ethical issues surrounding brain death
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. Cite As: United States. Scott Henderson provides a thorough look at the history of organ transplants and how brain death was used to push organ donors. Although some have been critical of Nevada’s law. It simply requires proof that the brain, as an entire organ with all of its functions, are irreversibly injured. J Clin Ethics. By moving the lungs up and down, a ventilator can “give the appearance of life,” Caplan said. deal with these sorts of situations. 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. 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. Issues surrounding brain death. 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. In the same way that philosophers, scholars, and the public have wrestled with questions about brain death, nurses may experience distress in caring for a brain-dead patient, especially if they do not personally believe in the validity of death by neurologic criteria. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1981). In the second part, some of the ethical issues related to neuroanesthesia practice, research, and end-of-life issues … Minimally conscious state: These patients are also alive, with a severe alteration in consciousness, with intermittent, but inconsistent, behaviors suggesting awareness. Doctors at Children’s Hospital in Oakland pronounced Jahi, 13, brain-dead on Dec. 12. © 2021 MJH Life Sciences™ and Neurology Live. From the Medical College of Wisconsin, Milwaukee, WI. Reflexes that go through the spinal cord may persist even in a brain-dead state. What’s missing from this, however, is the recognition by different states that these are, in fact, the medical standards by which brain death is determined. Number 2: The determination of brain death is dependent on proving the irreversible loss of all functions of the brain and the brain stem. 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. 19. This theme issue of the AMA Journal of Ethics examines growing ethical, social, and legal complexities of determining and declaring death by neurological criteria. The ethics of organ transplantation / "An ever-increasing demand for organs, with over 100,000 people on waiting lists, has driven a relentless search for new sources of organs. She developed complications after surgery for sleep apnea and lost a large amount of blood. 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? The woman’s husband, Erick Munoz, has said he’s been told his wife is brain-dead. ©2021 Verizon Media. McCullough said he worries about the emotional, spiritual and financial damage that the parents will suffer. MATERIAL … Knowledge and Ethical Issues in Organ Transplantation and Organ Donation: Perspectives from Iranian Health Personnel Ann Transplant. These are the stories that tend to make the news, including the rare cases where someone shows some recovery. Ethical and legal concerns with Nevada’s brain death amendments. Get Email Alerts The December issue of AMA Journal of Ethics ® ( @JournalofEthics ) investigates growing ethical, social and legal complexities of determining 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). The McMath family lawyer announced Wednesday that Jahi’s new doctors had inserted a tube in her throat and another tube to provide nutrition to her stomach. Such distress may become heightened when questions of organ donation arise. 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. The people who do not fully endorse brain death conceptually as equivalent to cardiopulmonary death, or the accuracy of its determination, don’t just lie within the lay public—there are many philosophers and many physicians and bio-ethicists, some of whom I have great respect for, who have differing opinions. doi: 10.1007/s11673-018-9852-y. 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. One of the more famous cases was that of Terri Schiavo. These are: respiration, pulse, nerve response, electrical activity in the brain (flat EEG; electroencephalograph), etc. It is an extremely rare event when a death is misdiagnosed, and even then, there is most probably carelessness involved. The voice of the individual, the victim if you will, seems to get lost in these debates. The problem with the medical-legal term “brain death,” is that when used amongst nonmedical professionals, it may convey partial or incomplete death. Vegetative state: Patients in vegetative states are alive but also have severely impaired consciousness, although their eyes may open spontaneously. The relation of brain death and organ donation is rather troubling. (RNS) The cases of two young women — a California teen and a pregnant Texas mother — have generated sympathy for their families, but also have left some doctors and bioethicists upset about their treatment. ... and the possibility of the defense lawyer arguing that the removal of LSMT was the cause of death. Masahiro Morioka. Freer, T. Tomlinson, A. Preus, and