It is now considered by the medical profession and supported by legal and some ethical consensus that if a person's entire brain is dead, the person is dead. The reason is that if the entire brain is destroyed, there is absence of spontaneous breathing and expected cessation of heartbeat soon. It is on the basis of this concept that all life support treatments which the patient may have had in place before brain death has been established can be removed because the patient is now dead. It also provides the opportunity to obtain organs from a brain dead patient, who had previously given consent, while the organs are still in good condition for transplantation. Families of a brain dead patient may have to be educated about the physiology. However, some religious groups and even some healthcare workers are uncomfortable with a brain death definition of death since the patient may still have a heart beat and wish to wait until there is persisting absence of heart beat, the classical criterion.
Here is the question:
Am I second year nursing student and so far I've been luck not to be involved in a brain death situation. But if a person is on a ventaler then I do believe if they cannot live without this help then I would personally say they are brain dead, if a member of my family where ever in this situation I would have to say the same thing. Helena
I've been in the medical field for 11 yrs. If a pt. has been confirmed "brain dead" through tests such as EEG, apnea test, etc. The pt. has no chance at surviving without ventilator assistance, multiple meds, and tube feedings. They have no quality of life left. Realizing that it is a very difficult decision for the family members to make regarding discontinuation care, but in the long run many headaches, and sleepness nights will be saved. Not to mention, the family feuds and enormous medical bills that can accrue. Just my thoughts.
I work as a nurse in an Intensive Care Unit. Over the past two weeks, I have seen three young men with massive head injuries resulting from motorcycle crashes. Although one has made it through so far, the other two are still on life support with a clinical diagnoses of being totally brain dead. I have to perform my job duties to fulfill the wishes of the patient and family. However, if I were ever in this situation as the patient or a family member, I would feel that being totally brain dead would classify as being dead. If a patient with this dx had not been rescued soon enough to be put on a ventilator than nature would have already taken its course and the patient would have ceased all respiratory and cardiac function. They would have still been dead. So to answer the question is brain death dead enough; it is for me. Thanks for allowing me to post my own opinion. Rene
Our son was determined to be brain dead in 1993. Like most families in this situation, we had only a surface knowledge of brain death. The surgeon explained the process he would use to determine brain death. He said that if our son showed even a slight reaction to any test, he would not be considered brain dead. The worst happened. We donated our son's organs in an attempt to derive something good from a terrible situation. We were told that our son was a perfect candidate for major organ donation. His brain stem had been crushed in an accident but he had no other injuries. He was on a ventilator. As you are probably aware, the patient is kept alive on a ventilator until all of the organs have been removed. This is done in a specific order with the heart being taken last so that the patient's blood continues to flow through all organs until the moment of removal.
A few years later there was a dispute in England among anethesiologists because of the reaction of brain dead patients during the organ retrieval process. Apparently if no anesthetic is used patients react to the pain of incisions by trying to move away from the scaple. At the moment the scalple cuts , the patients blood pressure and heartbeat increase dramatically as well. This is well documented medically but not commonly known by the public. We certainly were never informed of it. Had we been informed we would never have consented to organ retreival and would have let our son die naturally.
I called the organ retrieval team in BC to see if they had used any anesthetic during the procedures on our son. I was told that they do not because the patient would not be considered brain dead if anesthetic were neccessary. The procedure would be considered euthanasia, which is illegal under Canadian Law. They acknowledged the fact that patients do react during the procedure but likened the movement to that of a chicken when it's head has been cut off. You can imagine how this analogy was recieved.
I feel great sympathy for people requiring organ transplants. I can understand the negative effect on the number of organs retrieved, if the above information became common knowlege. As a parent, I feel like I have unwittingly subjected my son to unknown pain. I feel that we were deliberately mislead. The only reason I didn't pursue this legally is because of the devastating effects it would have had on other family members. However that situation will change within the next few years. When it does, I intend to lobby to have this situation corrected.
Deborah Dimitrov, DeborahDimitrov@monarch.net
When we think of death, we associate a physiological death and a psychological death. If the computers turn unstable, the rest of the warehouse is gone. When a natural brain death occurs, then a bodily death is inevitable, thus resulting in a rooted definition of death.
The subject question, "Brain Death: Is That Dead enough," says, by the fact that it is asked that brain death is NOT dead enough. At least for those who think the question should be asked, there is doubt, and if there is any doubt, then "that" is not dead enough.
As I read these opinions one seems to thrust itself forward, the one that asserts Philosophy as the best way to find an answer to the question. I agree, and would add that (religion aside) Theology may be of utmost Philosophic value.
