The Mind Illuminated: A Complete Meditation Guide Integrating Buddhist Wisdom and Brain Science for Greater Mindfulness

The Mind Illuminated: A Complete Meditation Guide Integrating Buddhist Wisdom and Brain Science for Greater Mindfulness









The Mind Illuminated: A Complete Meditation Guide Integrating Buddhist Wisdom and Brain Science for Greater Mindfulness Kindle Edition

by Culadasa (John Yates PhD) (Author),‎ Matthew Immergut PhD(Author),‎ Jeremy Graves (Contributor)







4.7 out of 5 stars 237 customer reviews



The Mind Illuminated is a comprehensive, accessible and - above all - effective book on meditation, providing a nuts-and-bolts stage-based system that helps all levels of meditators establish and deepen their practice. Providing step-by-step guidance for every stage of the meditation path, this uniquely comprehensive guide for a Western audience combines the wisdom from the teachings of the Buddha with the latest research in cognitive psychology and neuroscience.



Clear and friendly, this in-depth practice manual builds on the nine-stage model of meditation originally articulated by the ancient Indian sage Asanga, crystallizing the entire meditative journey into 10 clearly-defined stages. The book also introduces a new and fascinating model of how the mind works, and uses illustrations and charts to help the reader work through each stage.



This manual is an essential read for the beginner to the seasoned veteran of meditation.





Search

SORT BY

Top rated

FILTER BY

All reviewersAll starsAll formatsText, image, video

5.0 out of 5 starsGuidebook for Changing Your Life

ByHarvesteron June 19, 2016

Format: Kindle Edition|Verified Purchase

In trying to write a proper review for this book, it's first worth noting that this stands as a masterpiece of knowledge that has quite literally changed my life. It's not often that I'll read a book twice, but for this one I'm certain I'll be re-reading it for years to come. To be fair, I've not read many other books in this area, but I'm sure that I've somehow stumbled onto one of the best in its class.



I should start out by saying that I'm not a Buddhist, and quite frankly have developed a degree of skepticism and disappointment for all religions of the world. In saying that I'm not an atheist by any means, but really a seeker of the ultimate universal truth. Culadasa (and team) are able to guide the reader through a very thoughtful process of how to understand your own consciousness, where one's actual understanding of truth are compiled. Indeed, I've taken college level classes on neuroscience, and heard more than once that we know where all the components of your mind are located (emotions, memory, anger, happiness, etc.), but consciousness has no actual locus. This book takes you on a journey in the attempt to understand what that means, and ultimately provides one of the best articulations I have ever read on describing the conscious mind.



How can doing something so simple, like paying attention to one thing (i.e. breathing) for an extended period of time be so profound? How can this process cause so much turmoil as your entire belief system is turned upside down? And finally, how does this result in answering some of the deepest questions that have swirled around in your mind from as long as you can remember? As I began a practice of meditation using techniques outlined in the book, there were questions and thoughts that were followed by more questions and thoughts. I was (and still am) amazed at how thoroughly everything is addressed in complete detail. In fact, I went through something quite traumatic that's referred to as "The Dark Night of the Soul". It's ultimately caused when you come to the realization your whole concept of self is something fabricated in the mind. I went through a crisis of sorts, as the ego tried to hang onto its tenuous moorings in consensus reality. In letting go of the ego so to speak, and beginning the process of unifying the many components of the mind into one cohesive process has brought about an inner peace with clarity and focus like I've never had before. I'm convinced that this is just the beginning of something more profound as the journey unfolds.



I originally had just the Kindle version, but now went out and bought a hard copy for my coffee table in the meditation area. It's a book that gets opened just about every day. As mentioned, I'm now almost finished with the second cover-to-cover reading. I've actually created a document to outline the key points of the book. There are a number of lists, levels, and other important points that really need to be committed to memory. The book is organized using side notes, diagrams, and key points in offsets. It's suffice to say that the important points, are indeed *important* to remember.



If your looking for a treatise on mindfulness, or life changing guidebook to help you with the quest for truth, then I wholeheartedly recommend the knowledge in this book as the means to get you there.

2 comments| 107 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsIn a league of its own

ByK Knoxon September 11, 2015

Format: Paperback|Verified Purchase

The subtitle here, “A Complete Meditation Guide,” understates this astonishing book's comprehensiveness and profundity by half. This is a 475 page long magnum opus that's exponentially more useful than all of the previous guides to meditation I've read (and I've read plenty, having been involved in Buddhist study and practice since the early 1970's).



For a newcomer to meditation this book is the best possible introduction as well as a lifelong companion. For someone with an established practice, be it in the Theravadin, Tibetan or Zen tradition (or for that matter secular mindfulness or non-Buddhist contemplative approaches) The MInd Illuminated is a treasure trove of encouragement and clarification of key points in practice that no other book I'm aware of addresses. It comes as close as any book possibly can to having not just a teacher but a living meditation master with personal experience of every step of the path into your home.



While grounded in decades of obviously very serious and intensive practice and study of Buddhism this book uses the absolute minimum number of foreign words and defines them precisely. Someone with a purely secular interest in meditation will have no problem with the content, while devoted adherents of particular contemplative paths will feel supported. The tone throughout is kind, warm, clear and encouraging.



Anyone who's practiced meditation for years knows that motivation for practice often waxes and wanes, and that it's all-too-easy to run into dead ends that seem impossible to overcome, to stagnate in one's practice, or to stop sitting altogether out of frustration or fear. Culadasa anticipates all of this, starting with a chapter titled “Establishing a Practice” that in and of itself is worth the price of the book, and following up with dozens of pith instructions that seem to address even the subtlest mistakes in practice, obviously born from a combination of deep realization and extensive experience coaching meditators ranging from beginner to very advanced.



My only regret about this book is that it wasn't published decades ago!

Comment| 172 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsThis book is the best instruction book on buddhistic meditation I have read since ...

Byreviewer1on December 29, 2015

Format: Paperback|Verified Purchase

This book is the best instruction book on buddhistic meditation I have read since Daniel Ingram's `mastering the core teachings of the buddha'. However, Culadasa's book lacks the controversy surrounding the latter one. His book does not really deal with Buddhist orthodoxy but is a very precise and motivating manual how to meditate and how to achieve the higher meditation states that have been described over and over again in the oldest Buddhist literature (Pali canon and Visuddhimagga). These achievements are well-known within the Theravada literature and modern practice and can be achieved by proper practice (never withstanding the popular new wave/zen light misconception that the practice doesn't really matter and that there is nothing to be accomplished). I have never read a better and to-the-point manual how to start a dedicated meditation practice and how to actually do any relevant meditation exercise in a way that it leads to results. The book is extremely good in combining classical meditation instructions with the right mind set for motivation and positive reinforcement of the practice. If one has a decent background in some meditation discipline and some knowledge of the maps of what might happen with dedicated practice, then this book is in my opinion the only book one needs, together with actually doing the practice, to really get started and get a long way to achieve certain states and insights that can result from meditation. This is the one and only Dharma book you want to take to an inhabited island for a long time.

Comment| 77 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

4.0 out of 5 starsFantastic, but not as advertised

ByEzra Maureron March 27, 2017

Format: Paperback|Verified Purchase

I hesitate to post a review, there are so many already here, but there are a few thoughts I would like to share in hopes they will be useful to potential readers of this book. I hope these observations will be of use to some of you.



I happen to be a licensed clinical psychologist who has also practiced meditation for the past couple of decades. I decided to put together a seminar on meditation for people in my area, but I wanted to take a neuropsychological perspective in organizing the materials. Like many people, I am hoping that the perspective emerging from empirical investigation into the brain will offer a trans-theoretical and trans-disciplinary

approach to healing. This book appeared to be in line with my intentions, so I bought it expecting to have an enjoyable entrance into someone else's perspective that would also alert me to studies I might not have already found. While I certainly got a taste of Dr. Yates' perspective, and it is a perspective I very much appreciate, I found very little in the way of neuroscience. In fact, there were only a handful of studies referenced, and the

majority of those were out of date. Oddly, this fact does not detract from my overall positive impression of the work, but I do feel compelled to make a point of it given the way the book was marketed. Both the subtitle and the "reviews" included by the publishers emphasized a scientific angle, and this is simply incorrect. I want to warn potential readers of this because, in what I can only assume was a hasty zeal on the part of the publishers to capitalize on the neuroscience zeitgeist, they have succeeded in potentially undermining the true value of the book.



