As the late Whitney Houston and Bobby Brown’s only 21-year-old child Bobbi Kristina Brown lies in a hospital bed at Emory University Hospital in Atlanta, Ga., the family comes to grips with letting go. Bobbi has been in a medically induced coma since she was found unresponsive in her home on Jan. 31. Her mother’s family along with her father’s have agreed “she’s gone [brain-dead], and there’s nothing more that can be done for her,” a source close to the Brown family said.
Bobbi’s grandmother Cissy Houston proposed to take her off of life support on the anniversary of her mother Houston’s death in 2012. The decision to pull the plug on Feb. 11 is a symbolic way to keep mother and daughter together for eternity, the family says. When Houston passed she was found already past the point of resuscitation, and her family didn’t have to grapple with the agonizing decision of life support. But Bobbi was found by a friend face down in a bathtub with injuries to her face and mouth, teetering between life and death.
“The family would have to figure out what would this woman want if she had that future,” Dr. Arthur Caplan, the director of the Medical Ethics division at NYU Langone Medical Center, told Medical Daily, adding:
Ultimately, both sides of the family finally came to terms with the inevitability of Bobbi’s state, however difficult that must have been. In the most famous case of complicated end-of-life circumstances, Terri Schiavo, a 26-year-old married woman lived for 15 years awaiting a unanimous decision between her husband, family, and court. Schiavo’s brain’s ability to think and process emotion was gone, but her brain stem and cerebellum were still functioning, which is why the life support was dragged out for years. In Bobbi’s case, the family has already begun making funeral arrangements and planning the exact time to pull the plug, which indicates a likelihood of irreversible damage to her brain and brain stem.
“I have a feeling she may be brain dead and they’re waiting to establish that,” Caplan weighed in. “If she was more like Terri Schiavo, you’d usually wait longer to be sure, but if her brain has totally ceased to function, that takes 24 to 48 hours to determine. If they would put her in a coma, it might be even a little longer because they were trying to control brain pressure. But if she shows no brain activity over a 24-hour span and other lack of reflexes and other clinical symptoms, she’ll be pronounced dead. The way this sounds like, it’s going more in that direction.”
She could have already been in a near comatose state when she was found, and doctors put her in a medically induced coma in order to control swelling from brain damage. Caplan points out that there could also be drug or alcohol involved, which would make her chances of regaining consciousness less likely. Comas, brain death, and persistent vegetative states, which are chronic states of unconsciousness with limited movement and wakefulness, are often confused, according to Reuters. If she’s considered brain dead, she’s had a total irreversible loss of all brain function, including the brain stem. It can be difficult, controversial even, for some to see a person with a beating heart as dead by definition.
“It’s hard to decide who’s in charge because she can’t communicate,” Caplan said. “Does she have any written directives? For a young woman like her to do that [is] rare — probably not. Even though young people should do it. Everybody thinks writing down your wishes is for old people, but this is a case that shows it can happen to a young person. But the odds of a young person writing down their wishes of what to do are tiny. Not many people do it. If she doesn’t have it, they have to decide who’s calling the shots? Who’s the person in charge?”
On the medical side, there’s one doctor in charge, but that doesn’t necessarily mean he or she is the only one advising Bobbi’s family. The doctor will have a team of fellow doctors, nurses, and other medical professionals for counsel on how to proceed, along with the advisement of a neurologist who would have at that point administered an EEG on the patient in question. Problems occur when not everyone feels doctors can be trusted to make a full-proof decision. When it comes to an EEG, it’s nearly black in determining if there is brain function or not. If there is partial brain damage, there’s no telling how long a family would be willing to keep their loved one alive.
Medical advancements are an inevitability of human evolution, and with that comes responsibilities and slippery definitions. Ventilators, feeding tubes, and other technologies have made it possible for a life to extend longer than its biology is fated to last. As the century progresses, more humans will be supported by and rely upon machinery and drugs in the last days, weeks, months, or even years of life. So, the paradigm for life-ending decisions is oftentimes not made by the individual alone.
The foundation of human life has always existed on the balance of two pillars: quality and quantity. When one begins to crumble, a person or their family members must decide on a swift and pragmatic solution to stabilize without suffering. Being kept alive by some form of medical technology forces humans to confront death in a way our ancestors were never burdened or blessed with. Being logical and realistic about the amount of time a loved one has left has become a phenomenon of emotional evolution.
“New technologies are raising lots of hard questions about how to manage end of life,” Caplan said. “Every time you make an advancement to keep somebody alive, you also have to question when to stop using it.”