Clinical and ethical perspectives on brain death

Nair‐Collins, Michael

doi:10.2147/mb.s70369

Cited by 15 publications

(28 citation statements)

References 83 publications

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“…Whereas the Harvard standard requires the complete silence of the nervous system (Harvard Medical School 1968, 338), 19 the AAN guidelines affirm that the presence of a whole host of clinical signs, such as profuse sweating, blushing, tachycardia, sudden increase in blood pressure, motor stretch reflexes, Babinski reflex, and spontaneous movements of the limbs, is compatible with death (Wijdicks 1995, 1007). In other words, the change from the Harvard standard to the AAN guidelines is a post hoc move in order exclude those functions that are preserved in brain-dead patients as irrelevant, which then makes it possible to uphold the claim that BD is death (Nguyen 2019, 298–302; Nair-Collins 2015, 74). With its assertion that the presence of neuroendocrine function, reflexes, and spontaneous movements is compatible with death, the AAN standard contradicts both scientific realism and the tenets of sound anthropology, in particular, Christian anthropology as held and taught by the Catholic Church (Nguyen 2019).…”

Section: Critical Analysis Of the Arguments For The Revision Of The Uddamentioning

confidence: 99%

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Does the Uniform Determination of Death Act Need to Be Revised?

Nguyen

2020

Linacre Q

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Prompted by concerns raised by the rise in litigations, which challenge the legal status of brain death (BD), Lewis and colleagues recently proposed a revision of the Uniform Determination of Death Act (UDDA). The revision consists of (i) narrowing down the definition of BD to the loss of specific brain functions, namely those functions that can be assessed on bedside neurological examination; (ii) requiring that the determination of BD must be in accordance with the specific guidelines designated in the revision; and (iii) eliminating the necessity for obtaining consent prior to performing the tests for BD determination. By analyzing Lewis and colleagues’ revision, this article shows that this revision is fraught with difficulties. Therefore, this article also proposes two approaches for an ethical revision of the UDDA; the first is in accordance with scientific realism and Christian anthropology, while the second is grounded in trust and respect for persons. If the UDDA is to be revised, then it should be based on sound ethical principles in order to resolve the ongoing BD controversies and rebuild public trust. Summary: This article critically examines the recent revision of the Uniform Determination of Death Act (UDDA) advanced by Lewis and colleagues. The revision only further reinforces the status quo of brain death without taking into account the root cause of the litigations and controversies about the declaration of death by neurological criteria. In view of this deficiency, this article offers two approaches to revising the UDDA, both of which are founded on sound moral principles.

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Section: Critical Analysis Of the Arguments For The Revision Of The Uddamentioning

confidence: 99%

“…When he suffered an accident and was declared brain-dead, his parents, who were not against organ donation, wanted mechanical ventilation discontinued prior to organ removal. Neither the parents nor the patient knew that organ donation in BD takes place while the donor remains on a ventilator and with a beating heart (Nair-Collins 2015, 78).…”

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confidence: 99%

Does the Uniform Determination of Death Act Need to Be Revised?

Nguyen

2020

Linacre Q

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“…However, there are at least 30 known cases of pregnant women having been physiologically supported for up to 107 days to gestate a fetus 15 16 ; a young boy meeting ‘brain death’ criteria was physiologically supported for 20 years 17 ; and more recently, a young woman has been maintained on home ventilation for over 3 years following the diagnosis of ‘brain death’. 18 …”

Section: ‘Brain Death’ Pathophysiology and The Role Of Medical Technomentioning

confidence: 99%

Do the ‘brain dead’ merely appear to be alive?

Nair‐Collins

Miller

2017

J Med Ethics

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The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are (biologically) dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule.

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“…Ultimately, the National Organ and Tissue Transplant Organization (NOTTO) needs to be strengthened so that it may play a central role in coordinating the activities of deceased organ donation. 6 Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis at autopsy. They do not, therefore, completely exclude the reversible loss of integrated neurological functions in those certified as potential donors.…”

Section: Introductionmentioning

confidence: 99%

Assessment of awareness, knowledge, attitude and practice regarding organ donation among medical teachers and post-graduate

Manjit¹,

Ht²,

Kalpesh³

et al. 2019

International Journal of Health Research and Medico Legal Practice

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Introduction: Organ donation deals with the surgery which includes harvesting the organ and transplants them into end stage organ disease patient which on progression required organ transplantation surgeries. Organ donation rate in India is only 0.26 per million. 1 Absence of consciousness about the requirement of organ donation and the unfamiliarity among medical fraternity regarding its significance knowledge and legal issues create the huge splintering for end stage organ disease Patient. The objective of this study is to assess the awareness, knowledge, attitude and practice regarding organ donation among the Medical Teachers, & students perusing Post-Graduation. Materials and methods: Study was conducted among 100 subjects, where 50 Medical Teachers & 50 students pursuing Post-Graduation have participated. Questionnaires are distributed in order to assess their awareness, knowledge, attitude and practice regarding organ donation among the Medical Teachers, & students perusing Post-Graduation. Collected Data was analysed using Microsoft Excel program. Results: Total 100 subjects participated in this study, among this 50 are Medical Teachers & 50 are student pursuing post-graduation. Only 33% have gone through the provisions of Transplantation of human organ & tissue act, 1994, although 68% among them have motivated the patient's relative for the organ donation. Conclusion: Requirement for organ donation have been showing tremendous upsurge trends as there are increased number of patients diagnosed with end stage organ disease. On the other side lack of awareness, knowledge, attitude and practice regarding organ donation shall hamper the current scenario for upgradation of health status among end stage organ disease patient.

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Clinical and ethical perspectives on brain death

Cited by 15 publications

References 83 publications

Does the Uniform Determination of Death Act Need to Be Revised?

Does the Uniform Determination of Death Act Need to Be Revised?

Do the ‘brain dead’ merely appear to be alive?

Assessment of awareness, knowledge, attitude and practice regarding organ donation among medical teachers and post-graduate

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