In my honest opinion, this book is best described as a modern synthesis and partial reinterpretation of the Abhidamma Sutta. As a modern synthesis it certainly owes much of its language and perspective to cognitive science, but not in an academically rigorous sense (the Mind and Life Dialogues between the Dalai Lama and various leading scientists might be a better place to start). It is more an attempt to bring a Theravadan perspective on the wisdom of two thousand plus years of phenomenological investigation by advanced meditators to the English speaking public, and in this it is an astounding success. Culadasa shows himself to be a first rate teacher of meditation who has obviously guided a great number of people through the years. His compassion and experience come through from the initial chapter on just establishing a regular time to practice, to the advanced stages where the reader will find a very fine grained description of common experiences and how to best focus one's energies. As a meditation guide, it is certainly the most thorough and clear book I have ever encountered, and I would venture to say buying this book is a no-brainer for anyone seriously interested in taking up a practice. Certainly for those already inclined towards a buddhist perspective this book comes as close to being complete as any non-living guide could be expected to.



For those not commited to a buddhist world view, and even for those that are but are also willing to encounter some contradictory ideas, I would suggest that interested readers consider, "The Path of Liberation," by Adyashanti, the old gem, "Focusing," by Eugene Gendlin, and Judith Blackstone's several books. The first book will offer an interesting counterpoint to The Mind Illuminated that will help counteract the subtle but pervasive goal-orientedness that often leaks in to the types of practices Culadasa emphasizes. The second book offers an exceptionally useful method for working with feelings and emotions that come up in the middle and later stages of meditation. The third author provides a unique perspective that includes the body, feelings, and relationships in meditation. To Culadasa's credit, he clearly names many problems and offers his own suggestions, such as loving-kindness meditation as an adjunctive practice, but I have found over the years that many people are not best served by attempting to counteract negative emotions with positive ones. Rather than finding equanimity, they seem to more often feel guilty about their genuine experience and bypass the possibility of important psychological insight. They languish in the middle stages of their practice, and most eventually give up, discouraged and feeling like failures. I have found the authors above to be better medicine for people finding themselves awash in emotion and/or struggling with relationships. Of course, the best way to handle these kinds of technical questions that arise in the course of a consistent practice is on a case by case basis. No book or combination of books can replace a trusting relationship with a teacher and a community of supportive others, and again to Culadasa's credit, he is clear that there will be instances where people should consider therapeutic support, but I would suggest that later editions delve into the important issue of emotions and relationships more deeply. The basic stance that negative emotions are simple impedimets that should fade over time or be counteracted seems remarkably simplistic in the 21st century. Also, we are inherently relational creatures in many ways, so the experience of feeling angelic on the cushions only to immediately re-engage in old patterns with family and friends is legion. As Ram Dass quppied many years ago, "if you think you are enlightened, go spend a week with your family." I do not doubt that Culadasa has much useful advice on these questions, but there did not seem to be room in this volume.



Finally, there is the question of post-awakening experience and practice. In this area Culadasa is completely silent. Again, not a crticism as his intent is clearly to support the establishment of a solid practice, but his input would be fascinating. Theravadan Buddhism in particular has a clearly articulated map of awakening, so discussion among advanced practitioners and teachers would be tremendously useful in continuing the project of forging a modern and clear language regarding how and why to practice meditation. I hope we will hear more from him in the future on these questions.



I hope these reflections will be of some value to people looking for guidance on meditation, especially those without teachers who are encountering obstacles. I pray you find your way.

Comment| 73 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsPurposeful practice applied to meditation

ByJack Islandon October 8, 2016

Format: Paperback|Verified Purchase

I hastened to review this book after seeing the overwhelmingly positive reviews. Many books on spirituality enjoy something of an equivalent to grade inflation. Gratitude and reciprocity go together, sometimes to the detriment of a more objective, and useful review.



I read this book first on Kindle for the reduced price. Inspired to almost immediately purchase the print edition. The lush diagrams, artful cover, and tangible reading experience made for fuller immersion and better retention.



After six months and at least three readings later, I stick to my five star review.



Around the same time of my initial exposure to this book, I stumbled across Peak by Anders Erickson. He qualifies the oft cited 10,000 hour rule with the concept of purposeful practice. To master something we need both time and awareness.



I started meditating off and on almost ten years ago; merely sitting with a vague understanding of meditation meant many plateaus and confusion. I tended more toward what Culadasa calls insight practice, at the expense of calm abiding (in the introduction of this book, he explains how the two approaches interdependently produce fertile conditions for awakening).



I knew that I needed more concentration in my practice. I decided to make meditation my keystone habit. For the first time (with the watchful eye of this book) I maintained a daily habit now six months strong.



Make no mistake, this book demands effort. The first stage in the ten stages of mastery means making meditation a daily habit, and Culadasa advises longer sits (working up to at least 40 minutes). Without a strong commitment, not sure how much long term value one can expect. But that was exactly what I wanted - realistic expectations and vicarious coaching to make marginal gains and real progress.



Critically engaging with the techniques, setting goals both inside and outside sessions, and practicing the walking meditations, no doubt accelerated my progress. I started around stage two or three and now primarily practice at stage six. I noticed discernible differences in the stages. For example, overcoming subtle dullness considerably turned up the voltage on my sessions.



I would watch out for not identifying too much with progress. I'm also not sure how much you can expect to overcome a stage once and for all. Adding judgement to a temporary regression can only make it worse. I struggled to internalize positive reinforcement for whenever I caught my mind wandering because I thought it reflected poorly on my practice. I would recommended over blowing the positives in each session, with faith that time and awareness will inexorably improve your baseline of concentration.



Excited to see how my practice turns out over the coming months and years, but the fact that I practiced the teachings in this book now for hundreds of hours speaks volumes to my personal investment. I never had a book weave itself so thoroughly into my daily life.

Comment| 32 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsMy Practice has Flourished Since Reading this Book.

ByYvonneon April 13, 2016

Format: Paperback|Verified Purchase

I was very hesitant to buy yet another book on meditation. I passed on this book several times over the past months. Now, not only have I read the book, which runs about 460 pages (not counting the table of contents and index) in its entirety, but I am about 100 pages into a second reading.



The book is brilliant. It is extremely well-written in lucid prose. The text is clear, concise, packed full of practical instruction. This book has managed to illuminate the areas of meditation practice that have always seemed unclear and difficult to me before. The authors do not rely on the use of words taken from Pali, Sanskrit, or Tibetan, in order to describe concepts that other authors have found difficult to explain in English. They have found a way to fully explain the practice of mediation using words already in the English language.



Meditation Instructions are presented in easy stages, in such a way that even very advanced meditative states do not seem to be beyond reach. Each set of instructions builds on previous understanding and gently leads the reader through the stages of meditation. In addition, the instructions are provided within a framework of how the brain functions. This is especially helpful in providing a working concept of the interactions between the conscious, and the unconscious minds and how both can be influenced though intention. No longer will you perceive sheer will power to be the way to train the mind. The authors show how to use these models of brain function, to facilitate stable attention using positive tools; like intention, present moment awareness, relaxation and enjoyment.



Reading this book I have so much appreciation for how much knowledge the authors must have, from their teachers, from their own extensive meditative experiences and from what they have learned while teaching many, many other individuals. Every time I pick up this book, it seems impossible that so much knowledge could be contained in such a compact object. I did not think such a book could ever be written.



This book is exquisite and is sure to become a classic on the subject. In addition It is extremely well priced, and I want to thank the authors for making it so affordable.

Comment| 33 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsSit, stay... enjoy! --> Thank You!

BySamyamaon December 12, 2016

Format: Paperback|Verified Purchase

This has answered questions that I've been exploring for 27 years including how best to use my meditation time. Culadasa's guide is INDISPENSABLE in demystifying the signal-to-noise ratio of seated practice. He discloses how to effectively deal with the gap that seemed to exist between the real & ideal with steps that are simple, easy-to-follow & effective. I'm filled with enthusiasm & enormous gratitude to be able to practice with such clarity. This guide has made an immediate & tangible impact on the *quality*, consistency & quantity of my practice. The best part is that I'm able to sit on the cushion & stay for extended periods now. I refer back to this book again & again, as other reviewers have said --> read, reread & rereread. It's a pleasure to do so. I'm not sure that what I was doing before was entirely meditation--even though I did my best. Now, rather than by sheer force of will, I'm able to use the momentum ignited by Culadasa to fuel my attention & awareness. I daresay I'm enjoying meditation--though I'm sure there will be a range of experiences ahead along with a sine-wave type learning curve. I keep updating this review because the process is evoking so transformation. I feel blessed every day. Since discovering this book I've cleared away many books from the bookshelf. Meditation is one of my favorite subjects & I've been a long-time student. This volume clarifies many things (known & unknown--as others have noted as well). The bottom line is that I was able to clear/donate so many books because now I'm able to *practice* rather than second-guess myself, wondering if I'm doing it right. Sidenote: I also recommend "The Attention Revolution" by Wallace as an excellent counterpart (I especially find the audio version helpful). Both books shine light on perhaps the *most* important question: What allows real transformation to take place? (I also like what Einstein posed as the most important question we can ask ourselves: "Is the Universe a friendly place or not?") This book is such a gift. I trust this path & I'm grateful it found me. I'm overcome with relief, appreciation & delight. Thank You Culadasa & best wishes to all on your chosen path!