G. Jones on the ethical issues surrounding brain death. Confirmation of brain death makes it obligatory for clinicians to cease all treatment but what if the family refuses to accept the diagnosis. The “iron lung,” an artifact of the poliomyelitis epidemic, gave rise to a new category of illness—first described as coma-depassein 23 patients who survived on the ventilator despite the lack of any respiratory effort . ©2009—2021 Bioethics Research Library Box 571212 Washington DC 20057-1212 202.687.3885 Pope TM. There are so many different ways I can answer that. There is a consensus in Western society that "brain death" is the medical and legal standard for human death. We can only work to make sure that the processes by which brain death is determined are done compliantly, uniformly, correctly, and accurately to make sure that we get it right 100% of the time, which is important. McCullough said the case of Texas mother Marlise Munoz is more complicated, because her hospital has not announced her condition. In 1968, a Harvard committee proposed that death could also be defined neurologically as the irreversible loss of brain function. Patients in persistent vegetative states may have lost their "personhood," but they are not dead. “She is going to start to decompose.”. Source: Robert Stevens, associate professor of neuroscience and critical care at Johns Hopkins University School of Medicine. Having one person serving as the decision maker eliminates all other “outside” interferences. It takes time. To the best of our knowledge, when complied with, they’re uniformly accurate as they obviously need to be. Many doctors are questioning continued medical procedures on a 13-year-old girl declared brain-dead … 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 term simply describes how the death was determined, said Laurence McCullough, a professor at the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston. 2018;15(2):193—198. “In desperate cases, you respond with very careful thought and deliberation,” said McCullough, who chairs the fetal therapy board at Texas Children’s Hospital. The Ethics Of Being Brain Dead: Doctors And Bioethicists Discuss Jahi McMath And Marlise Munoz. When a patient is medically brain death, the family is informed and is expected to make a decision. “You probably have a fetus who is terribly devastated,” Caplan said. “Are there some living cells in the body? But, they are not allowing anyone to die. Russell JA, Epstein LG, Greer DM, Kirschen M, Rubin MA, Lewis A. Having one person serving as the decision maker eliminates all other “outside” interferences. A look at some of the differences between states of consciousness and brain death: Brain death: These patients are no longer alive. Given the long-standing controversy about whether the brain-dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. Follow him on Twitter @byMattHoffman or email him at mhoffman@neurologylive.com. 1983;286:209–210. … There is a word for this: crazy.”, Caplan agreed: “You can’t really feed a corpse.”. This chapter provides an ethical context for forensic mental health professionals in death penalty cases. In December of 2013, Jahi McMath suffered bleeding complications following a tonsillectomy and tissue removal for sleep apnea. The morphine remedy is, in a manner of speaking, a double-edged sword. Then, test your understanding with a brief quiz. The UDDA authorized the medical profession to provide these standards and the medical profession did so, but individual jurisdictions never passed any laws that said, “Yes, these are the medical standards.”. Why is brain death controversial? There has been an irreversible cessation of all activity in both the brain and the brain stem. Number 3: The determination of brain death is first and foremost a clinical diagnosis and that the role of ancillary testing is to serve as a surrogate means of assessment when a clinical assessment is not possible. Eternal rest, grant unto him (her) O Lord and let perpetual light shine upon him (her). Ethical issues in brain death and multiorgan transplantation. 2019 Mar;26(2):553-563. doi: 10.1177/0969733017708331. The death of the brain almost always spells the death of the person. Matt Hoffman, Senior Editor for NeurologyLive, has covered medical news for MJH Life Sciences, NeurologyLive’s parent company, since 2017, and previously wrote for its sister publication, HCPLive. But that’s the only state in which that has occurred, and one of the goals of the Brain Death Working Group is to, hopefully, figure out some way to get other jurisdictions to do exactly the same, so that some so that these difficult cases—which I don’t think serve anybody very well—perhaps are resolved in a more constructive fashion for everybody’s benefit. 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. As it’s written, Caplan said, the law says “you can’t have a living will if you are pregnant, even one day pregnant.”. 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