A father's bid to keep his 20-year-old daughter on life-support at a Reno hospital after doctors declared her brain-dead is pending before a Nevada state court judge. Beyond the family attorney's claim on Wednesday that the cost of caring for Aden Hailu (AY'-dehn HEHL'-oo) is driving hospital efforts to pull the plug, the case raises key questions about Nevada's interpretation of national end-of-life guidelines.
Q: What's the issue?
A: The Nevada Supreme Court wants to know whether Saint Mary's Regional Medical Center met state law when doctors declared Aden Hailu dead May 28, several weeks after she failed to regain consciousness following abdominal surgery.
Washoe County Family Court Judge Frances Doherty is revisiting the case because the state high court ruled Nov. 16 she was too quick to reject Hailu's family's request to keep Hailu on life-support. Justices say they want evidence that American Association of Neurology guidelines used by the hospital to determine Hailu's brain had ceased to function met "accepted medical standards," as required by state law.
Hailu's father, Fanuel Gebreyes of Las Vegas, now wants Saint Mary's to continue to treat his daughter, or to send her to a facility that will.
Saint Mary's says Hailu failed to breathe on her own when her ventilator was disconnected to test her response in May.
Gebreyes says the hospital failed to promptly confirm Hailu's death by follow-up brain-wave tests.
Saint Mary's says it now wants to perform brain-wave tests to show Hailu is dead.
The judge on Wednesday scheduled additional hearings Dec. 29 and Jan. 22.
Q: What's the Nevada law?
A: Nevada requires a finding "in accordance with accepted medical standards" of irreversible cessation of circulatory and respiratory function or "all functions of the person's entire brain, including his or her brain stem."
The law also requires the determination to be "applied and construed to carry out its general purpose which is to make uniform among the states which enact it the law regarding the determination of death."
The state Supreme Court acknowledged Nevada sets an "extraordinarily broad standard" by requiring a finding that irreversible cessation of brain stem functions is the accepted medical standard among the states that enact the Uniform Determination of Death Act.
Q: What's the Uniform Determination of Death Act?
A: In 1980, the National Conference of Commissioners on Uniform State Laws adopted the act as a guideline, in cooperation with the American Bar Association, American Medical Association and the President's Commission on Medical Ethics. It stemmed from advances in lifesaving technology in the 1960s, including the use of hospital ventilators, which prompted a Harvard Medical School committee in 1968 to develop criteria for determining what it called "irreversible coma."
Q: What did the Uniform Determination of Death Act do?
A: The act widened the basic and most common determination of death - total failure of the heart and lungs - to include irreversible cessation of all brain function. It deems death to be the point at which the "entire brain" ceases to function, including the brain stem regulating involuntary body functions such as heartbeat and breathing.
Q: How many states follow the act?
A: Nevada is among 37 states and the District of Columbia with laws based on the act, according to the National Conference of Commissioners on Uniform State Laws.
Q: What tests are recommended to determine brain death?
A: American Association of Neurology guidelines cite three measurements: Coma or responsiveness to stimuli; brainstem activity gauged by reflexes; and whether the patient can breathe unassisted.
So-called Harvard criteria check for lack of response to pain stimuli, lack of spontaneous muscular movement or respiration, and absence of reflexes including eye movement, swallowing and pupil reaction. The Harvard standard also recommends testing showing flat electroencephalogram, or EEG, brain wave activity.
Q: Have there been cases similar to Hailu's in other states?
A: In Texas, a pregnant woman, Marlise Munoz, was taken off life-support in January 2014 after her husband won a nearly two-month court fight. The fetus wasn't delivered. John Peter Smith Hospital in Fort Worth contended that state law required life-sustaining treatment so the baby could be born. Legal experts say the hospital misinterpreted the intent of the Texas Advance Directives Act.
In California, the family of Jahi McMath fought a court battle to keep her on life support after she was declared brain-dead in December 2013 at age 13. Jahi failed to regain consciousness following an operation at UCSF Benioff Children's Hospital in Oakland. She's now at a facility in New Jersey, where she remains on a ventilator.