17. Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death. Published online January 2, 2019. doi: 10.1212/wnl.0000000000006750, 2. An assessment of advance relatives approach for brain death organ donation. In media reports, he’s said that his wife didn’t wish to be kept alive artificially and would have wanted to be taken off a ventilator. ©2021 Verizon Media. The other thing—and I’m coming at it as someone that has an interest in biomedical ethics—that sometimes gets lost in this discussion by those who oppose the brain death concept, is the question: What would the individual who is in the ICU want if they had been in a position to speak for themselves, would they want to be maintained in what might well be an indefinite state of unconsciousness and unawareness, with the arguably remote hope that somehow, someway, they could be returned to a quality of life that they want? There is no ethical debate about that.”, Both Caplan and McCullough were critical of the unnamed medical facility that agreed to put Jahi’s body on a ventilator. J Clin Ethics. It takes time. In April 2018, a group authored a perspective in the Journal of Bioethical Inquiry regarding their concern surrounding the amendments to the Nevada law.2 They wrote that “even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this.”, Additionally, they pointed to Nevada’s desire to resolve uncertainty following a high-profile case by amending their legislation to include the AAN guidelines, noting that “in doing so, Nevada has raised more legal issues than it has solved, particularly given its impact on patient and religious rights.”. Although very few people actually take any steps toward causing their own death, many dying people at least consider suicide—even more so as the public debate about doctor-assisted suicide grows. S/N 040-000-00451-3 Item 851-J Includes bibliographical references President's Commission for the study of ethical problems in medicine and biomedical and behavioral research QIU Ren-zong (Institute of Philosophy, Chinese Academy of Social Sciences, Beijing 100732, China) In the field of life ethics, the basic standard or view is also the basic ethical principle, by which the ethical framework of judging what and how to do in velevant fields (including brain death). 2018 May 4;23:292-299. doi: 10.12659/AOT.908615. ASSOCIATED PRESS. Many doctors are questioning continued medical procedures on a 13-year-old girl declared brain-dead nearly a month ago, calling interventions to provide nutrition to a dead body wrong and unethical. Ethical Issues in Brain Death. Tap here to turn on desktop notifications to get the news sent straight to you. A seventh ethical issue is the respect for patients’ autonomous wishes to donate their organs which is legally supported by the US Uniform Anatomical Gift Act. Contrary to appearances of being alive, in reality the “brain dead” individual is a corpse. There are so many different ways I can answer that. One of the more famous cases was that of Terri Schiavo. When a patient is medically brain death, the family is informed and is expected to make a decision. 18. The 13-year-old, Jahi McMath, was pronounced dead by the coroner’s office, after suffering rare complications from a Dec. 9 tonsillectomy. Of course, any story illustrating the issues surrounding brain death is going to be a sad and tragic tale. -- Proceedings of International Congress on Ethical Issues in Brain Death and Organ Transplantation, University of Tsukuba, (2004):57-59. deal with these sorts of situations. 1. If she is brain-dead, then “you have a pregnancy in a cadaver,” McCullough said. This can be for the better or for the worse: A patient who consistently refused to eat, now suddenly decides to eat. In this chapter, brain death and medical ethics are discussed individually in two parts. Texas law states that a person may not withdraw or withhold life-sustaining treatment from a pregnant patient. Cite As: United States. This resulted in a cardiac arrest with an apparent prolonged period of lack of blood flow to the brain. Studies outline key ethical questions surrounding brain-computer interface tech. Yanke G, Rady MY, Verheijde JL. He briefly summarizes each author's arguments and emphasizes the importance of clarifying concepts when discussing death, personhood, values, informed consent, and the definition of life. The hospital, John Peter Smith Hospital in Forth Worth, has not commented publicly on her condition. All rights reserved. The issues surrounding brain death occur with limited frequency for those working in acute critical care settings. Coma: These patients are alive, but in a state of eyes-closed, depressed consciousness from which they cannot be aroused. In 1995 the American Medical Association supported taking organs from anencephalic infants, children born without brains. If Munoz is alive but unconscious, McCullough says the hospital shouldn’t be blamed for taking the legally cautious approach of keeping her on life support. Follow him on Twitter @byMattHoffman or email him at mhoffman@neurologylive.com​. From the Medical College of Wisconsin, Milwaukee, WI. In fact, all US jurisdictions have adopted the UDDA either verbatim or in some variation thereof. 19. Our proposal: (1) Various ideas of life and death, including that of objecting to brain death as human death, should be guaranteed. Why is brain death controversial? Bernat JL(1). In short, basically, the UDDA report equated brain death with cardiopulmonary death. Issues for the family to consider at this time include organ or tissue donation, autopsy examination and funeral arrangements. Ethical issues surrounding brain death though continue to confront us. Legal briefing: brain death and total brain failure. deal with these sorts of situations. Number 2: The determination of brain death is dependent on proving the irreversible loss of all functions of the brain and the brain stem. Hopefully, we can appeal to the pragmatic aspects of this, one being that I don’t think we as a society can tolerate a negotiated standard for what death is or is not, even if we disagree on what that standard is. Life and Death In the first part, brain death definition, clinical criteria, ancillary tests, and controversies in using the tests are described. “The family should have been allowed to spend some time with the body if they wished. Ethics, brain death, family care Introduction Brain death remains a controversial ethical issue. Palliative care interventions can help families to accept the death. The morphine remedy is, in a manner of speaking, a double-edged sword. Cultural and especially religious beliefs play