“The Girl Who Died Twice” Lesson Plan

Ambiguous 

Capable of being understood in two more possible senses or ways.

Circulatory Death 

A permanent, irreversible loss of heart and lung function, including the loss of blood circulation.  

Death by Neurological Criteria, or Brain Death 

A permanent, irreversible loss of brain function or activity. 

Dogma 

Something held as an established opinion.

Life Support 

Medical treatments, techniques, and technologies that can replace essential bodily functions. 

• A ventilator is a form of life support for patients who struggle to breathe on their own. 

Social Construct 

In medicine, the idea that the understanding and experience of health, illness, and disease are not solely based on biological facts, but are also significantly shaped by cultural meaning and societal norms, created and widely accepted by the people in a society.iii 

• Brain death (death by neurological criteria) is a socially constructed definition of death. It is not only marked by biological conditions, like an absence of brain function, but is also significantly informed by societal norms, medical technologies, and ethical considerations, whereas circulatory death is a biological phenomenon. 

• How did Jahi McMath end up on life support?  

• What is brain death? What is its history? What is the difference between brain death and circulatory death?  

• What factors contributed to the disagreement between Jahi’s family and the doctors in California? Sample answers provided.
  • Her family’s cultural and religious beliefs about death
  • The way they were treated in the hospital
  • Racism
  • A lack of action from doctors and nurses 
  • How quickly the doctors declared her dead 

• What problems might arise if families and doctors disagree about whether someone is dead? Sample answers provided.
  • Hospital resources: medical and nursing staff care, specialized equipment and care if a patient is maintained on life support 
  • Mistrust in healthcare and healthcare providers 
  • Legal or practical problems: having two death certificates 
  • Lack of closure for family and others close to the patient

• Can you think of a time when your input was not considered or overlooked? How did you react or feel?  

• Who do you think should be involved in discussions about brain death?
  • Should families be involved in decision making about whether a patient meets criteria for death?
  • Should families be allowed to opt out of medical professionals’ declaration of brain death? Why or why not?
• Who should be invited to create policies about brain death criteria?
  
•  In what ways could the medical team have handled Jahi McMath’s situation differently to better support the family? 

• Do you think the history of mistrust in healthcare played a role in this story? If so, how?  

Instructions: 

Split the class into groups of 4-5 students. One student (Student A) will play the role of a doctor and another student (Student B) will play the role of a patient’s family member. The two will simulate a conversation in which Student A must deliver the diagnosis of brain death of the patient to Student B, and Student B can react, expressing emotions, asking follow-up questions, etc. After a few minutes of simulated conversation, the role play can pause and the small group can debrief and give feedback on Student A’s delivery of the diagnosis and response to Student B’s concerns.  

After a few minutes of debriefing, two new students in the group can assume the roles and simulate the conversation again. The conversation will likely look different after students give feedback each time. 

Prompts to Reflect on the Conversation: 

• Was the diagnosis delivered in clear language? Did the family member understand the diagnosis and its implications? 

• Did the doctor show empathy or acknowledge the emotions that were expressed? 

• Did the doctor do a good job responding to the family member’s questions and concerns?  

• How did the conversation end? Based on how the conversation went, what do you think will happen next?  

• How did the conversation go well? 

• In what ways did the conversation go wrong? Or, how could it have gone better?  

What Does it Mean to Die? The New Yorker, 2018.

The Uniform Determination of Death Act, 1980. 

Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline, 2023, A Report by the American Academy of Neurology Guidelines Subcommittee, the American Academy of Pediatrics, the Child Neurology Society, and the Society of Critical Care Medicine. 

Standards and Ethics Issues in the Determination of Death: A Position Paper From the American College of Physicians, 2023. 

Death is universal, but sometimes murky, The Harvard Gazette, 2018. 

Expanding the Social Status of “Corpse” to the Severely Comatose: Henry Beecher and the Harvard Brain Death Committee, Perspectives in Biology and Medicine, 2022.