Comment| 11 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsThe very best book on meditation I've read

Byerperreaulton March 24, 2016

Format: Kindle Edition|Verified Purchase

The very best book on meditation I've read, and I have read many. My primary interests have been in Zen, Theravada / Thai Forest Buddhist teachings, and S.N. Goenka's meditation teachings. Most secular Buddhist types will probably have a similar background so this review is for you.



I don't know Culadasa (John Yates) or any of his students or much of anything about his school. This book was my first exposure to his teaching. I came away from reading it with what feels like a crystal clear understanding in broad terms of the path of meditative practice. The ideas laid out in this book unified and stitched together various teachings I've bumped into across different traditions, and made sense of all of them by introducing clear standardized terminology and doing away with all abstraction and poetic pretense.



It was immediately obvious to me reading The Mind Illuminated exactly where in Culadasa's 10 step demarcation of the path I am currently. It was also immediately obvious how my years of spiritual practice so far lined up against the 10 stage model; it is not a simple forward progression. Demoralizing backslides and sudden bursts of insight are given perfectly sound rational explanation in this book, and in that way many of my greatest hangups about meditative practice have been put to rest.



The second major point here is that even the stages I haven't reached were absolutely clear on first reading. Without any grasping attempts at fully describing heightened meditative experiences, just enough reference is given so that even someone at an earlier stage will understand what later stages might be like, and exactly what changes/effort are required to reach them. The entire spectrum from bored / tentative beginner to full Awakening are represented such that any layman will understand what is meant, and in that way this book is extremely motivating.



A third striking feature of this book is that it hardly comes across as a book about Buddhism. If you read only the main body of text and ignore all the endnotes, you will see only two or three significant mentions of Buddhism or Buddhist-specific terminology (except for the quite vanilla Anapanasati Sutta, which is briefly referenced at the end of most chapters). It is presented as a basically secular layman's meditation manual. However if you are familiar with Buddhism and the various traditions of meditative practice, those concepts will jump right out at you and if you flip to the endnotes you'll be treated to lovely, lengthy selections and citations straight from the Pali Canon and other widely studied Buddhist sources.



The appendices are very helpful and flesh out all the most important peripheral practices that are NOT simple concentration on the breath: walking meditation, metta, jhanas, progress of insight, etc.



I have to add my main criticism here as well, to be fair. I feel Culadasa shied away from discussing ethical conduct at any great length, perhaps for good pedagogical reasons and not wanting to put anyone off. But at least in my experience, meditation never bore any fruit whatsoever until it connected with my daily life in the form of practicing sila. I would have loved to see an appendix discussing the traditional five precepts, or any other permutation of tangible moral guidelines. Instead the extend of ethical discussion is something like, "don't hurt people because it will destroy your peace of mind," which is fine, but too general to be useful. In terms of the eightfold path and three trainings model (sila, samadhi, panna), this book only really addresses samadhi. It is clear why sila is important to support samadhi, and why samadhi is important to cultivate panna, but actual teachings on sila or panna are extremely thin.



To summarize my glowing review, reading this book clarified and energized my practice unlike any other book I've read, and each chapter felt like another years-old mystery was laid to rest. I truly believe this is the best "owner's manual" for the meditator's mind that has ever been put together. Practicing meditation without having read this is like teaching yourself microbiology with just a microscope and no textbook or teacher... It'll take years to even figure out the basics for yourself, which could have been mastered in a few weeks with proper explanation.

Comment| 13 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsTEN STARS!

ByTable_for_5on March 30, 2017

Format: Paperback|Verified Purchase

The Mind Illuminated: A Complete Meditation Guide is just that -- a COMPLETE meditation guide. This book is a game changer for meditators, whether just beginning or those with years of experience and all points between. The book demystifies meditation and reveals it for what it is: training of the mind so the it can become unified and able to penetrate the nature of reality in the now. Dr. Yates comprehensively details the ten stages of meditation, clearly delineating the goals for each stage, the obstacles one will encounter in each stage, the mitigating practices to navigate through the obstacles, the states the mind can expect to experience with each stage, and the markers that one has successfully mastered each particular stage.



The book warns against training the mind to chase after the various phenomena that arise during meditation, which, while being pleasing, intriguing and seemingly profound, the phenomena are distractions that take one's attention off the meditation object and will thwart one's progress. Dr. Yates also writes about dullness of mind, during which seemingly profound experiences can occur, but, again, only thwart one's progress. He does not only list the various obstacles and distracting mind states that arise, but he teaches the reader to identify them and gives remediating practices to help the meditator move beyond them.



The book also includes a number of appendices with supplemental meditation practices, as well as a helpful glossary. I cannot recommend this book enough to those who are interested in meditation or who already meditate. The instruction and wisdom shared in the book will truly help your meditation practice to progress in ways that are verifiable and clear to the meditator.

Comment| 8 people found this helpful. Was this review helpful to you?

Yes

NoReport abuse

5.0 out of 5 starsI cannot express how much this book has improved my practice!!

ByFe S.on April 3, 2016

Format: Paperback|Verified Purchase

Oh my goodness. I cannot express how much this book has improved my practice. I've been meditating on and off for years, but never really had clear enough guidance to help me feel totally comfortable and confident in what I was doing. Because of that I would fall away from practicing and go back a while later with a totally different approach. I felt like there was something wrong with me that I couldn't "get it." This book changed all that. Now I feel like I KNOW what I am doing and because of that I don't shy away from sitting every day. I actually look forward to practicing daily because I now experience joy during meditation instead of frustration. And because I'm sitting daily I can see the fruits of my practice. Today's session was a very different experience from 6 weeks ago. I'm in stage 3 of the 10 stages, am confident with where I'm at, and so look forward to where my practice will go from here. Culadasa so thoroughly explains what to expect & what one might experience so that when I do experience it I know I'm on the right track and because he's talked about it, I know how to get through it. I absolutely LOVE LOVE LOVE this book and will recommend it (and even gift it) to anyone I know who is interested in establishing a serious meditation practice.

What Does It Mean to Die? | The New Yorker

What Does It Mean to Die? | The New Yorker
Annals of Medicine
February 5, 2018 Issue
What Does It Mean to Die?
When Jahi McMath was declared brain-dead by the hospital, her family disagreed. Her case challenges the very nature of existence.



By Rachel Aviv









For the past four years, Jahi McMath has breathed with the help of a ventilator. A neurologist described her as “an extremely disabled but very much alive teenage girl.”Photograph by Doug DuBois for The New Yorker



Audio: Listen to this story. To hear more feature stories, download the Audm app for your iPhone.


Before having her tonsils removed, Jahi McMath, a thirteen-year-old African-American girl from Oakland, California, asked her doctor, Frederick Rosen, about his credentials. “How many times have you done this surgery?” Hundreds of times, Rosen said. “Did you get enough sleep last night?” He’d slept fine, he responded. Jahi’s mother, Nailah Winkfield, encouraged Jahi to keep asking questions. “It’s your body,” she said. “Feel free to ask that man whatever you want.”

Jahi had begged not to get the surgery, but her mother promised that it would give her a better life. Jahi had sleep apnea, which left her increasingly fatigued and unable to focus at school. She snored so loudly that she was too embarrassed to go to slumber parties. Nailah had brought up four children on her own, and Jahi, her second, was her most cautious. When she saw news on television about wars in other countries, she would quietly ask, “Is it going to come here?” Her classmates made fun of her for being “chunky,” and she absorbed the insults without protest. A few times, Nailah went to the school and asked the teachers to control the other students.

The operation, at Oakland’s Children’s Hospital, took four hours. When Jahi awoke, at around 7 p.m. on December 9, 2013, the nurses gave her a grape Popsicle to soothe her throat. About an hour later, Jahi began spitting up blood. The nurses told her not to worry and gave her a plastic basin to catch it in. A nurse wrote in her medical records that she encouraged Jahi to “relax and not cough if possible.” By nine that night, the bandages packing Jahi’s nose had become bloody, too. Nailah’s husband, Marvin, a truck driver, repeatedly demanded that a doctor help them. A nurse told him that only one family member was allowed in the room at a time. He agreed to leave.

