Accommodating Religious and Moral Objections to Neurological Death

Olick, Robert S.; Braun, Eli A.; Potash, Joel

doi:10.1086/jce200920213

Cited by 36 publications

(3 citation statements)

References 18 publications

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“…Two surveys of health care professionals involved in BD/DNC declaration in the US found these requests are made for a variety of reasons, including belief that a person who is brain dead could regain neurologic function, desire to await arrival of additional family members prior to discontinuation of support, and lack of acceptance that a person can be dead if their heart is beating . Religious objections, however, are the foundation for the majority of these requests . BD/DNC is generally accepted in most religions, but the frequency of this acceptance varies both between and within religions(Table 3 and Supplement 12).…”

Section: Minimum Clinical Criteria For Determination Of Bd/dncsupporting

confidence: 84%

“…109,112 Religious objections, however, are the foundation for the majority of these requests. [113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128] BD/DNC is generally accepted in most religions, but the frequency of this acceptance varies both between and within religions(Table 3 and Supplement 12). [129][130][131][132][133][134][135][136][137][138][139][140][141][142] Recommendations and Suggestions…”

Section: Somatic Support After Bd/dnc For Organ Donation and Other Sp...mentioning

confidence: 99%

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Determination of Brain Death/Death by Neurologic Criteria

Greer

Shemie

Lewis

et al. 2020

JAMA

443

533

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ImportanceThere are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.ObjectiveTo formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel.ProcessRelevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery.Evidence SynthesisBased on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed.RecommendationsPrior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability.Conclusions and RelevanceThis report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in...

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Section: Minimum Clinical Criteria For Determination Of Bd/dncsupporting

confidence: 84%

Section: Somatic Support After Bd/dnc For Organ Donation and Other Sp...mentioning

confidence: 99%

Determination of Brain Death/Death by Neurologic Criteria

Greer

Shemie

Lewis

et al. 2020

JAMA

443

533

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“…Guidelines are available for managing cases of religious exception to brain death. 72 The circulatory criterion of death Determination of death using the circulatoryrespiratory criterion is straightforward for most deaths in which respiratory and circulatory support is not admini stered (Box 4). Use of this determination in the ICU has become controversial, however, owing to increasing use of protocols for organ donation after the circulatory determination of death (DCDD), formerly called non-heart-beating organ donation or donation after cardiac death.…”

Section: Requirementsmentioning

confidence: 99%

Controversies in defining and determining death in critical care

Bernat

2013

Nat Rev Neurol

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Circulatory-respiratory or brain tests are widely accepted for definition and determination of death, but have several controversial issues. Both determinations have been stimulated by organ donation, but must be valid independently of this process. Current controversies in brain death include whether the definition is conceptually coherent, whether the whole-brain or brainstem criterion is correct, whether one neurological examination or two should be required, and when to conduct the examination following therapeutic hypothermia. Controversies about the circulatory determination of death include the minimum duration of asystole that is sufficient for death to be declared, and whether the distinction between permanent and irreversible cessation of circulatory functioning is important. In addition, the goal of organ donation raises issues such as the optimal way to time and conduct the request conversation with family members of the patient, and whether the Dead Donor Rule should be abandoned.

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Respecting Choice in Definitions of Death

Ross¹

2018

Hastings Center Report

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The definition of death was clearer one hundred years ago than it is today. People were declared dead if diagnosed with permanent cessation of both cardio‐circulatory function and respiratory function. But the definition has been muddled by the development of new technologies and interventions—first by cardiopulmonary resuscitation and ventilators, which were introduced in the mid‐twentieth century, and now by extracorporeal membrane oxygenation, which creates the ability to keep oxygenated blood circulating, with or without a beating heart or functioning lungs. In Defining Death: The Case for Choice, Robert Veatch and I argue that the definition of death should focus on “what change in a human being is so fundamental that we can say the individual is no longer with us as a member of the human community bearing rights such as the right not to be killed.” We assert that this decision is a normative issue about which different stakeholders may believe that different changes are fundamental, and we therefore propose that the optimal policy solution may be to allow stakeholders to choose their own definition within a reasonable range of options. There are three caveats that need to be highlighted regarding this approach.

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Accommodating Religious and Moral Objections to Neurological Death

Cited by 36 publications

References 18 publications

Determination of Brain Death/Death by Neurologic Criteria

Determination of Brain Death/Death by Neurologic Criteria

Controversies in defining and determining death in critical care

Respecting Choice in Definitions of Death

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