I believe that brain death is not real death because the patientís heart is still beating and when we touch him or her, we feel his body is warm, which proves they are still alive. Although I donít consider brain death as a criterion for death, I support the idea that obtaining the organs from a brain dead patient while the organs are still good condition for transplantation. To obtaining the organs from a brain dead patient is to not only help other people but also live in other people as a second life. I have heard that there are many people who canít live without transplantation. If I was a brain dead patient and my organs were needed, I would be willing to give my organs to those people. I have also leaned that there is a rule that transplantation canít be held without a brain dead patientís will and his familyís agreement. So I believe itís very important for all of us to discuss this brain death matter, whether it should be considered as a criterion for death or not and transplantation. Thank you for your time and attention. Sincerely, Yuka
Thank you to everyone for interesting, and sometimes heartwrenching, reading. My condolences to those who have learned about brain death through losing a loved one.
I am a neurology professor, so my answer to the question is yes. My reading of the relevant literature is that clinical criteria (supplemented, when appropriate, by diagnostic testing) can accurately identify a situation from which no one has ever recovered. Less scientifically, the concept is so very consistent with my clinical experience. Sometimes, when Iím asked to pronounce a person brain dead, I do, because the many criteria are met, and sometimes I cannot, for various reasons. There is definitely something different missing from someone who is brain dead. I imagine this sounds biased or superstitious, but I would point out that I am not particularly religious. Being at the bedside of an individual who is brain dead does feel like being in the presence of a person who has died by cardiac criteria. Whether one calls it spirit, soul, or something else, whatever it is that makes us human has left.
There was a post asking how careful doctors are in making a pronouncement of brain death. I canít think of too many things I take more seriously. I have seen the bewilderment in the faces of family members too often not to have a grasp, even if tenuous, of how counterintuitive it must be to have someone there, with a heartbeat on the monitor, yet have doctors say they are dead.
This brings me to my last point. I came across this discussion while doing background work for medical student teaching I'll soon be doing on brain death. I can't begin to say how valuable reading this has been in shaping what I am developing. Part of what I want to convey is what I just alluded to that it is a huge responsibility, and therefore must be taken with seriousness, dignity, and humanity. Your comments have reinforced this, and taught me a great deal more. I am confident it will inform and improve what I teach my students. I am most grateful, and offer my sincere thanks to everyone for sharing their thoughts and feelings.
Hello. Like most others I agree that brain death makes you dead in all aspects. Your whole body depends on your brain, and it there is no brain body is nothing more then a body. Since soul is more your personality and your mind, your spirit, it can not possibly be contained in the body. Therefore even if you cells are still living but your mind no longer exists - the soul is no longer in the body. Plus this is scientific - it is proven, as in math. You can not drag religion and feelings into something that has a firm ground to stand on. Religion and belief only make the question complex, and allow logical argument, which unfortunately doesn't change the obvious truth. Once the brain no longer functions the person is no longer in this world.
As an intensive care nurse I am often confronted by severe brain injuires that lead to brain death. Some responses to you, suggest that the body is 'alive' whilst it is on ventilatory support leading to a beating heart. Some years ago, whilst working in a Cardiothoracic unit, an air embolus whilst on 'bypass' led to eventual brain death. For some days this was denied and the patient maintained on the ventilator. In the absence of brain stem function, the heart eventually arrested and a pacemeaker was inserted. The underlying rhythm was asystolic and I eventually met the patient day 5 post surgery. Brain Death testing was performed within the context of Australian Law and the next day Ventilatory support ceased after family counselling. There was no issue of Withdrawal for death had occurred. It is important to separate Withdrawal of Life Support from Brain Death. The difficulty at that time was the crossing over of medical fields, from neuro intensive care to life saving sardiothoracic surgery. The Assistant Director of Nursing for the unit had a problem with brain death, and its meaing, and her concept of spiritual life, and the separation of the spirit, soul, from the body. Such beleifs are not antithetic to brain death. It is possible to still believe that brain death has occurred, and that the spirit is conncected to the body and unable to move on until the body is freed from the ventilator and asystole and no cardiac output allowed to occur. Organ donation is a separate element to brain death, and not all brain death victims become organ donors. It is important to keep the separation morally and ethically, so that people understand the distinct reality of death that has occurred to their loved one. Whilst organ donation is a system of care that has developed through technology that allows people to be mechanically supported and therefore require brain death testing, it is not the origin for brain death testing. Advanced life support, early resuscitation at the time of injury and the ability to prevent the cessation of respiration has caused society to examine the brain. In previous socieies, people died from brain stem death, as respiraion could not occur. Asystole had to follow. Death is not an emotion. It is philosophic as well as physical. Human life requires the connection of the physical body to the spirit and the psyche. They are not independent isolates, each capable of survival without the other. Brain Death accounts and records physical death. It does not prevent respect of the processes that occur in religious beliefs in care of the dead body. It is a process that few people have had to confront or willingly would. I applaud the generations of the present and the future who not only confront brain death but discuss with their loved ones and family the concept of organ donation. It is always important to remember that the right to be an organ donor or refuse to be an organ donor will recieve no indictment from the medical community, and always the respect of the individual life is paramount. Judy.