Nailah, who worked in contractor sales at Home Depot, said, “No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.” Crying, she called her mother, Sandra Chatman, who had been a nurse for thirty years and who worked in a surgery clinic at Kaiser Permanente, in Oakland.

Sandra, who is warm and calm and often wears a flower tucked into her hair, arrived at the hospital at ten o’clock. When she saw that Jahi had already filled a two-hundred-millilitre basin with blood, she told a nurse, “I don’t find this to be normal. Do you find this to be normal?” A nurse wrote in her notes that the physicians on duty were “notified several times over course of shift” that Jahi was bleeding. Another nurse wrote that the doctors were “aware of this post op bleeding” but said “there would be no immediate intervention from ENT or Surgery.” Rosen had left the hospital for the day. In his medical records, he had written that Jahi’s right carotid artery appeared abnormally close to the pharynx, a congenital condition that can potentially raise the risk of hemorrhaging. But the nurses responsible for her recovery seemed unaware of the condition and didn’t mention it in their notes. (Rosen’s attorney said that Rosen could not speak about Jahi; the hospital couldn’t comment, either, because of medical-privacy laws, but a lawyer said that the hospital is satisfied that Jahi’s nursing care was appropriate.)

There were twenty-three beds in the intensive-care unit, spread over three rooms. A doctor was standing on the other side of Jahi’s room, and Sandra asked him, “Why aren’t you guys seeing about my granddaughter?” The doctor instructed the nurse on duty not to change Jahi’s hospital gown, so that he could assess how much blood she was losing, and to spray Afrin in her nose. Sandra, who teaches a workshop at Kaiser Permanente on the “four-habits model,” a method for improving empathy with patients, told me she was surprised that the doctor never introduced himself. “He was all frowned up with his arms crossed,” she said. “It was like he thought we were dirt.”

At twelve-thirty in the morning, Sandra saw on Jahi’s monitor that her oxygen-saturation levels had fallen to seventy-nine per cent. She yelled to the medical staff, and several nurses and doctors ran toward Jahi and began working to intubate her. Sandra said that she heard one doctor say, “Oh, shit, her heart stopped.” It took two and a half hours to restore Jahi’s heartbeat and to stabilize her breathing. Sandra said that when she saw Rosen early the next morning he looked as if he’d been crying.


Two days later, Jahi was declared brain-dead. With the help of a ventilator, she was breathing, but her pupils did not react to light, she did not have a gag reflex, and her eyes remained still when ice water was dripped in each ear. She was briefly disconnected from the ventilator, as a test, but her lungs filled with carbon dioxide. On an EEG test, no brain-wave activity could be seen.

Like all states, California follows a version of the 1981 Uniform Determination of Death Act, which says that someone who has sustained the “irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” California law requires that hospitals permit “a reasonably brief period of accommodation” before disconnecting a ventilator—long enough to allow family to gather, but not so long that hospitals neglect the “needs of other patients and prospective patients in urgent need of care.”





Jahi at home with her family in January. “I knew that Jahi was in there,” her mother, Nailah, said.Photograph by Doug DuBois for The New Yorker

At a meeting with Rosen and other medical staff, the family asked for an apology. According to a social worker’s record of the meeting, Rosen “expressed sympathy.” The family wasn’t satisfied. “Step outside your job,” Marvin told him. “This was totally wrong!” Sandra said that Jahi had not “got the treatment she deserved.”

Over the next few days, a social worker repeatedly urged Jahi’s family to make a plan for taking her off the ventilator. She also recommended that they consider donating her organs. “We were, like, ‘Nah,’ ” Marvin said. “ ‘First, tell us what happened to her.’ ” The family asked for Jahi’s medical records, but they weren’t allowed to see them while she was still in the hospital. Nailah didn’t understand how Jahi could be dead when her skin was still warm and soft and she occasionally moved her arms, ankles, and hips. The doctors said that the movement was only a spinal reflex, described in the medical literature as “a Lazarus sign.”

An African-American critical-care doctor named Sharon Williams asked the hospital’s administration to give the family a little more time to grieve, expressing concern that taking Jahi off the ventilator right away “was not in the best interest of the family.” But, after a week, when their position still hadn’t changed, Williams asked to have a conversation with Sandra, “woman to woman.” Sandra said Williams told her that, if she waited too long to take Jahi off the ventilator, she wouldn’t look good for the funeral, adding, “You know how we are.” (Williams disagrees with Sandra’s description of the conversation.)

“Who’s ‘we’?” Sandra remembers thinking. “We African-Americans? I felt so belittled. Yes, a lot of black children die in Oakland and people do have funerals for their children—but that don’t mean all of us are like that. Do you think we’re supposed to be used to our children dying, that this is just what black people normally go through?” She said, “At that point, I just lost all my trust.”


Nailah’s younger brother, Omari Sealey, began sleeping in a chair next to Jahi’s hospital bed, to make sure no one could “kill her off.” He said, “I just felt her life wasn’t worth that much in their eyes. It was like they were trying to shoo us away.” A former baseball star at San Diego State University, he had a large following on social media, and on Instagram and Facebook he announced that the hospital was rushing them to unplug Jahi’s ventilator. “They are trying to feed us legal bull shit,” he wrote. “It’s not over until God say so.” In the comments section, one friend wrote, “This is universal chain of DISRESPECT!!!! FCK THIS HEALTHCARE SYSTEM!!!” Another wrote, “They either wana see us dead or in jail they don’t wana see us alive.”

A week after the surgery, Sealey called a personal-injury lawyer, Christopher Dolan, and told him, “They’re going to kill my niece.” Dolan agreed to take on the case pro bono, though he had no experience with legal issues involving the end of life. A self-described “cafeteria Catholic,” he acted on a vague feeling that a child with a beating heart was not entirely dead. He wrote a cease-and-desist order: if doctors unplugged Jahi’s ventilator, he said, they would violate her and her family’s civil rights. Sealey taped the note to Jahi’s bed and oxygen monitor.

In a petition to the Alameda County Superior Court, Dolan requested that a physician unaffiliated with the hospital examine Jahi. He wrote that the hospital had a conflict of interest, because if its doctors were found guilty of malpractice they could “drastically reduce their liability by terminating Jahi’s life.” In cases of wrongful death, California places a cap of two hundred and fifty thousand dollars on damages for pain and suffering. But there is no limit on the amount that can be recovered when a patient is still alive. In a separate motion, Dolan argued that the hospital was infringing on Nailah’s right to express her religion. He said that, as a Christian, she believed that her daughter’s soul inhabited her body as long as her heart beat.

On December 19th, ten days after the surgery, David Durand, the hospital’s senior vice-president and chief medical officer, held a meeting with the family. They asked Durand to allow Jahi to remain on the ventilator until Christmas, suggesting that the swelling in her brain might subside. Durand said no. They also asked that she be given a feeding tube. Durand dismissed this request, too. The idea that the procedure would help her recover was an “absurd notion,” he later wrote, and would only add to the “illusion that she is not dead.”

When they persisted, Durand asked, “What is it that you don’t understand?” According to Jahi’s mother, stepfather, grandmother, brother, and Dolan, who took notes, Durand pounded his fist on the table, saying, “She’s dead, dead, dead.” (Durand denies pounding his fist or repeating the word.)


Three days before Christmas, a group of church leaders in Oakland gathered in front of the hospital and asked the district attorney to investigate what had happened to Jahi. “Is not Jahi worthy of the highest amount of medical treatment?” Brian K. Woodson, Sr., the pastor of Bay Area Christian Connection, said at a press conference.

The next day, Evelio Grillo, a judge for the Alameda County Superior Court, appointed an independent expert, Paul Fisher, the chief of child neurology at Stanford University’s children’s hospital, to examine Jahi. During the hearing, two hundred people marched in front of the hospital, holding signs that said, “Justice for Jahi!” and “Doctors Can Be Wrong!” About a quarter of the protesters were Nailah’s friends and neighbors. She lived a short walk from her mother, who lived a few blocks from her own mother, who had moved to East Oakland from Opelousas, Louisiana, during the height of the civil-rights movement.

Fisher repeated the standard brain-death exam and confirmed the hospital’s conclusion. He also performed a radionuclide cerebral-blood-flow study. “You see a complete white void, a whiteout in the part of the head where the brain is,” he told Judge Grillo the next day. “Normally it would be dark black.” Grillo ruled that the hospital could unplug Jahi’s ventilator in six days.

