One thing that pisses me off more than almost anything else is the willful propagation of misinformation. The Internet is a wonderful treasure trove of information, and a wealth of information on any subject imaginable is only a few keystrokes away thanks to the magic of Google (fuck you, Bing). But the downside is that false information is just as readily available, and people are just as liable to believe it.
The more I read about Jahi McMath, the more upset I become. Not so much about how the family is handling the situation, though I believe they are handling it exceedingly poorly. Not so much how their lawyer Christopher Dolan (aka Scummy McDouchebag) is making himself sound like a clueless jackass and attention-whore, though he obviously is ("It is our position that no doctor determination can end a life without parental consent", he stupidly said). No, what bothers me the most is that in spite of the fact that six different doctors confirmed that little Jahi has died, the family wanted a 7th opinion. And the seventh opinion they wanted was from Paul A. Byrne, MD.
If you haven't heard of Dr. Byrne, you're about to be educated on just how blinded by faith a supposed man of science can become.
Dr. Byrne is an American neonatologist and pediatrician from St. Louis, Missouri. He is past-president of the Catholic Medical Association and an avid opponent of the entire concept of brain death, and he is vehemently opposed to organ transplantation. Despite the stance of the vast majority of the medical community, Dr. Byrne does not believe brain death even exists - "it has become clear that 'brain death' is not true death" he wrote in August, 2011 . In that story he makes several references, including quoting his own article from The Journal of the American Medical Association as if it were someone else's work. That's red flag #1: quoting yourself. Tsk tsk, Paul. The second red flag, arguably much bigger, is that one of his other references is www.lifesitenews.com, a site which was started by anti-abortion zealots and which is anti-homosexual, anti-contraception, anti-stem cell research, and anti-anything-that-isn't-strictly-Catholic. They state on their website, "LifeSiteNews gives priority to pro-life, pro-family commenters and reserves the right to edit or remove comments."
Riiiight. Not exactly a respected scientific outfit there, Pauly.
The third (and biggest) red flag is that Dr. Byrne posts his commentary on www.renewamerica.com, an ultra-conservative website started as support for a radical whack-job. His arguments against the concept of brain death are so ridiculous they could almost be considered comical. The only reason it's not funny is that people actually believe him.
People have known for hundreds of years that the brain is where the person actually lives, not the heart. The other organs (heart, lungs, intestines, spleen, liver, pancreas, etc) merely support the brain. This is not subjective, conjecture, or opinion, this is fact. People can live normally without a spleen. People can live without kidneys (on dialysis). People can live with a failed liver for months while waiting for a transplant (Yes Paul, a transplant). People can even live without intestines (on IV nutrition). And people can live without a heart - the first artificial heart was implanted in 1982, and people can now live for months with artificial pumps circulating their blood while waiting for a heart transplant.
But you can not live without a brain. This is a very simple fact, one that is taught on Day 1 of medical school, and one that Dr. Byrne and his followers consistently and stubbornly and ridiculously fail to acknowledge.
Death is defined as either 1) the complete cessation of biologic function or 2) the irreversible loss of brain function. Without the brain, there is no life. Death by #1 is no less dead than death by #2. But Dr. Byrne states that "Death is separation of the soul from the body." That one line speaks volumes - this doctor, this purported man of science, defines death religiously rather than physiologically. Dr. Byrne also likes to use misdirection to further his lies:
"Since there are two definitions of death (cardiac death and brain death), it is clear that either is enough to be called deceased. If there are 2, Jahi must not be dead by the other method, or she would have been, or could have been declared dead by the other one."No, Dr. Byrne. It doesn't work that way. Brain dead is just as dead as cardiac dead.
Dr. Byrne also seems to have completely forgotten his basic physiology. I'm sure he learned in medical school, just as I did, that the lungs and heart both function independently of the brain. The heart can still beat and the lungs can still ventilate (move air in and out) and respirate (exchange oxygen for carbon dioxide) without input from the brain. But Dr. Byrne incorrectly says, "After true death chest compressions or a ventilator can only move air; there cannot be respiration, because respiration is a function of a living human body." This is patently false - respiration is a function of functional lungs, NOT of a living body. Lungs simply do not require a brain to do their job.
Think that's bad? Oh but wait, it only gets worse:
"So-called 'brain death' or 'cardiac/circulatory death' are terms concocted by transplant physicians and their allies who wanted to enlarge the donor pool by including patients who are really not dead in the traditional sense of the word."Another fabricated lie by the good doctor, a preposterous conspiracy theory that transplant surgeons, who wish only to give their patients a new chance at life, hover like vultures, waiting to rip organs out of unsuspecting victims, like grave robbers in the 1800's. The concept of brain death as death was advanced by the Harvard Medical School in the 1960's to differentiate brain death from a persistent vegitative state as the possibility of organ transplantation was becoming a reality. Brain death was not remotely a new concept, but at the time it had to be more strictly defined so ethical lines would not be crossed. It was transformed into law in the United States in 1981 as the Uniform Determination of Death Act, which was supported by the American Medical Association and the American Bar Association (probably the only time in human history when doctors and lawyers have agreed on anything). The Australian definition of brain death is identical. "Brain stem death" in the UK is a similar concept. In fact, when you look at the worldwide view, brain death is universally accepted, and there was universal agreement on the neurologic examination in diagnosing brain death, though the exact criteria vary from country to country .
I've spent the past week following this entire story and reading comments from other readers. It is astounding just how many people are convinced Jahi is alive because her heart is pumping, and that she will miraculously wake up. Several of them reference other people who have been diagnosed (obviously misdiagnosed) as brain dead who have woken up. However, after an exhaustive search of the medical literature, I can find exactly zero documented cases of someone whose brain is actually devoid of blood flow and function coming back to life. Brain dead is NOT THE SAME as a coma or a persistent vegitative state.
Our job as doctors is to help patients get better, but part of our job is also to educate our patients and their families. Spreading false information based on lies is dangerous and completely against the purpose and spirit of medicine. Brain dead is dead, despite what Dr. Byrne and Jahi's family choose to believe.
If you'd like to read Dr. Byrne's complete ridiculous column, make sure you're sitting down, and prepare to be completely exasperated. Ready? Go.
2. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria.Neurology. 2002 Jan 8;58(1):20-5.