I recently became a widow at the age of 32. My husband of 9 years diagnosed as brain dead. I am still awaiting the results of his autopsy to determine the exact cause of his brain death. I have read all of the comments on this topic and must say that some are very disturbing. For a very brief moment a few made me question my decision to let go. Again, this was a very brief moment. I am not in a position to battle anyone elses moral or ethical decions. All I know is that my husband always had expressed his wishes to me, and I can only encourage everyone to discuss these wishes with there loved ones. I know 3 things for sure. 1-My husband would never want to live if he could not have a full quality of life. He told me this over and over again. I know for a fact he did not want to live if the only means were life support. 2-He wanted to be an organ donor. We never could see eye to eye on this subject and he would always make me promise that I would grant this wish. 3- I loved my husband to much to be selfish and allow his body to remain "alive" for my own benefit. Which is exactly what technology allows us to do. Those who argue that the body is alive as long as it has a beating heart and is breathing (only due to a ventilator) need to understand that this is not a natural occurance. There are many many things that are being done to maintain organ function. I unfortunately had the chance to witness this. I saw the bags of meds and IV's that were necessary to honor my husbands wish to be an organ donor. The heart only continues to beat because it is being stimulated by medications and is being given oxygen by means of a ventilator. Don't get me wrong, this was still not an easy choice. I wish everyday I never had to make it. All I know is that knowing my husbands wishes made this decision one that I am able to live with. Even if I was not given the brain death diagnosis which I do believe to be a true diagnosis of death, my husband would not want to be sustained by life support. For those of you that question "brain death" , I offer one suggestion. Don't allow it to be anyones choice but the person who has suffered it. Know you're loved ones wishes.........that is after all, all that should matter.
What bothers me about most discussions of brain death is that the arguments many people use are based upon what they "feel" is right, upon what medical science can observe about the brain, or upon appeals to "quality of life" or to the necessity of using those organs to help others who need them. These arguments all beg the question: what is death? This can only be answered by a right philosophy, not by science. Science can only portray the physical evidence; it is doctors and ethicists who have made the determination of death based upon that evidence. The medical evidence says nothing except that there is no apparent functioning in the brain; this upon its own does not say whether or not it is death of the person. This is a definition based upon a person's judgement of these facts. Medical ethicists, who admittedly have a vested interest in this, due to the possibility of harvesting organs, have taken over the job of defining death and life. This is not something that should be taken lightly.
To those who argue based upon the fact that they "feel" it is right: one's subjective feelings about something, even though his/her conviction may be very strong, is never a valid basis for truth, unless it is backed up by something objectively right. If there is any question at all, one's feelings may not suffice to provide direction. Especially in matters of life and death, this should NOT be any kind of green light to go ahead.
To those who argue that the benefits of organ harvesting are enough to justify brain death as death of the person: One may not use a relativistic argument that assumes that one person's life is more important than another. Just because you know that a person, because of his medical condition, has little or no chance of living a normal life, and may even die soon, does not make that person's life any less valuable. That person deserves to be nurtured and cared for, until the very end, and the end may not be hastened by well-meaning attempts to help others. Otherwise, human beings play God and decide that this or that person is expendable, because of X,Y, & Z. Where does that end? That's the thinking of Hitler - he disposed of people that he had no use for. Life (ALL life) is precious and sacred, and it must be cherished and respected at every stage, from conception until natural death; otherwise, NO human's life is sacred. The same arguments that are used to justify this situation, as well as many more such current issues in medical ethics, can be used either for or against anyone, according to whoever is making the rules.