The family set up a GoFundMe page to pay for Jahi to be airlifted to another hospital (“We acknowledge that the odds are stacked against us,” Nailah wrote), and strangers who learned about the case in the media contributed more than fifty thousand dollars. The Terri Schiavo Life & Hope Network—an organization founded by the parents and siblings of Terri Schiavo, who was in a persistent vegetative state for fifteen years and became a cause célèbre for the right-to-life movement—offered to use its contacts to find a facility. Nailah had never had an opinion on the right to life. On abortion, she was pro-choice. But, she said, “I just wanted to get her out of there.” Sandra said she sometimes wonders, “If the hospital had been more compassionate, would we have fought so much?”

Nailah asked Children’s Hospital to perform a tracheotomy, a surgery that enables ventilator air to be pumped directly into the windpipe—a safer way for Jahi to breathe when transported to a new hospital. The hospital’s medical-ethics committee unanimously concluded that the intervention was inappropriate. “No conceivable goal of medicine—preserving life, curing disease, restoring function, alleviating suffering—can be achieved by continuing to ventilate and artificially support a deceased patient,” they wrote. They said that the doctors and nurses caring for Jahi were experiencing “tremendous moral distress,” and that accommodating the family’s requests would raise “significant concerns of justice and fairness.”

Just before the court’s protective order was set to expire, Judge Grillo extended it by eight days. Not long afterward, Dolan and the lawyers for the hospital reached an agreement: the hospital would release Jahi to the Alameda County coroner, who would declare her dead. Then the family would become “wholly and exclusively responsible” for her.

On January 3, 2014, the coroner issued Jahi’s death certificate. For cause of death, he wrote, “Pending investigation.”


Two days later, two nurses from an air-evacuation service slipped into Jahi’s hospital room. A doctor from Children’s Hospital detached her from the ventilator, and the two nurses connected her to a portable one and put her on a gurney. They took her to an unmarked ambulance at the hospital’s back entrance. The San Francisco 49ers were playing the Green Bay Packers that day, and Dolan hoped the game would distract a crowd of journalists who had gathered in front. Dolan didn’t tell anyone where Jahi was going—not even her family—because he was afraid that the hospital would find out and somehow thwart the plan.





Nailah and Marvin’s wedding, with Jordyn and Jahi.Photograph by Ke’er Orr

Nailah was the only family member permitted on the plane, which was paid for with money received from GoFundMe. Nailah was terrified of the noise her daughter’s portable respirator was making, which seemed as loud as the jet’s engine. It wasn’t until they landed that she learned they were in New Jersey, one of only two states—New York is the other—where families can reject the concept of brain death if it violates their religious beliefs. The laws in both states were written to accommodate Orthodox Jews, some of whom believe, citing the Talmud, that the presence of breath signifies life.

Jahi was admitted to St. Peter’s University Hospital, in New Brunswick, New Jersey, which is run by the Roman Catholic Diocese of Metuchen. Nailah said, “I had no plan, no place to live, no nothing.” She had packed one suitcase. “When it comes to my kid, I’m an animal,” she told me. “It wasn’t until later on that I was, like, What did I do?”


Children’s Hospital hired Sam Singer, an expert in crisis communications and reputation management, to deal with the media that were covering the case. “The general perception inside the hospital was that they were under siege,” Singer told me. “They were not used to engaging in a gutter fight.” Two days after Jahi’s departure, Singer (whom the San Francisco Chronicle calls the city’s “top gun for hire”) told a local paper, “I’ve never seen such reckless disregard for the truth.” At a press conference in front of the hospital, he said that Dolan had “created a hoax. A very sad hoax. That Jahi McMath is in some way alive. She’s not. She’s deceased by every law in the state of California. And by every spiritual belief system imaginable.”

Bioethicists also disparaged the family’s decision. In an op-ed in Newsday, Arthur Caplan, the founding director of N.Y.U.’s Division of Medical Ethics and perhaps the best-known bioethicist in the country, wrote, “Keeping her on a ventilator amounts to desecration of a body.” He told CNN, “There isn’t any likelihood that she’s gonna survive very long.” In an interview with USA Today, he said, “You can’t really feed a corpse” and “She is going to start to decompose.” Laurence McCullough, a professor of medical ethics at Cornell, criticized any hospital that would admit Jahi. “What could they be thinking?” he said to USA Today. “There is a word for this: crazy.”

Robert Truog, the director of the Center for Bioethics at Harvard Medical School, said that he was troubled by the tone of the media coverage. “I think that the bioethics community felt this need to support the traditional understanding of brain death, to the point that they were really treating the family with disdain, and I felt terrible about that,” he told me. Truog thought that the social context of the family’s decision had been ignored. African-Americans are twice as likely as whites to ask that their lives be prolonged as much as possible, even in cases of irreversible coma—a preference that likely stems from fears of neglect. A large body of research has shown that black patients are less likely to get appropriate medications and surgeries than white ones are, regardless of their insurance or education level, and more likely to receive undesirable medical interventions, like amputations. Truog said, “When a doctor is saying your loved one is dead, and your loved one doesn’t look dead, I understand that it might feel that, once again, you are not getting the right care because of the color of your skin.”


Until the nineteen-sixties, cardio-respiratory failure was the only way to die. The notion that death could be diagnosed in the brain didn’t emerge until after the advent of the modern ventilator, allowing what was known at the time as “oxygen treatment”: as long as blood carrying oxygen reached the heart, it could continue to beat. In 1967, Henry Beecher, a renowned bioethicist at Harvard Medical School, wrote to a colleague, “It would be most desirable for a group at Harvard University to come to some subtle conclusion as to a new definition of death.” Permanently comatose patients, maintained by mechanical ventilators, were “increasing in numbers over the land and there are a number of problems which should be faced up to.”

Beecher created a committee comprising men who already knew one another: ten doctors, one lawyer, one historian, and one theologian. In less than six months, they completed a report, which they published in the Journal of the American Medical Association. The only citation in the article was from a speech by the Pope. They proposed that the irreversible destruction of the brain should be defined as death, giving two reasons: to relieve the burden on families and hospitals, which were providing futile care to patients who would never recover, and to address the fact that “obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation,” a field that had developed rapidly; in the previous five years, doctors had performed the world’s first transplant of a pancreas, a liver, a lung, and a heart. In an earlier draft, the second reason was stated more directly: “There is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.” (The sentence was revised after Harvard’s medical dean wrote that “the connotation of this statement is unfortunate.”)

In the next twelve years, twenty-seven states rewrote their definitions of death to conform to the Harvard committee’s conclusions. Thousands of lives were prolonged or saved every year because patients declared brain-dead—a form of death eventually adopted by the United Kingdom, Canada, Australia, and most of Europe—were now eligible to donate their organs. The philosopher Peter Singer described it as “a concept so desirable in its consequences that it is unthinkable to give up, and so shaky on its foundations that it can scarcely be supported.” The new death was “an ethical choice masquerading as a medical fact,” he wrote.

Legal ambiguities remained—people considered alive in one region of the country could be declared dead in another—and, in 1981, the President’s Commission for the Study of Ethical Problems proposed a uniform definition and theory of death. Its report, which was endorsed by the American Medical Association, stated that death is the moment when the body stops operating as an “integrated whole.” Even if life continues in individual organs and cells, the person is no longer alive, because the functioning organs are merely a collection of artificially maintained subsystems that will inevitably disintegrate. “The heart usually stops beating within two to ten days,” the report said.

The commission’s staff philosopher, Daniel Wikler, a professor at Harvard and the first staff ethicist for the World Health Organization, told me that he didn’t think the commission’s theory of death was supported by the scientific facts it cited. “I thought it was demonstrably untrue, but so what?” he said. “I didn’t see a downside at the time.” Wikler told the commission that it would be more logical to say that death occurred when the cerebrum—the center for consciousness, thoughts, and feelings, the properties essential to having a personal identity—was destroyed. His formulation would have rendered a much broader population of patients, including those who could breathe on their own, dead.

Despite Wikler’s reservations, he drafted the third chapter of the report, “Understanding the ‘Meaning’ of Death.” “I was put in a tight spot, and I fudged,” he told me. “I knew that there was an air of bad faith about it. I made it seem like there are a lot of profound unknowns and went in the direction of fuzziness, so that no one could say, ‘Hey, your philosopher says this is nonsense.’ That’s what I thought, but you’d never know from what I wrote.”


When Jahi arrived in New Jersey, she hadn’t been fed for more than three weeks, and her organs were failing. The chief of pediatric critical care at St. Peter’s wrote in her records that there was “no hope of brain recovery.” Nailah said, “I didn’t have a clue. I had really thought that I would get her a feeding tube and a tracheotomy, and she would just get up, and we would be good.” In the hospital cafeteria, she saw other families whispering about her.

