Jahi McMath has improved after being declared dead from anguish, according to doctors

A few days after the announcement of his death, a new report published by Harvard Medical School indicates that Jahi McMath's brain has shown slight signs of improvement over the five years following the initial statement. that she was dead. "The resurrection" from death to life and challenging our widespread understanding of what it means to be officially dead.

California declared Jahi dead in 2015, but the teenager from Oakland continued to grow, developed bads, had his menstrual cycles, digested excreted garbage, fought infections, healed wounds and seemed to respond to basic commands, according to medical testimonials provided at a conference on the case.

In addition, her severely damaged brain had intact regions – and there are clinical signs that she gradually improved over time, seemingly crossing the line between "dead brain" in life in a " minimal state of consciousness ", although there has never been

The long and painful saga of Jahi – which began when oral surgery went awry at the Children's Hospital. Oakland – is over last week with news of his biological death, caused by internal bleeding and kidney problems. She now has two death certificates – one issued by California on December 12, 2013 and the other by New Jersey on June 22.

Her parents, never believing that there was no hope, took her across the country state that allows to challenge a declaration of brain death for religious reasons, where she stayed connected to respiratory machines until last week.

The widely publicized struggle, fiercely debated over its fate, sheds light on a little known fact: "Brain death" is an important legal term, but the underlying biology can be much less decisive.

Its impact could affect traditional medicine for years to come as science advances much faster than courts or legislators.

"The law tends to favor clear distinctions – yes or no, black or white, not in-between," said Dr. Robert Truog, director of the Harvard Bioethics Center, who organized the conference. Held in April, his proceedings were released immediately after Jahi's death.

Improving, Jahi has crossed this luminous line. Clinically, it's not so surprising, the doctors said. This is because, unlike the law, "biology tends to involve a continuous spectrum. He said: [TRADUCTION] "By slightly improving its functioning, it is legally part of the" dead "part of being in the" alive "part," said Truog. Not necessarily means biological death, says Truog, but is simply the extreme end of the spectrum of the neurological lesion.

important role in society, he added.Although patients are not biologically dead, their profound neurological involvement means that for legal purposes they can be treated as dead.It is essential to know when wills can be performed and when organs can be donated, says Truog.

There are other examples of biological transitions that are legally definitive: for example, when a person is 18 years old, he or she moves from childhood to adulthood, with a completely new legal status. People whose life are less than 20/200 are "legally blind" even though they can still see.

But this can be very confusing for families in mourning. Jahi suffered a serious brain injury at UCSF Benioff Hospital for children in Oakland after suffering cardiac arrest as a result of complications related to complex surgery of the nose and throat. When Jahi's family rejected California's determination, experts like bioethicist Laurence McCullough of Baylor College of Medicine in Houston called their logic "messy, from a medical point of view … There is a word for this: crazy. "

But now some doctors think differently. "We would say that Jahi's parents were far from being crazy in believing that their daughter was still biologically alive," according to Truog. He published an important article on the controversy, titled "Defining Death," in the May 8 issue of the Journal of the American Medical Association.

The current definition, established in 1981 by the US Presidential Commission, is based on the position that biological and legal "brain death" is the same – baduming that brain function is necessary for the functioning of the brain. organization as a whole.

But in recent decades, doctors have learned that this is not scientifically correct. Truog said. There is irrefutable evidence that people who meet the diagnostic criteria for brain death can continue to live and maintain their bodies indefinitely through mechanical ventilation.

Jahi meets the three legal criteria for brain death: coma, lack of brainstem reflexes, and yet, using additional tests, she was still alive, said Dr. D. Alan Shewmon, emeritus professor of pediatrics and neurology at UCLA, which examined magnetic resonance imaging and other tests, as well as 49 videos of the teenager. She responded intermittently to stimuli, such as the voice of family members, said Shewmon, who publicly explained MRI scans and footage to Harvard for the first time. While his movements were not consistent, they were reproducible and sufficiently supported to be differentiated from reflexive behavior.

This was not just the result of Jahi being supported by machines, he said. In other "cerebral" patients sustained, all the contents of their skull were replaced by a chaotic clutter of tissues, fluids and calcifications, eventually liquefying.

"If Jahi died brain, we would wait for his MRI at nine months to show a similar pattern with almost complete destruction," said Shewmon, which was also reached by Dr. Charles J. Prestigiacomo, director of neurosurgery cerebrovascular and endovascular at Rutgers University Hospital in Newark, NJ

Of course, her brain was mbadively damaged, according to advanced brain scans presented at the Harvard Conference, conducted at Rutgers University Hospital. has suffered the destruction of the insulation, called myelin, around the nerves.His "cortical ribbon", also damaged, is a thin band that includes the outermost part of the brain.There was degeneration in its deep white substance, as well as his corpus callosum, which joins the two hemispheres of the brain.There were also signs that the contents of his brain had changed, perhaps c atastrophic, due to elevated intracranial pressure.

But there was surprisingly little damage to the other parties. There was no atrophy of the cortex. His upper brainstem was largely intact. "As these are the structures that cause wakefulness and vigilance," said Shewmon, "it is tempting to speculate that its relative conservation, unlike the weaker, is an area called the thalamus, according to the slides shown. by Shewmon, the destruction of the brain stem, could explain Jahi's intermittent consciousness – despite his severe motor disability and absent brainstem reflexes. "

Improved diagnostic tools blur the clear line established by law. "This raises questions about the accuracy of the tests to determine brain death and the pressure that doctors might feel to intervene aggressively," said Arthur Caplan, founding chief of the Division. of Medical Ethics at the University of New York School of Medicine.

"Should we reinforce the tests?" Asked Caplan. "Is it affordable to do it? For all those who are declared dead, are we putting our heads in an fMRI machine?"