What strikes me is that many people, in saying that brain death is "real" death, often contradict themselves by stating that it is cruel to keep someone here on earth indefinitely. The person is either here or not; if dead, the life support machines are not prolonging anything. One thing I hear often when people say brain death is real death, is that the person's soul is no longer there, just the body. While I agree that humans have a spiritual soul, the body and soul are not separate. We are "embodied souls"; the body and soul are intrinsically united. How can the body continue to breathe, the heart beat, and blood flow to the organs, keeping them healthy, if the person is not alive? Machines cannot do all this work: they can pump air into the person and can stimulate the heart to beat, but they cannot cause the exchange of oxygen to happen at the tissue level. Eventually, when the person does die, no machine in the world can keep this process going. Does this not tell us that there is something more to death than mere "brain death"?
I realize that there are still many more questions, and that this does not sufficiently cover all the grounds. But, my point was to at least emphasize that it is CRITICAL what methods we use to justify such an argument. Our culture is so used to using faulty logic to arrive at the conclusions that we do. Only a solid foundation in morality and good philosophical reasoning, based upon objective truth, will suffice to even discuss this question. This question should be considered in the light of these solid foundations, separate from the pressures of organ donation. The pressure of organ donation should not be a factor in determining whether or not brain death is true death; this question has to be fully answered before any questions about organ donation can be answered.
In a message dated Wed, May 1, 2002 , Chelsey Risseeuw touched upon the problem I have with brain death, namely, as long as there are known cases of patients who have been misdiagnosed as brain dead who have recovered, there have also undoubtedly been cases where patients have been misdiagnosed "brain dead" who were hustled off to surgery to have their organs harvested for transplantation who were effectively killed as a result. It leaves me wondering what kind of studies were conducted to determine the incidence of errors in diagnosing brain death before its use as a basis for organ donation.
My name is Chelsey Risseeuw and I am a senior at Deuel High School and a student of Mrs. Lundberg's Advanced Biology class. We are researching bioethical topics and the topic that I chose was Brain Death. I recently posted a Filamentality Web Quest about that particular topic. At first, I had a preconceived idea that brain death was not the same as actual death and that it was possible for a brain dead person to recover in some miraculous cases. After researching the topic, I realized that this was not the case. Brain dead is in actuality, dead. In some cases, there have been misdiagnosisin which people who were falsely determined brain dead actually recovered. These cases are responsible for the numerous misconceptions about brain death. Through the course of my research, I have also realized that brain death is a highly emotional and difficult situation and it is important that people comprehend all of the facts about brain death before making any kind of decision either way. I also believe that it should be the family's right and decision to make the final say about the welfare of a brain dead person. Thank you for allowing me to share my opinion on Brain Death.
I fully believe that brain death is death. I worked with many patient declared brain dead and they are gone. The only reason the heart beat remains is because of artifical mechanical ventilation. Once ventilation is removed, they do not breath and their heart stops in minutes. There is so much fear of death in this country and we do so many crazy things to stop what is a natural part of life. I have been a nurse for 13 years and believe in medicine and all it's miracles. However, we can not keep death away forever and when it comes, why prolong it? Unless it is to save another life through organ donation.
As a family member who suddenly finds herself looking for answers to "What is brain-death?" I feel dissatisfied with the answers out here. Who are any of us to decisively say when life begins and ends? I am waiting for a determination of brain-death for a troubled mother of two young children. I am not as concerned for her physical state as her spiritual one. No one truly knows whether the soul is still in the loved ones who are determined to be in this state of "death". No one can claim to know if sitting and praying with the loved one and sharing our love with him/her is going to comfort or help them in this state. In my case, I have to believe that until they take my loved one off support and her heart stops beating that she is still in there. That in this brain-death her soul will be given a second chance to die and go with God.
As a Nuclear Medicine student I recently had the experience of assessing the Cerebral Perfusion of a man who had been involved in a motorcycle accident. The basic aim of the study was to assess drain death. Our assessment concluded that the man had no blood going to his brain and was therfore brain dead. The mans life support systems were turned off and his respiration and heart beat ceased almost instantly. I can not see how it could have been considered that this man was 'alive' simply because a machine was making it breath and pump blood. I read the response written by a person saying that it is not a humans responsibility to terminate a life but instead it is gods. I agree with this theory to an extent but I also think has god not shown us enough by taking this persons brain function.In pre-ventilator medicine we did not question if god infact wanted this person to die simply because they maintained respiration and heart beat for a short time after brain death occured. It brings forward the question of quality of life. If there is a heaven do we have the right to keep a man on this earth in a state of relative unrest simply because of human emotion rather than allowing him to transcend to a nother place? If there is not a heaven and we are not at anystage reincarnated then what is the point of sustaining resiration and heart beat in a body that has no idea of what is going on around it and is of relatively no use to us, but is rather taking up a bed where we could treat a person who has a possibility of recovery? This may sound like a rather inpersonal approach but do we not have to take this stance to some degree when dealing with this issue. We are either a being that lives in more than one dimension/time in which case are we not better to alow the spirt to move on (or rather has the spirit moved on and are we holding on to false hope) or we are not. I believe the best approach is to diagnose the status of drain death, in the case where drain death is diagnosed we should cease any mechanical assistance. under the christian approach god will save those he wants saved and under the opposing stance survival of the fittest will be applied.