A surgeon at St. Peter’s gave Jahi a tracheal tube and a feeding tube, which provided nutrition and vitamins. Nailah, who spent all her waking hours in the hospital, became friendly with some of the nurses, who told her that the surgeon who performed the tracheotomy had been ostracized by his colleagues. “They were, like, ‘You operated on that dead girl?’ ” she said. (The hospital did not return calls to speak about the case; in Jahi’s records, a physician wrote that the St. Peter’s administration had agreed to treat her “without medical personnel’s acceptance.”)

Nailah and Marvin slept at a house that the hospital owned, until, after three months, they were told they needed to move on, to make room for other families. They took a cab to a Motel 6. For the next three months, they stayed at whatever motel had the best weekly rate. Nailah’s youngest child, Jordyn, moved in with her aunt, and her son, Jose, moved in with his father, in Oakland. (Nailah’s oldest child was an adult, living on her own.) The human-resources department at Home Depot kept calling Nailah to ask when she’d return. “I don’t know,” she told them. They finally stopped calling. Nailah, who owned her house in Oakland, told me, “I felt like I was exiled out of my state.”

By March, Jahi’s condition had begun to stabilize. Her skin became more elastic, her limbs and face became less swollen, and her blood pressure steadied. In their progress notes, her doctors simply wrote, “Status quo.” No rehabilitation facilities would accept her as a patient, so she remained in the hospital’s intensive-care unit, her treatment covered by Medicaid. Nailah said that the cost of care was roughly a hundred and fifty thousand dollars a week. According to New Jersey’s 1991 statute on death, insurance providers can’t deny coverage because of “personal religious beliefs regarding the application of neurological criteria for declaring death.” Alan Weisbard, the executive director of the bioethics commission that drafted the law, told me, “I thought our position should be one of humility, rather than certainty.”

Weisbard had previously served as the assistant legal director for the President’s Commission on death and, like Wikler, he felt uneasy about the result. He said, “I think that the people who have done the deep and conceptual thinking about brain death are people with high I.Q.s, who tremendously value their cognitive abilities—people who believe that the ability to think, to plan, and to act in the world are what make for meaningful lives. But there is a different tradition that looks much more to the body.” The notion of brain death has been rejected by some Native Americans, Muslims, and evangelical Protestants, in addition to Orthodox Jews. The concept is also treated with skepticism in Japan, owing in part to distrust of medical authority. Japan’s first heart transplant, in 1968, became a national scandal—it was unclear that the donor was beyond recovery, or that the recipient (who died shortly after the transplant) needed a new heart—and, afterward, the country never adopted a comprehensive law equating brain death with the death of a human being. Weisbard, a religious Jew, said that he didn’t think “minority communities should be forced into a definition of death that violates their belief structures and practices and their primary senses.”

Nailah kept thinking about a conversation that she’d had with her children a year before. She’d been teasing them, saying, “I’m going to run your business for the rest of your lives.” When her son bragged that he’d outlive her, she joked, “Well, I’m going to get put on a ventilator.” Jahi had never heard the word and asked what it meant. “It’s a machine that keeps you alive,” Nailah explained. She told me, “I’ll never forget: the rest of the kids laughed, and Jahi said, ‘Well, if something ever happens to me, make sure you keep me on one of those.’ ”


At St. Peter’s Hospital, a music therapist visited the intensive-care unit every few days. She stood next to Jahi’s bed and played lullabies and soothing melodies on a harp. Nailah observed that Jahi’s heart rate, which tended to be high, would lower when the harpist played. She wondered if her daughter found the songs calming.



Nailah said, “I knew that Jahi was in there.” She began requesting that she move different parts of her body. In one test, which Nailah recorded on her cell phone, she stands at the side of Jahi’s hospital bed without touching it. Jahi’s eyes are closed, and the upper half of her bed is raised at a forty-five-degree angle. Her hands are placed on rolled cloths, to keep them from contracting into fists. “Move your hand,” Nailah says. Two seconds later, Jahi cocks her right wrist. “Very good!” Nailah says. “Can you move your hand again? Move your hand so we can see it. Move it hard.” Nine seconds later, Jahi flexes her forearm, turns her wrist, drops the cloth, and lifts her fingers. Her face is expressionless and still.

In another video, Nailah says, “Kick your foot.” Jahi’s purple blanket has been folded back, revealing her bare feet and ankles. After fifteen seconds, she wiggles her toes. “Try your hardest,” Nailah says. “I see you moved your toes, but you have to kick your foot.” Twenty-two seconds later, Jahi flicks her right foot upward. “Oh, I’m so proud of you,” Nailah says, leaning over the bed and kissing her cheek.

Seven months after moving to New Jersey, Jahi began menstruating. Sandra was visiting, and she asked the doctor on call to give Jahi a heating pad and Motrin—all the women in her family had severe cramps—and to note in Jahi’s medical records that she had got her period for the first time. The doctor told Sandra and Nailah that he couldn’t say for sure what was causing the blood flow. Nailah told him, “Blood is coming out of a teen-age girl’s vagina, and nowhere else, for five days—what do you think it is? Is there another diagnosis?” Sandra said that they both became so agitated that the doctor finally told them, “Why don’t you two girls go for a walk in the park outside.”


In late August, 2014, Jahi was released from St. Peter’s. Her discharge diagnosis was brain death. She moved into a two-bedroom apartment that Nailah and Marvin had rented in a colorless condominium complex near New Brunswick. They slept on an air mattress on the floor, and Jordyn, who had just moved to New Jersey, to begin first grade, slept on the couch. Jahi had the brightest room, with a large window overlooking the parking lot. Nurses, paid for by Medicaid, provided twenty-four-hour care, in eight-hour shifts. Every four hours, Nailah helped them turn her daughter’s body. One of Jahi’s most loyal nurses taped a note to the wall of her bedroom: “During your shift, interact with her,” she had written. “She does hear you! Speak clearly, softly, slowly.” She added, “No one knows if she understands, but just your comforting voice or touch should help.”

Not long after the family moved in, two detectives and a patrol officer showed up at the apartment. The Franklin Township Police Detective Bureau had received an anonymous tip that there was a dead body in the house. Nailah led the detectives into Jahi’s room and showed them her ventilator. The cops concluded that there was no criminal activity and left, but the nurse on duty was rattled, and she quit. Nailah had for months been flooded by e-mails and Facebook messages accusing her of child abuse or of exploiting her daughter for money. Strangers started a petition on Change.org to “stop NJ from paying for corpse care out of taxpayers money”; the petition said that Nailah had bought a Michael Kors purse and expensive wine, an accusation based on pictures on Instagram. Nailah’s lawyer, Dolan, told me, “They think she’s just some black lady sucking down social resources.”

Nailah read the Bible more than she ever had, and she tried to entertain the idea that God had chosen her to suffer this way because she was resilient enough to endure it. On her Facebook page, she described herself as “just a strong black woman who is not in the mood for anyone’s bullshit!” But she couldn’t accept the idea that divine logic was at work. “I really don’t feel like this was God’s plan for my kid’s life,” she said.

A month after Jahi’s discharge, the International Brain Research Foundation, a neuroscience think tank that supports novel research, helped pay for Jahi to have MRI scans at Rutgers New Jersey Medical School. Calixto Machado, the president of the Cuban Society of Clinical Neurophysiology, flew to New Jersey to analyze the scans. Machado has published more than two hundred papers on disorders of consciousness and runs a symposium every four years that attracts the world’s leading scholars of brain death. He said, “Everybody was talking about Jahi—Jahi this, Jahi that—but nobody knew the neurological picture.” The fact that Jahi had begun menstruating—a process mediated by the hypothalamus, near the front of the brain—suggested to him that not all neurological functions had ceased.

Dolan sat beside Machado in the hospital as he looked at two computer screens showing images of Jahi’s head and the top of her spine. In the rare cases in which brain-dead patients are sustained by a ventilator, neurologists have reported a phenomenon called “respirator brain”: the brain liquefies. Machado said that if Jahi’s original diagnosis was correct, and she’d had no cerebral blood flow for nine months, he expected that she’d have little tissue structure in her cranial cavity, just fluid and disorganized membranes.

On the scans, Machado observed that Jahi’s brain stem was nearly destroyed. The nerve fibres that connect the brain’s right and left hemispheres were barely recognizable. But large areas of her cerebrum, which mediates consciousness, language, and voluntary movements, were structurally intact. Dolan shouted, “She’s got a brain!”

Machado also performed a test that measures the interplay between the sympathetic and parasympathetic nervous systems, a relationship that regulates states of arousal and rest. He used three experimental conditions, one of which he called “Mother talks to the patient.” Nailah stood next to her daughter without touching her. “Hey, Jahi, I’m here,” she told her. “I love you. Everyone is so proud of you.” Machado noted that Jahi’s heart rate changed in response to her mother’s voice. “This CANNOT be found in a brain-dead patient,” he wrote.