a big part of ethical issues surrounding the brain death. Once brain death has been diagnosed according to the clinical criteria 17 outlined above, physicians and families must realize that brain death equals the death of the patient. Part of HuffPost Religion. By contrast, when Robyn Benson was pronounced brain dead after a brain hemorrhage at 22 weeks of pregnancy, both her husband and the physicians agreed to continue support until a viable child could be delivered. He also worries about the psychological effect of seeing the the girl’s body, which is already said to be deteriorating, continue to break down. Source: Robert Stevens, associate professor of neuroscience and critical care at Johns Hopkins University School of Medicine. In the cases with w… LEGAL AND ETHICAL ISSUES SURROUNDING BRAIN DEATH 1 Abstract The irreversible loss of brainstem function is clinically recognized as brain death. Brain death cannot be reversed by medical or surgical intervention as the brain cells are not able to get rejuvenated (Goila & Pawar, 2009). Nurs Ethics. May he (she) rest in peace (Amen) May their souls and the souls of all the faithful departed, through the mercy of God, rest in peace. We made it easy for you to exercise your right to vote! Her parents, unwilling to disconnect Jahi from machines that keep her heart beating artificially, have transferred her from an Oakland hospital to an unnamed facility. James Russell, DO, MS: Let me speak to the Nevada situation because, in a number of different ways, it’s ironic that you bring it up. Pope TM. Reflexes that go through the spinal cord may persist even in a brain-dead state. Amen. Number 4: Although the responsibility to determine brain death falls under the purview of the medical profession as authorized by the UDDA, the authority to determine brain death or to withdraw organ-sustaining technology may be superseded by legal considerations. Br Med J. Ethical Issues Surrounding Brain Death The ethical issues arise when a loved one’s value of death contradicts with what is medically proven. Liz Szabo USA Today. Since … ScienceDaily. To further address this opposing position of the Nevada law, the AAN’s position on brain death, and what clinicians need to know in regard to determining it, James Russell, DO, MS, neurologist, Lahey Hospital and Medical Center, and an author of the position statement, spoke with NeurologyLive®. It does not require that you prove that every neuron within the brain is irreversibly injured, any more than cardio-pulmonary death requires the proof that every myocardial cell is irreversibly injured. The issues surrounding brain death occur with limited frequency for those working in acute critical care settings. In addition to reaching out to the ethics committee, I would also seek out an individual within the family that has established closest ties to the patient, and try to persuade him/her to act as the patient’s designated decision maker. © 2021 MJH Life Sciences™ and Neurology Live. But in fact, “brain death” is no different than any other sort of death: A brain-dead person is no longer alive. There has been an irreversible cessation of all activity in both the brain and the brain stem. Defining death: a report on the medical, legal and ethical issues in the determination of death. But, they are not allowing anyone to die. Washington, DC: US Government Printing Office; 1981. These are: respiration, pulse, nerve response, electrical activity in the brain (flat EEG; electroencephalograph), etc. Definitely worth reading in understanding the ethical issues surrounding brain death and organ donation. 2014;25(3):245–257. “She is going to start to decompose.”. Although some have been critical of Nevada’s law. The Ethics Of Being Brain Dead: Doctors And Bioethicists Discuss Jahi McMath And Marlise Munoz. The uniform acceptance of the UDDA in 1981 authorized the medical profession to identify and provide the medical standards by which brain death was determined. In commenting on these cases the bioethicists have stated, in no uncertain terms, that an individual correctly diagnosed as “brain dead” is dead, pure and simple. The eye opening may give the impression of consciousness, but there is no awareness of the environment. The death of the brain almost always spells the death of the person. Neurology. By moving the lungs up and down, a ventilator can “give the appearance of life,” Caplan said. McCullough said he worries about the emotional, spiritual and financial damage that the parents will suffer. “I do think the family’s wishes should be honored.”, At this point, Munoz’s fetus is not viable, said McCullough, noting that infants are generally not considered viable — or able to survive with full medical support — until the 24th week of a 40-week pregnancy. It is an extremely rare event when a death is misdiagnosed, and even then, there is most probably carelessness involved. Two cases involving “brain death” have received considerable public attention, including commentary by several well-known bioethicists. 1. Hopefully, we can all agree that we can’t function as a society unless we figure out a standard that we can all agree to. Freer, T. Tomlinson, A. Preus, and G. Jones on the ethical issues surrounding brain death. In commenting on these cases the bioethicists have stated, in no uncertain terms, that an individual correctly diagnosed as “brain dead” is dead, pure and simple. There may be exceptions to that, but that’s the basic rule. The AAN position statement author further addressed the opposing position of the Nevada law, the AAN’s position on brain death, and what clinicians need to know in regard to determining it. McCullough said the case of Texas mother Marlise Munoz is more complicated, because her hospital has not announced her condition. In a 4th, New Jersey, the law recognizes an indefinite right for a family to allow maintenance of organ sustaining technology despite a medical determination of brain death, based, I believe, largely, on religious grounds. The goal of this chapter is to provide a basic understanding about ethical principles and to explore issues surrounding the issues that can arise during end of life decisions in patients who are nearing the end of life. They didn’t criticize the guidelines—they simply pointed out that the lower courts had failed to prove that they were indeed this medical standard, which was a concern to us. Her husband has asked for his wife to be taken off a breathing machine. Many doctors are questioning continued medical procedures on a 13-year-old girl declared brain-dead … Ethical and legal concerns with Nevada’s brain death amendments.