As a nursing student I feel that the criteria for a patient to be declared brain dead is extensive enough that if th EEG is flat then that is enough clinical evidence that they are dead . If they are taken off the vent and they can not sustain a heartbeat sponataneously then they should allowed to die. I feel that it is the responsibility of the health care team as a whole to inform tha family of the diagnosis and not to instill a false sense of hope. I feel that the family often do not realise that even if the heart is beating that with out the brain the other body systems will eventually fail . I think that they families often feel that the vent will sustain the brain and it will in time regain function .This as all health professionals know is not true and I feel that it is interfering with the families grieving process.
I think that brain death is a reliable criterion for death. If the person is on life support systems that is why their heart continues to beat. I have seen this alot of times since I work in an ICU. We have someone on a ventilator and their EEG is flat and we take them off and death is almost instantaneous.
I think we have to consider whether or not their heart would be beating if they were not on the ventilator. If the patient is truelly brain dead as evidenced by the EEG then their heart would not be beating if it were not for the ventilator.
Prolonging death is acceptable if the family is looking at organ donation but just to keep them on until their heart fails is not fair to the family. If the person is young and ventilated then their heart can beat for a long time even after they cease to have any brain activity.
Sandra McCoy, NSU college of nursing
I think you should wait until the heart stops beating.In my oppinion you are still alive physically until your heart stops beating.Do they take your organs when your heart is still beating but yet you are brain dead? If so this is horrible.
In light of the recent news about stem cells, I'm curious to know what people think about the possibility of brain resucitation when "brain death" has been diagnosed. Could so-called brain dead individuals be candidates for receiving stem cells? And, if so, what happens to organ donation?
Thanks for listening! Zerobar
It is the life that remains in dead organ donors that makes their gift worthwhile. If brain death and death were identical and equivalent, there would have been no need to coin the term "brain death". Jell-O and the human brain show similar wave patterns on an EEG. For those who decry "prolonging death," remember that the only thing that prolongs death is life. Removal of life support has never been performed at the request of the patient.
If someone has a EEG done and it shows no activity in the upper areas of the brain, does that constituent PERMANENT brain damage/death? Is their ever a state were a brain may have no or activity below the EEG measurement readings? I wonder and im sure many people have wondered. I think that too many doctors assume that, does the brain ever repair itself? Most people may lay on a breathing machine 2-3 months sometimes with no higher level brain activity, but how many people have been left on for years in that state. If the brain is truly dead and is in a state of no being self repairable then maybe the rest of the body catches on and then die. I read something that really made me wonder. Their was a study of about 200+ people who had been classified as brain dead(meaning high order brain function) Most of the people who were taken off ventilators after being "brain dead" for 10 hours showed in autopsy the their brain has massage damage. But the ones who were left on for 120 hours showed statically less damage, and I mean 25-50% less damage, and one group who were on life support for weeks showed a lot less damage then people on for 10-120 hours range. Does this mean the people ever would have improved? Maybe not, but it did raise the question that even after massive damage the brain did seem in most of the cases to be in better (but probably still fatal) shape after being fed oxygen for weeks after the initial damage. I would like to see a further study in this issue. But do to the current pressure placed on most families to harvest the organs we may not have enough cases to further study this.
As a Christian I believe death is a manifest reality completely different from life. The intrinsic worth of a human being is not in his/her brain or other bodily part but in the whole person, an organism with spiritual and material dimensions united. Death signifies the separation of this unity, which unity is served by the intercooperation of at least three vital systems--the circulatory and respiratory systems, and the entire brain. Therefore, when making a diagnosis of death, it is imperative that no one be determined or declared dead unless and until there is destruction of at least these three basic unifying systems.
Criteria for declaring death are not something to take lightly. As long as "brain death" continues to be accepted and used as a sole diagnosis for death, some patients will be sent to the grave prematurely.
God alone is the Author of a person's life, and He alone may determine when a person's life will end. Since human life is a gift from God, there is a primary moral obligation to show reverence for that life at all times from its beginning until death. Any failure to show reverence for or to safeguard life is an attack on the individual patient, on others involved, on the medical profession, on society, and on God.