Three days after the scans, Dolan submitted a report by Machado to the Alameda County Coroner’s Bureau and asked it to rescind Jahi’s death certificate, so that Nailah could return to California and have Jahi treated there. The coroner and the county’s public-health department rejected the request. “Any opportunity to overturn the Court’s holding that Jahi McMath is brain dead has long expired,” their lawyers wrote.


D. Alan Shewmon, who had just retired as the chief of the neurology department at Olive View-U.C.L.A. Medical Center, read Machado’s report and wondered if Jahi had a condition, first proposed by the Brazilian neurologist C. G. Coimbra, called ischemic penumbra. Coimbra hypothesized that this brain state could lead to a misdiagnosis of brain death in patients whose cerebral blood flow was diminished enough that it couldn’t be detected by the standard tests. If blood was still flowing to parts of the brain, however slowly, then, in theory, some degree of recovery could be possible.

Shewmon has given a diagnosis of brain death to roughly two hundred people. He is measured, formal, and precise. When I asked him what he thought of the media coverage stating that Jahi would die imminently, he paused and said, “I sit back and let it play out.” He laughed, harder than I would have expected, and said nothing more.

Two months after Machado’s tests, Shewmon flew to New Jersey and visited Jahi at her apartment. He pulled a desk chair next to her bed and, with a notepad in his hand, watched her for six hours. Jahi did not respond to his instructions to move her limbs, a fact that Shewmon did not find particularly revealing. He had analyzed the videos that Nailah had recorded, and they suggested to him that Jahi was in a minimally conscious state, a condition in which patients are partly or intermittently aware of themselves and their environment. He wrote that her condition “creates a particular challenge to either disprove or verify, because the likelihood of Jahi being in a ‘responsive’ state during a random examination is small.”

After Shewmon left, Nailah took more videos. She followed Shewmon’s instructions not to touch her daughter during the filming and to begin the video outside Jahi’s room. Shewmon eventually analyzed forty-nine videos containing a hundred and ninety-three commands and six hundred and sixty-eight movements. He wrote that the movements occur “sooner after command than would be expected on the basis of random occurrence,” and that “there is a very strong correspondence between the body part requested and the next body part that moves. This cannot be reasonably explained by chance.” He noted that the movements “bear no resemblance to any kind of reflex,” and that, in one video, Jahi seemed to display a complex level of linguistic comprehension. “Which finger is the eff-you finger?” Nailah asked her. “When you get mad at somebody, which finger you supposed to move?” Two seconds later, Jahi flexed her left middle finger. Then she bent her pinkie. “Not that one,” Nailah said. Four seconds later, Jahi moved her middle finger again.

James Bernat, a neurologist at Dartmouth who helped develop the theory of brain death that formed the basis of the 1981 President’s Commission report, told me that Shewmon showed him some of the videos. “My thoughts about this are not fully formed,” he said, adding, “I’m always skeptical of videotapes, because of the videos of Terri Schiavo.” Her family had released video clips that they presented as proof of consciousness, but the videos had been edited, giving the impression that she was tracking people with her eyes, even though she was blind.* Bernat said, “I have a huge amount of respect for Alan, and if he says something, I am going to pay attention to it.” He called Shewmon “the most intellectually honest person I have ever met.”


When Shewmon was a college sophomore, at Harvard, he listened to Chopin’s Trois Nouvelles Études No. 2, in his dorm room, and the music lifted him into such a state of ecstasy that he had an epiphany: he no longer thought it possible that all conscious experience, particularly one’s perception of beauty, could be a “mere electrophysiological epiphenomenon,” he said. The music seemed to transcend “the spatial limitations of matter.” An atheist, he converted to Catholicism and studied Aristotelian-Thomistic philosophy. He went to medical school, in 1971, and then specialized in neurology, because he wanted to understand the relationship between the mind and the brain.

For the next fifteen years, he believed in and defended the notion of brain death, but in the early nineties he began to feel increasingly troubled by the concept. When he engaged in what he called “Socratic conversations” with colleagues, he saw that few doctors could confidently articulate why the destruction of one organ was synonymous with death. Usually, they’d end up saying that these patients were still living biological organisms but had lost the capacities that made them human. He thought the formulation seemed too similar to the idea of “mental death,” which the Nazis embraced after the publication, in 1920, of a widely read medical and legal text called “Permission to Destroy Life Unworthy of Living.”



In 1992, Shewmon was asked to consult on the case of a fourteen-year-old boy who, after falling off the hood of a moving car, had been declared brain-dead. The boy’s family was religious and insisted that he remain on a ventilator. His physicians, certain that his heart would soon fail, acceded to his parents’ request. He survived for sixty-three days and began puberty. “This case flew in the face of everything I had been taught regarding the universality and imminence of somatic demise in brain death,” Shewmon later wrote. “It forced me to rethink the whole thing.”

Shewmon began researching similar cases, and found a hundred and seventy-five people, many of whom were children or teen-agers, who lived for months or years after they were legally dead. The longest survivor was a boy who had been declared dead after contracting meningitis, when he was four. His heart beat for twenty more years, during which time he grew proportionally and recovered from minor wounds and infections, even though he had no identifiable brain structure and the outside of his brain had calcified. In 1997, in a paper called “Recovery from ‘Brain Death’: A Neurologist’s Apologia,” Shewmon disavowed his earlier views. He acknowledged that “dissenters from the ‘brain death’ concept are typically dismissed condescendingly as simpletons, religious zealots or pro-life fanatics,” and announced that he was joining their ranks.

Shewmon’s research on what he calls “chronic survival” after brain death helped prompt a new President’s council on bioethics, in 2008, to revisit the definition of death. The council’s report referred to Shewmon’s research thirty-eight times. Although it ultimately reaffirmed the validity of brain death, it abandoned the biological and philosophical justification presented by the 1981 President’s Commission—that a functioning brain was necessary for the body to operate as an “integrated whole.” Instead, the report said that the destruction of the brain was equivalent to death because it meant that a human being was no longer able to “engage in commerce with the surrounding world,” which is “what an organism ‘does’ and what distinguishes every organism from nonliving things.”

In a personal note appended to the end of the report, the chairman of the council, Edmund Pellegrino, expressed regret regarding the lack of empirical precision. He wrote that attempts to articulate the boundaries of death “end in some form of circular reasoning—defining death in terms of life and life in terms of death without a true ‘definition’ of one or the other.”


In 2015, after Nailah filed her taxes, her accountant called to tell her that her submission had been rejected by the I.R.S. One of the “dependents” she’d listed was deceased. “I was, like, Oh, God, now I have to tell this guy what is going on—that she’s alive on a state level and dead on the federal level,” she said. She decided not to fight the I.R.S.; she was sure that she’d lose. “It’s not even about money,” she told me. “It’s the principle: I really have a human being that I get up and see about every day.”

Nailah sold her house in Oakland to pay her rent in New Jersey. She almost never left the apartment. Consumed by guilt for having urged Jahi to have her tonsils removed, she was given a diagnosis of depression. “I used to watch the antidepressant commercials, where people would stare out the window and say they couldn’t go outside, and I’d think, That is ridiculous,” she told me. “Who can’t go outside? Who can’t get off the bed? Where I’m from, you have survival skills—you learn to adapt. If you’re poor, if anything goes wrong, you can still make it. But this is one situation that I cannot adapt to.”

In the spring of 2015, Nailah filed a malpractice lawsuit against Oakland Children’s Hospital, seeking damages for Jahi’s pain, suffering, and medical expenses. The hospital argued that deceased bodies do not have legal standing to sue. “Plaintiffs are preserving Jahi’s body from its natural post-mortem course,” the hospital’s lawyers wrote. “It would be against public policy to hold health professionals liable for the costs of the futile medical interventions performed on a dead person.”

Dolan submitted video recordings of Jahi and declarations from Machado, three New Jersey doctors who had examined her, and Shewmon, who concluded that Jahi had fulfilled the requirements of brain death at the time of her diagnosis but no longer did. He wrote, “With the passage of time, her brain has recovered the ability to generate electrical activity, in parallel with its recovery of ability to respond to commands.” He described her as “an extremely disabled but very much alive teenage girl.”

The hospital hired its own medical experts. Thomas Nakagawa, who wrote the 2011 guidelines for pediatric brain death, said that the only accepted criteria for brain death were those stipulated by the guidelines. MRI scans, the heart-rate analysis, the videos of movement, and the evidence of menstruation were not relevant to the criteria. Sanford Schneider, a professor of pediatrics at the University of California, Irvine, referred to Jahi as a “corpse,” and told the court that she “cannot respond to verbal commands, because she has no cerebral mechanism to hear sound,” a conclusion based on a test that measured Jahi’s brain-wave activity in response to different noises. Schneider wrote, “There is absolutely no medical possibility that J McMath has recovered, or will someday recover, from death.”

