Emergencies, accidents, non-accidental injury and the law
Rachel U Sidwell, Mike A Thomson in Concise Paediatrics, 2020
Brain death is the irreversible loss of consciousness and the capacity to breathe. This is accepted to occur when there is permanent functional death of the brainstem. Diagnosis of brain death requires the absence of brainstem function (no brainstem reflexes) for at least 24 hChild must be unconscious with no drugs acting that affect consciousness or respiratory functionAssessment of brainstem reflexes, tested by two senior physicians working independently. The reflexes must be retested at least ½ h apart
Surviving death
Fredrik Svenaeus in Phenomenological Bioethics, 2017
Brain death is not the same thing as coma. Persons who are permanently comatose may still have intact brain stem functionality necessary for cardiopulmonary and other vital bodily functions. And the cerebral functions necessary for consciousness, which are absent in coma, may be only temporarily gone, as it is when people are anaesthetized, for instance. Brain death is also different from what is called a persistent or permanent vegetative state (PVS), in which a person is awake (or asleep) but not aware of what is going on. People in a coma or a vegetative state have not lost all the functions of the brain, and even though the doctors, after studying the damage done to their brains and assessing their long-term condition, may establish with very high likelihood that they will not regain consciousness, it is impossible to establish this beyond all doubt. These patients are kept alive by feeding tubes and nursing care, and they can live for years or even decades if nutrition and care of the body is maintained. The wishes of and conflicts between relatives and medical personnel concerning whether or how to allow these patients to die are legendary in bioethics (McMahan 2009).
Death and Dying
Gary Seay, Susana Nuccetelli in Engaging Bioethics, 2017
Brain-dead patients like Jahi McMath have permanently lost (1) and (2) owing to catastrophic damage to the entire brain, including the brainstem. Yet some brainstem functions can be maintained externally. By contrast, patients in VS typically retain partial or total unassisted brainstem functions, such as the ability to have open eyes for long periods of time, sleep/wake cycles, breathing, cough-and-gag reflex, pupillary response to light, and blood pressure. They can smile, frown, and cry, though in ways unrelated to external stimuli. None of these is considered a sign of awareness or sentience. These patients are not brain dead, though they have sustained catastrophic damage to the higher brain from which there is almost no possibility of recovery (depending on their age and the cause of damage). They are also not in a coma, which is a state of prolonged unconsciousness resulting from many conditions (head injury, stroke, brain tumor, intoxication, etc.). Although a dysfunctional brainstem may allow spontaneous breathing, comatose patients are in a sleep-like condition of unarousability with eyes closed.
When Does Consciousness Matter? Lessons From the Minimally Conscious State
Published in AJOB Neuroscience, 2018
Finally, consider patients who meet the criteria for higher level function brain death. Traditionally, brain death has been defined as the “irreversible cessation of all functions of the entire brain, including the brainstem” (President's Commission 1981, 119). Some parties, however, have pushed for a revised definition of brain death, one that focuses on the cessation of higher level function (for a discussion, see DeGrazia 2017, section 2). On the proposed revision, individuals would count as dead when their higher level functions have ceased, regardless of whether their brain stem is functional. Determining whether this is an appropriate definition of brain death falls outside my current purposes. It is worth noting, however, that patients who meet the higher level function criteria for death are distinguished precisely by their lack of the potential for consciousness in the sense I have discussed. For these individuals, the restoration of consciousness is not medically possible. Now, it is up for debate whether we should describe these patients as dead, given their lack of the potential for consciousness. Given what I have argued, however, their lack of the potential for consciousness is indeed normatively relevant.
Factors affecting organ donation rate during devastating brain injuries: a 6-year data analysis
Published in Acta Chirurgica Belgica, 2021
Reyhan Arslantas, Banu Eler Çevik
The current population-based cohort study identified ICH (37%) as the leading cause of brain death, followed by TBI (22%) and SAH (22%). In contrast to other studies [7,8], the most frequent cause of brain death in our hospital was ICH. However, the most common reasons for brain death in Çekirge City Hospital, Bursa/Osmangazi [9] and a tertiary university hospital in Izmir [10] were ICH and intracranial hemorrhage, respectively. Unlike these results, Kompanje et al. [8] reported that only 5% of patients who died due to ICH progressed to brain death. Differences in the most common reasons for brain death among various studies may be attributed to the use of different classifications for the cause of brain death. Some countries, like Spain, generally admit all patients with devastating ICH to critical care in order to provide adequate care and assess for the possibility of donation. In such countries, the most common cause of brain death has been ICH [1].
The Case Against Solicitation of Consent for Apnea Testing
Published in The American Journal of Bioethics, 2020
Further, maintaining support despite suspicion for brain death requires hospital staff to devote time to a potentially dead patient that could be better spent on a living patient. In this setting, nurses and doctors need to provide both ongoing physical support to the patient and emotional support to the family. This detracts from their ability to treat living patients, which could increase the risk for suboptimal care and medical error. Attempting to “treat” the dead, the ultimate example of medical futility, also adds to emotional distress and moral injury for healthcare workers. In an analysis of 13 cases where brain dead patients were kept on organ support due to family request, ethical consults were called urgently in 8 cases. This dire need for ethical guidance indicates the level of moral conflict the medical team was experiencing when asked to “treat” dead bodies; this is further demonstrated by the fact that the clinicians involved in these cases expressed a “deep sense of moral harm” (Flamm et al. 2014). Emotional injury amongst healthcare providers has been correlated with worse patient outcomes (Panagioti et al. 2017).
Related Knowledge Centers
- Brainstem
- Coma
- Differential Diagnosis
- Electroencephalography
- Cerebrum
- Vegetative State
- Locked-In Syndrome
- Legal Death
- Medical Subject Headings
- Brainstem Death