I think that brain dead is to be dead. But I would specify that brain death should mean death of the lower parts of brain, namely "brainstem death". When the conscience is over but the brainstem continues to integrate the cardiopulmonary system the individual is not dead. At this point we don't assume the concept of "neocortical" death but we have to decide policies about euthanasia and organ trasplants. We have to treat a living organism that hasn't biographical life but has still biological life and we can't fulfill our purposes treating the individual as dead.
I am a nurse and I believe "brain dead" to be dead. Like others have stated, without the machines breathing for the body, the heart would stop beating. I think it's unethical and painful to keep a person on a ventilator if they are "no longer there anymore". I believe a person should be taken off all life-support when there is no longer brain function.
To answer your question yes I believe when the brain is dead that is enough. As a student I have studied the brain and I believe when it has sustained enough damage there is no return. It is beyond my comprehension why people want to hang on to a loved one by placing them on "life saving" machines there is no life anymore just a body. I speak from experience when I say there is nothing more painful that watching someone you love waist away. God is merciful when death is quick I don't understand why people want to prolong the enviable and watch it take place.
By definition, brain dead is when the patient can no longer breathe, and would have died from that cause if technology didn't exist to sustain ventilation. So why would someone keep their family member on a machine if they were already dead? We judge death as when a body is no longer breathing. Suppose you saw someone lying in a hospital bed. You knew nothing about them before, but you had to judge them on appearance. This person was not breathing, had no response to stimuli, and reflected no qualities of life at all. You as well as I would consider them dead. But they are not, they are just brain dead. They should not be forced to keep alive by a machine. They should be able to go on to another life without any problems. To answer your question, I think that being brain dead is dead enough. Families who keep their families on machines to keep them "alive" are in my opinion, having trouble coping with the death. They as the loving family need to let the person go. They cannot keep the person alive for their own sake to deny the fact that their family member died. The family should think of the their dead family member's well being first.
The medical experts assume that the brain is the integrative principle of the body. That is, the brain is the central integrating organ of the human body and its destruction entails loss of bodily integrative unity. People who are brain dead are claimed to be dead for this reason. Defenders of this criterion say that those who are brain-dead cannot be kept alive even by advanced medical means for very long.
Dr. Alan Shewman has documented cases, however, where brain dead people have not only lived beyond two weeks on respirators (some have lived for years), but whose bodies have been able to function as a whole--some of which have even been able to recover from colds and wounds.
If this is so, then I think there is room to question whether or not the brain is in fact the integrating organ of the body. If it is not, then the person in question has not died.
As a practising neurologist in a large public hospital, my experience with brain death is significant. To answer the posed question- of course it is enough. By its very definition, the patient can no longer breathe, and would have died from that cause if technology didn't exist to sustain ventilation. More often than not, patients who linger to legal life due to the preservation of one or two brain stem reflexes undergo degeneration while still "plugged in." It is this process of apoptosis that leads to other organ systems collapsing after the brain has ceased to function. I feel strongly that if the AAN guidelines of declaring brain death are followed, there is no role for eeg or other adjunctive testing, Electric signals from the ekg leads and even the ventilator can cause false hope when lack of brain stem reflexes after 24-48 hours always bodes poorly.
I have gone through this just last year. My dad was declared brain dead. His heart was still beating but he could not breathe on his own and had no reflexes. We were going to keep him on the vent for a few days but his heart stopped beating the next day. I believe he was dead because he was not there anymore. It was just his body there. I also believe most vent patients who die on the vent are not ideal organ donors because of the changes to the organs being on the vent causes. But I believe the family should honor their wishes in donating their organs if they still meet the criteria.
I am an Organ and Tissue Procurement and Transplant Coordinator. On a regular basis, I see the anguish and heartache that accompanies a family's decision to donate the organs of a clinically brain dead loved one. I am a person with strong Christian beliefs. I believe that one's soul departs when the brain no longer functions. I believe very firmly in the current criteria that M.D.'s use in determining brain death. There is nothing quite as depressing and frustrating as working with a family that is misinformed and poorly educated (by medical personnel) concerning the definition of brain death. I could be mistaken, but as far as I know, no one who has met the criteria for brain death (or "irreversible coma") has ever survived for a prolonged period of time. If I am wrong, please let me know. I do know that once brain death has been established, the patient's organ systems quickly begin to "shut down." Usually within 24 to 48 hours, the patient will suffer cardiac and respiratory arrest. Once the heart stops beating, the patient is no longer a candidate for organ transplantation. The lives of as many as 7 people that are waiting on recipient lists miss the opportunity for a "second chance on life." Many people, medical professionals and lay people alike, are uncomfortable with the fact that a person on ventilatory assistance with a beating heart could be considered "dead." Again, I do not know of a single case in which a patient that meets the brain death criteria, is removed from ventilatory assistance, and "survives" for an extended period of time. Look into the eyes of a single organ recipient and you will understand the need for clear education and understanding of brain death. When families are properly informed and knowledgeable about the futility of "hanging on" to a clinically brain dead loved one, they are more receptive to the life saving opportunity of donating the organs of their loved ones. The tragedy of the loss of one life can save as many as 7 people and enhance the lives of as many as 120 others.