Last summer, a judge on the Alameda County Superior Court rejected the hospital’s argument that the brain-death exam from 2013 “must be accorded finality for any and all other purposes.” He ruled that “a triable issue of fact exists as to whether Jahi currently satisfies the statutory definition of ‘dead.’ ” In a trial expected to last a month, a jury will decide if Jahi is alive.


Jahi’s case has sparked what Thaddeus Pope, a bioethicist at Mitchell Hamline University School of Law, calls the “Jahi McMath shadow effect”: a rise in the number of families, many of them ethnic or racial minorities, going to court to prevent hospitals from unplugging their loved ones from ventilators. In Toronto, the family of Taquisha McKitty, a young black mother declared dead after a drug overdose, argued that she couldn’t have died, because she still had a menstrual cycle. At a court hearing this fall, her doctor said that he was aware of vaginal bleeding but “nobody knows if that was menstrual.”

A similar debate unfolded in 2015, when an Ethiopian college student, Aden Hailu, was declared brain-dead at a hospital in Nevada after exploratory surgery for stomach pain. A district court rejected her father’s request to keep her on a ventilator, but the Nevada Supreme Court reversed the lower court’s decision, ruling that expert testimony was needed to determine whether the standard brain-death tests “adequately measure all functions of the entire brain.” (The hearing never happened, because Hailu’s heart stopped beating.)

Pope told me that “every extra hour of nursing time that goes into one of these dead patients is an hour of nursing time that didn’t go to somebody else.” He also worries that these disputes, which often get media attention, will cause fewer people to register as organ donors, a practice whose social acceptability depends on the idea that patients are dead before their vital organs are removed. When I expressed anxiety that my article could perpetuate the problem, he remarked that it could “do a small amount of harm.” Then he reconsidered and said, “The cat’s already out of the bag.”

Nailah’s lawyer, Dolan, a registered organ donor, told me that he struggles with the practical consequences of advocating for Jahi. “There’s a part of me that’s, like, Shit, we may screw up organ donation,” he said. When families in similar situations call him, he tells Nailah’s story to warn against following her path. “This is like Job,” he said.

Truog, the director of the Center of Bioethics at Harvard, said that once, when he gave an academic talk on brain death, he described it as a catastrophic brain injury, rather than death. A transplant physician stood up and told him, “You should be ashamed of yourself. What you are doing is immoral: to put doubts in the minds of people about a practice that is saving countless lives.” Truog told me, “I’ve thought long and hard about that. In order to support public trust in the scientific enterprise, I guess I feel that the medical profession is always going to be better off, in the long run, if we speak honestly and truthfully about what we know.”

He continued, “I don’t think there’s anything morally wrong with the fact that we take organs from these people, even though there is no scientific reason for believing them to be dead. I believe it is a morally virtuous thing to do and we ought to facilitate it. We are doing the right thing for the wrong reasons.”


Although Jahi has come to represent a different way of defining life, her family is not sure that they would keep her on a ventilator if she still fulfilled the expectations for brain death. Sandra said that, before Jahi was given the MRI scans at Rutgers, she told herself, “If her brain is jelly, we are going to have to accept that. I don’t think people should live on that way. If they’re gone, they’re gone.”

Jahi’s family believes that she is capable of a fuller range of thought than she is able to express, an idea that Shewmon has also considered. “Given the evidence of intermittent responsiveness,” he wrote in a declaration to the court, “we should be all the more willing to remain agnostic regarding her inner state of mind during periods of unresponsivity, rather than automatically equate it with unconsciousness.” Recent advances in neuroimaging have led some clinicians to consider the possibility that a significant portion of patients thought to be in a vegetative state—those who demonstrate no overt awareness of their environment and do not make purposeful movements—have been misdiagnosed; they may be periodically conscious and capable of some degree of communication.

Nailah said that nearly every day she asks Jahi, “Are you O.K. with what I’m doing? Do you want to live? Are you suffering?” She said, “I know that things change—people change. If Jahi has given up and doesn’t want to be here anymore, I’m just going to go with what she wants.” She said that Jahi answers her questions by either squeezing her hand or pressing her own index finger toward her thumb, a signal for “yes” that Nailah taught her. “When I see that,” she said, “I think, Who am I to not want to live? Because many days I do want to die. But then I see her every day, trying her best.”



Last December, I visited Nailah at her apartment, and she said that she had begun to feel more hopeful. She felt more confident that the courts would allow her to bring Jahi home to Oakland, although the trial has not yet been scheduled. Recently, she had asked Jahi how long she thought it would take. Six months? she asked. A year? A year and a half? Jahi squeezed her hand after the third question. Nailah took it as her answer. “I am planning this big-ass welcome-home party in my head,” Nailah told me. “I know my city really, really loves us.”

“Hi, girl, are you sleeping or awake?” Nailah said to Jahi as we walked into her room. Jahi wore pink pajamas, and her face was clear and smooth but bloated, a side effect of a steroid she takes to raise her blood pressure. Her eyes were closed. “Are you sleeping? I want to know,” Nailah said. She picked up Jahi’s hand and held it with both of her palms. Jahi’s other hand was draped over the belly of a baby doll. Her hair was in thin braids that Nailah worried were getting thinner. Stacey, a nurse who had been caring for Jahi for the past year, stood by her feet. Stacey had spent the morning reading her a Sherlock Holmes story.

Nailah spoke about how much she had come to appreciate her own mother, who called Jahi three times a day, singing to her, reading prayers, relaying family gossip, and updating her on the Golden State Warriors. Stacey interrupted: “She’s moving her hand on the baby.”

Jahi’s index and middle finger had shifted about half an inch, moving from the doll’s belly to its chest. “Good job,” Stacey said. “Good job, Jahi!”

“Can you move your pointer finger on the baby?” Nailah asked.

Jahi’s fingernails, which Nailah had painted pink, remained still.

“That’s your baby,” Nailah said, referring to the doll. “That’s my grandbaby,” she said, laughing.

Jahi’s thumb trembled.

“Not your thumb, but your pointer finger,” Nailah said. “I know you can do it.”

After a few seconds, Jahi’s middle finger flickered. She raised it slightly and then dropped it.

“There you go,” Nailah said. “Thank you.”

Daniel Wikler, the Harvard philosopher, told me that he guessed Jahi’s family might be suffering from “folie à famille,” a rare condition in which a delusion is shared by all members of a family. It struck me as a coherent response to the death of a child: who wouldn’t find comfort in the fantasy that the child’s will had been preserved? It seemed so intuitive that I worried I could also be investing undue meaning in gestures nearly too subtle to discern. Given the weight of the evidence, though, it seemed unlikely. Jahi’s doctors and nurses were all converts, too. On Nailah’s cell-phone recordings, which document the past four years of her daughter’s life, several different nurses can be heard congratulating Jahi for gathering the strength and commitment to move a foot or a finger.

Jahi’s little sister, Jordyn, was similarly devoted. A wiry girl wearing faded skinny jeans and Day-Glo high-top sneakers, she walked into her sister’s room as soon as the school bus dropped her off. In Oakland, she and Jahi had shared a bedroom, and now she liked to lie in bed with her sister; sometimes she’d put lip gloss on her or rub lotion on her legs. Jordyn was unruly in school, and Sandra worried that her misbehavior was an expression of alienation at home. Once, when Jordyn seemed jealous of all the love directed toward her sister, Nailah said, “Do you think your sister would do this for you?” Jordyn said yes. “Well, that’s why we’re doing everything for her,” Nailah told her.

Jordyn has learned that if she wants to have a conversation in her sister’s room she needs to stand on the same side of the bed as her mother. “Jahi doesn’t like when two people talk over her,” Nailah said. “Her heart rate shoots up.” It makes Jahi nervous and upset, Nailah said, to be treated as if she didn’t exist. “She listens to everybody’s conversations—she has no choice,” she said. “I bet she has some secrets she can tell us.” She smoothed back Jahi’s hair. “You know how sometimes, when you’re just sitting still, thinking, you can take yourself somewhere else? I always say, ‘Jahi, one day, I want to know everything you know and everywhere that you’ve been.’ ” ♦

*Bobby Schindler, Terri Schiavo’s brother, contends that, although an autopsy confirmed that she was blind at the time of her death, it is unclear if she was blind when the video was recorded.

A previous version of this article incorrectly stated that Jahi’s mother has a do-not-resuscitate order for her.This article appears in the print edition of the February 5, 2018, issue, with the headline “The Death Debate.”