Disputes in the Declaration of Brain Death: A Case Illustration

Abstract

Death by neurologic criteria is a legal definition upheld in all 50 states in the United States. Confusion among the public may cause the declaration of death to be disputed and the removal of physiologic support delayed. In this report, a case is described of an infant who died from traumatic brain injury, but whose removal from respiratory and cardiovascular support was delayed due to a legal injunction brought forth from his family against the hospital. In addition, ethical issues faced by the health care team are discussed surrounding continuing medical therapies for a patient after the declaration of death.

Keywords

brain death - ethics - legal

• References

• 1 Uniform Determination of Death Act. Available at: http://pntb.org/wordpress/wp-content/uploads/Uniform-Determination-of-Death-1980_5c.pdf . Accessed February 11, 2015
• 2 Controversies in the Determination of Death. The President's Council on Bioethics. Washington, D.C. 2009 . Available at: https://bioethicsarchive.georgetown.edu/pcbe/reports/death/chapter1.html . Accessed February 11, 2015
• 3 Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. ; American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74 (23) 1911-1918
• 4 Nakagawa T, Ashwal S, Mathur M, Mysore M. ; Committee for Determination of Brain Death in Infants and Children. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations - executive summary. Ann Neurol 2012; 71 (04) 573-585
• 5 Burkle C, Sharp R, Wijdicks E. Why brain death is considered death and why there should be no confusion. Neurology 2014; 83 (16) 1464-1469
• 6 Flamm AL, Smith ML, Mayer PA. Family members' requests to extend physiologic support after declaration of brain death: a case series analysis and proposed guidelines for clinical management. J Clin Ethics 2014; 25 (03) 222-237