I have not seen an actual confirmation of a brain death, so I don't know the exact meaning of it. However, may I ask the experts how long it takes for the rest of the body to detect that brain function is gone, and so begin to deteriorate? My feeling is that when all the other bodily systems have stopped functioning, that would be death. Any one system still showing signs of work, then death has not set in yet. You can't lop off a foot or take out an organ to donate. This might seem weird but there is wisdom in the way the old folks prepare chicken for the table. The killed chicken is set aside for a time for that one final gasp. Sometimes the gasp would be barely perceptible but they always knew when it can already be prepared for dressing. Just chopping off the head does not mean straight to the cauldron. All bodily function should stop first. IMHO.
I have read the comments on brain death. As a professional in the healthcare field, I believe that the only way to establish death is by a flat line EEG or the absence of functioning of the higher levels of the brain. I have watched patients die on the ventilator whose families did not want to turn loose and believe that patient was gone. It is very difficult to watch a family member die during a prolonged natural death, and I am sure the families of those on a ventilator suffer immensely while struggling to make a decision to "pull the plug". In my opinion, we as healthcare professionals should give the families emotional support and all the information possible about the meaning of brain death. In the past, I also was confused about the true meaning of "death". However, now I feel confident that the flat line of the EEG means the end of the person's life as we knew that person. The soul and everything we loved about that person is gone. I will donate my organs if possible. My husband is a candidate for a heart transplant and we struggled with making the decision to accept a heart, from a spiritual standpoint. Our physician who was a Christian also gave us good advice, he encouraged us by telling us he would do it if he were in our situation.
If the heart is still pumping , your still alive
I think we should concentrate on Higher brain death rather than whole brain death. Organs are still alive and viable for transpantation, and thusly giving the gift of life from ones death. The debate of bodily death v. brain death is long over...our tecnological means has made it possiible for us to superceed body death. One could argue that does "might make right? How far away are we from nontechnologic means to perevent even brain death? In the face of our evolving society we need to someday recogize when enough is enough.
As a critical care nurse, I have had the opportunity to deal with patients who are determined to be brain dead. I have seen flat line EEGs and cerebral arteriograms that demonstrated no blood flow at all to either side of the cerebral hemispheres. How can anyone argue that brain dead is not death? These patients have no ability to feel, breathe, any of the basic functions of the brain that sustain life. I agree with the comment that eventually the body realizes that the brain is dead and begins to deteriorate. But, in the case of brain death, I think life support should be removed after the patient's family has come to terms with the fact that their loved one is gone, and if that takes disconnecting the ventilator so that they can see that their loved one does not breathe, then so be it. The only situation in which I advocate continuance of life support in the brain dead individual is in the case of organ donation.
If an individual experiences cardiac arrest followed by resuscitation, that individual is not considered to have been brought back from the dead by anyone with a minimal understanding of human physiology. However, those who should have a greater understanding (in my experience, physicians) still shy away from stating death by neurologic criteria as death. Rather, they say essentially dead or brain dead, as though that were something other than the cessation of life. A better question may be, "How do we educate those that should know the difference about death and it's finality regardless of it's origin?" Electromechanical function of the heart organ does not imply life just as cessation of the same does not imply death. And yet ventilator dependent patients are allowed to succumb to the effects of a non-intact neurological system rather than removing them from the machines that assist organ function.
