Friday, November 14, 2008

Brain Death - Social Convention or Biologic Fact?

John Lantos, MD
November 14, 2008

The controversy at Children’s National Medical Center in Washington, DC over the treatment of a child with no detectable brain activity highlights the ambiguities surrounding the concept of brain death.

The concept of brain death came into existence in the late 1968 when an ad hoc group of Harvard professors published a paper in the Journal of the American Medical Association
entitled “A definition of irreversible coma.” The goal of the Harvard group was to define clinical criteria that doctors could use in order to determine that a patient had experienced irreversible cessation of brain function.

Over the next decade, all states adopted the concept of “brain death” as a new way of determining that someone was no longer alive. The primary purpose of brain death criteria was to facilitate the recovery of organs for transplantation. A secondary purpose was to help families make decisions about the withdrawal of mechanical ventilation.

There has always been confusion and disagreement about whether people who meet the neurologic criteria for brain death are “really” dead. There are clearly physiologic differences between patients who are brain dead and patients whose hearts have stopped.

Brain dead patients are still warm and pink. Their hearts beat. They maintain their blood pressure. They make urine. They can gestate babies. Their state of “deadness” is a social convention that allows certain things to be done to them that cannot be done to living people and that limits their rights to certain things to which living people have rights.

But what should we do in the cases involving people who do not accept the consensus? The clash is one of fundamental moral beliefs. For one side to win, the other side must lose. There is, unfortunately, no compromise position here. Either the ventilator will be turned off or it will be left on.

Because I believe that brain death is a social consensus, rather than a biologic fact, I think that parents have the right to make the decision about whether to authorize removal of the ventilator.
Because I believe that health care workers should not be forced to violate their conscientious beliefs, I believe that they have the right to refuse to participate in such a medical project.

For utilitarian reasons, I think society can decide whether or not to pay for such care.

Thus, I believe that, if the parents really want to continue mechanical ventilation, they should learn to do it themselves, at home, and should pay for it themselves. Few parents can do that.

Thus, pragmatically, I think the judge should allow the hospital to turn off the ventilator and let cessation of bodily function follow, as it inevitably will, cessation of brain function.

What do you think? To view and to contribute comments, click here.


Judge Delays Decision on Removing Life Support, Washington Post, November 11
Medical Advances Complicate Definition of Death, National Public Radio, November 11
CNMC v. Brody - Reasons to Stop Treatment, Medical Futility Blog, November 11

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Blogger bon said...

They aren't dead. They should be kept alive. People don't belong to their families. It would be unfair to kill people simply because they lack a good family to help them.

Sunday, January 03, 2010  
Anonymous Generic Cialis said...

I know that we are human and all the other nice speech, but sometime we have to be more cruels, I don't want to hurt the feelings of anyonem but for example my child born with this illness, and your son is dying, if my son can save the life of yours, well Euthanasia is the solution.

Friday, March 04, 2011  

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