with us and will live forever”.

Christopher Dolan, the solicitor of Jahi and Nailah, who provided free of charge representation
over the last 4 years said: “It is a tragedy that the State of California has refused to recognise
that Jahi was a living, sentient human being and didn’t reverse her previous, wrong, death
certificate so that she could not return home. The legal steps to prove she was alive were
prolonged by doctors who, instead, wanted her dead. The fight for Jahi is not over yet. Despite
the terrible criticisms, I have no regrets in representing this family. I am honoured to have been
serving them as their legal representative. Justice in fact, is not a popularity contest. At no time
this has been as important as now. The case of Jahi led to the development of a body of laws
proclaiming that parents have the right to challenge a hasty diagnosis of brain death. These
diagnoses are often made before the brain has had the opportunity to recover from the severe
trauma. In this way, money can be saved, and organs collected with no interferences. Doctors
should not have the right to play God and decide who is able to live and who to die solely
based on their ideas of what is the best or what the best use of resources is. Life is
precious, and this is a slippery slope.If we allow doctors to determine which quality of
life deserves to be preserved and who should or should not die, then we’re creating a
scenario in which, for instance, they can decide to abort children with severe birth
defects or end the lives of people they consider as marginal as people with severe brain
damage, more the elderly or those who have dementia and are unable to live
independently or who do not know what is happening in their own world. The more our
society becomes old, the more we must protect it against the culture of death using the
committee to protect the vulnerable and the sanctity of life.”
He also added that “now that Jahi is dead, the fight to convict the negligent doctors who allowed
Jahi to suffer severe brain damage will continue in the Supreme Court of Alameda through an
act of illicit death”.

Moreover, he stated that he intends to continue to fight on behalf of Jahi through the federal civil
rights lawsuit that was filed in the Northern District of California and try to reverse his hastily
prepared death certificate along with her death date of 22 June 2018″.

The family is asking for peace and for opportunity to mourn the loss of their beloved Jahi while
they organise the burial of her body in California.

THE BIOETHICAL ISSUE IN THE MCMATH’S CASE

Bioethicists denigrated the family’s decision.

In an editorial on Newsday, Arthur Caplan, the founding director of the NYU Medical Ethics
Division and perhaps the country’s most famous bioethicist, wrote: “Keeping her on a ventilator
is equivalent to the desecrating of a body”.

He told to the CNN: “There is no chance that she will be able to survive very long”.

In an interview released to USA Today, he said: “You can’t really feed a corpse” and “She is
about to start decomposing”.
Laurence McCullough, Professor of ethical medic at Cornell, criticised every hospital which
could have hospitalised Jahi. “What can they think?” told to USA Today. “There’s only one word
for this: madness”.

Robert Truog, director of the Centre for Bioethics at Harvard Medical School, declared that he
was annoyed by the tone of the media coverage. He said: “I think the bioethics community felt
the need to support the traditional understanding of brain death to the point that they were really
treating this family with contempt. I felt guilty about that”.

Truog thought that the social context of the family decision was ignored.

“African-Americans have double of the probability respect to whites to demand their lives to be
prolonged as much as possible, even in the case of irreversible coma, because of fears of being
disregarded by the society. A large group of research papers has shown that black patients are
less likely to get appropriate medications and surgeries than white ones, regardless of the level
of insurance or education. Furthermore, they are more likely to receive unwanted medical
interventions, such as amputations”.

Truog also added: “When a doctor says that the loved one is dead, and the loved one doesn’t
seem to be dead, I understand that they might feel that, once again, they won’t receive the right
treatments because of the colour of their skin”.

Troug, during an academic speech on brain death, described it as a catastrophic brain damage
rather than proper death. A transplant specialist stood up and said: “You should be ashamed of
yourself. What you are doing is immoral: putting doubts in people’s minds on a practice that is
saving countless lives”.

Truog later declare, in an interview with The New Yorker, the following: “I thought about it for a
long time. To support public confidence in the scientific business, I believe that in the long run
the medical profession will always be better off if we speak honestly and sincerely about what
we know. I don’t think there is anything morally wrong with the fact that we take organs from
these people, even if there is no scientific reason to believe they are dead. I think it’s a morally
virtuous thing to do and we should make it easier. We are doing the right thing for the wrong
reasons”.

Jahi’s case sparked what Thaddeus Pope, a bioethicist at the Mitchell Hamline University
School of Law, define as “shadow effect of Jahi McMath” where an increase number of families,
many of them from ethnic or racial minorities, go to court to prevent hospitals to disconnect their
loved ones from ventilation. A similar debate took place in 2015 when an Ethiopian university
student, Aden Hailu, was declared brain dead in a Nevada hospital after an exploratory surgery
for stomach pain. A district court rejected his father’s request to keep him on a ventilation, but
the Nevada Supreme Court rejected the lower court’s decision and decided that an expert
evidence was required to determine whether standard brain death tests “adequately measure all
the functions of the whole brain”.

The hearing never took place as Hailu’s heart stopped beating earlier.

Pope is also worried that these disputes, which often attract media attention, can cause fewer
people to register as organ donors, a practice whose social acceptability depends on the idea
that patients are dead before their vital organs are removed.

After visiting Jahi with Bobbi Schindler, Wesley J Smith, a Senior Fellow at the Discovery
Institute Centre on Human Exceptionalism and known for his criticism regarding assisted suicide
and utilitarian bioethics, wrote in an article in September 2017 which said: “I hope that several
important neurologists, without any profit in the situation, can come forward and volunteer to
examine Jahi, – and not just for a couple of days, but for a long period of time – to thoroughly
test her brain and body functions to determine if she is actually responding to requested stimuli.
In the event she miss even one brain death requirement, the death certificate of Jahi in
California should be revoked, letting the chips to fall wherever they can”.
Regarding the relatively limited bioethics coverage of the McMath’s case, Smith noted: “I am
amazed at the fact that the medical and bioethics communities generally show such a marked
lack of curiosity about Jahi’s situation … Maybe it is just a case of “experts” who don’t want to
know more – because if Jahi isn’t dead, it would become of an epochal legal, social, medical
and scientific impact. But then what? Jahi deserves justice. If she is alive, she is a full and
equivalent member of the moral community”.