The definitions and dilemmas of brain death

February 26, 2014 by Dennis Walikainen, Michigan Technological University
What do We do Now? Family Members and the Brain Dead

When a patient is declared brain dead, what options are available for family members? Who decides his or her fate? A recent case in California triggered the interest of Syd Johnson, assistant professor of philosophy at Michigan Technological University.

Her article, "A Tragic Death and a Fight for Life," was published in Impact Ethics: Making a Difference in Bioethics.

In it, she addresses the California case and the many issues involved in it and similar cases.

"The 13-year-old girl went in for a tonsillectomy, had complications from the surgery, and was considered brain dead," Johnson says. "The hospital wanted to withdraw , and the family disagreed on religious grounds. Taking to social media, the family raised enough money to move her to a facility to keep her alive."

The definitions—and dilemmas—of brain death go back at least as far as 1968 and an Ad Hoc Committee to Examine the Definition of Brain Death, she says. At the time, there were two complications: if someone ended up in intensive care, they could be considered in an "irreversible coma," from which they would not recover but could be kept alive, filling up hospital beds even though there was very little that could be done for them. Also, the growing successes with organ transplantation created pressures to remove them from life support.

"In the four decades since, it has remained a controversy," Johnson says. "Is brain death the same as death by cardiac arrest? Those are the two ways of being dead in all 50 states."

Brain death is not, however, well accepted by the public, with many religious and moral objections.

"It's hard for many to call them dead when the body is still warm and there are still some reflexes working," she explains. "We wouldn't put them in a box in the ground that way."

One of Johnson's main arguments is for "reasonable accommodations" for the family members. In the California case, the family was allowed to gather around the girl to say their goodbyes. Then the hospital was going to withdraw life support, according to state law.

Johnson favors a more tactful approach, at the very least.

"Some patients have been known to live on for another 20 years on life support," she says. "When the heart stops beating, that is usually the point when even moral and religious objections disappear."

New York has laws similar to California, Johnson says, but New Jersey is the only state that says you must use cardiac criteria to be considered dead, and that is important for medical insurance, which would continue to cover hospital care.

"Other states declare the person legally dead, and he or she must leave the hospital," Johnson says. "And there is much discussion in the literature on brain death. Disagreement exists among doctors, neurologists and bioethicists."

In following the California case, Johnson also says the hospital was quite insensitive and cruel, referring to the girl as a "dead body" and "deceased person" and implying that the family was crazy.

"It was an inappropriate way of talking to and about them," she says. "Even when they finally moved the girl, the hospital transferred her to the coroner first; then the family had to move her to the long-term facility."

So, the girl is alive by one definition and dead according to the state of California, Johnson says. The subject raises legal, medical, religious, bioethical and other issues.

"We need to talk about it as a society," Johnson says. "What to accept, where do you give leeway to define death: when the heart stops and the body goes cold? We need to be reasonable to allow for broader definitions of it, even if it is a small number each year."

The recent case in Texas where a was removed from life support is another prime example, she says.

"She was an EMT and so was her husband, and this is significant because they both really understood brain death, and they had a clear understanding that they would not want to be kept alive if brain dead," Johnson says. "However, Texas law prohibits removing life support from a pregnant woman. The husband had to fight to remove it, and the judge agreed with him."

There can also be complications when the brain dead person wishes not to be kept alive, but a family member wants to do so.

"The precedent is that the family member is overruled, and usually a pastor or counselor helps the family work through the disagreement," she says.

Johnson calls it a fascinating topic because is not like traditional death, and the need for organs and tissues can complicate the issue.

"Organs can be donated to seven or eight people, but tissues can be used by as many as 50," she says, including some tissues as important as corneas and heart valves.

The brain dead can be an important source of those donations, and we need to be more honest about what we are doing in those circumstances, Johnson says.

"Brain death does not equal traditional death, and it is hard to accept," she says. "The difference can be as significant as your death versus the death of your child. It would be better public policy to look at how those families are treated."

Explore further: Dr. David Magnus on understanding brain death

More information: The paper, "A Tragic Death and a Fight for Life," is available online: impactethics.ca/2014/01/29/a-t … nd-a-fight-for-life/

Related Stories

Dr. David Magnus on understanding brain death

February 6, 2014
When is a person considered dead? Two recent cases have thrust the issue of "brain death" back into the national conversation. In Texas, the brain-dead Marlise Muñoz was connected to machines that kept her other vital organs ...

Petition launched to take pregnant Texas woman off ventilator

January 9, 2014
Abortion rights activists launched a petition Wednesday to take a pregnant American woman declared brain dead off life support in Texas, as requested by her family.

Waking the dead? Some things you should know about dying

August 9, 2013
Not content with saving lives, doctors are now credited with (accused of?) bringing the dead back to life. But how true are the stories we hear about people "coming back" from being dead and how does it work?

A better model for brain death needed

December 3, 2013
Process variations related to brain death have far-reaching implications beyond delaying an official declaration of death, including added stress for the patient's family, missed opportunities for organ donation and increased ...

Australian doctors bring woman back from the dead

August 19, 2013
An Australian woman has lived to tell the tale after being brought back to life from being clinically dead for 42 minutes, doctors said on Monday.

Brain-dead woman gives birth to son in Canada

February 11, 2014
Doctors in Canada have delivered a frail but healthy baby boy from a brain-dead woman kept on life support for several weeks, the infant's father wrote in a blog post.

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.