A person that is "brain-dead" could in the very near future transplant more than just his or her internal organs. They can provide hands, feet, and even their entire body. Now if current medicine could keep his body healthy than maybe the brain dead person could have a "body dead" person (i.e., someone with a perfectly good brain with a failing body) attached to it? Interesting notion. As far as current laws that exist in Wisconsin, a person in a persistent vegetative state may be taken off of life sustaining measures (i.e., feeding tube or other technological or remedial supports). In this case the equipment was delaying imminent natural death of the body. If the person had an advance directive or power of attorney for health care instrument the matter would be easy to solve -- regarding what should be done in such a circumstance. The best solution is that the person chose what is to be done with his body. In this case the individual's right to chose what course is to be taken, considering his options (i.e., cost of health care, emotional and physical drain on family members, etc.). If a person does not have an "just in case" kind of "end of life instrument" the person's making the decision to continue or stop support measures must act in "the best interests" of our brain dead person. We know that if I, as a guardian of such a person, decide to continue care because of my own religious beliefs-knowing that my good "brain dead" friend is a long-standing Christian Scientist, than I am not acting in that person interests. The "best interest imperative requires that I act as that person would have acted, as I and others have known that person to act in the past. It would require that I act consistent with the values and beliefs the brain dead person. In this case our brain dead friend wanted to have his organs donated. This can only be done while it is viable. If his organs are at risk than the decision should be to no longer delay the death of his body. The person wanted it that way. With respect to health care workers attitudes, values, and opinions are not relevant and as professionals they should respect the wishes and desires of their patients. They should feel comfort in the fact that they have the right to determine what happens to their own body and not have it dictated by another. Because we live in a society, with an individualistic constitutional democracy that is the way it goes.
Although I have the highest respect for life in all of its forms I do not feel that there is a need to keep a brain dead patient alive. The body exists seperate from the soul. The body is a complex machine made of millions upon millions of microscopic parts, but what good is any machine without someone to run it? Even the most complex of computers cannot perform a task without being told to. In the same way, what good is a body without a mind? What possible function could it provide other than the prolonged anguish of those who loved the mind that once inhabited the body. A person cannot be defined as a body, but only as a soul. In a worldly existence this soul exists within the mind. For all purposes other than those on a higher plane the brain dead person is already dead.
I am an organ recovery coordinator, and have seen many brain dead patients. I truly believe with all my being that a person is truly dead when brain function in the entire brain and brain stem have ceased to function. This is irreversible and even if a brain dead person is maintained on a ventilator, the body eventually realizes that the captain is gone and will also cease to function, regardless of ventilatory support.
W. Drucker, RN CPTC
The term "brain death" is a misnomer and should be deleted from our medical useage. Death is death is death is death. Just because science has discovered means to keep tissues functioning after death does not change the diagnosis. In the coming decades, I have no doubt that methodologies will be discovered to keep almost every human tissue functioning outside of the body. Does this mean that you your pancreas is "alive" after you die? I do not believe so. Let us avoid the laziness of speaking of "brain death" which only disorients families and speak of "death due to brain failure" or similar terminology.
Hans G. Engel, M.D.
I am only seventeen and am not a medical professional but i beleive i have a valid opinion. As i understand brain death it is final and without cure and I don't beleive that by using addititional life support after brain death you are prolonging death because the victim is already dead. I beleive that you are just prolonging burial. When my family was told that my mother was brain dead all we could do is beleive them so I truly hope that all doctors have ethics and are sure of their decisions. I think they realize the responsibility placed on them and take it seriously. I also watched the light on the respirator that lit up when my mother breathed on her own and after waiting long enough for it to light up you have no doubts that there is no one left to hold onto in that bed. I won't ever say that was easy but I also know that she was gone and that the only people that benefited were her organ recipients who she saved.
I guess the only question that iI ever wonder is, How careful are doctors?
In my opinion I think once a person is pronounced brain dead then they are dead. And so it is a criterion for death. The term “brain death” has been confessed its an inception. The real definition includes the total and irreversible cessation of the brain function and activity in both the cerebrum and brain stream. In my terms it is just saying that the body as a whole cannot function. Doctors have been trying to decide for years on what it really means. The doctor may decide if the person is really brain dead. Doctor had found out that the brain required much more energy then other organs and, if its needs were not met, it would cease to function, while other parts of the body (requiring less energy) might remain viable and even regain their activity. The result would be a dead brain in a viable body. Then the doctor has to find out if this says the brain is dead or not; and to do so they have to detect a coma and find out what caused it. In brain death there are two parts. First, the heart would eventually stop. Second, was of the cardiac prognosis an individual with a dead brain stream was already dead (because they are unconscious). In these facts I can say that if a person is considered brain dead then they are dead. They can not think for themselves, feel, move and so anything the brain controls everything if it is dead then the body is also dead. Perhaps the problem with their loved ones is that they feel that the person may come out of it and be back in there life. The loved ones feel grief, denial and simply each day they see the person the same way as the day they were pronounced brain dead and it is hard to let go of a person. But I think it is better for them to let go and let the person go on to a better life. Furthermore I believe if the brain is absent then that the brain is dead and the person can not do anything then why should they stay alive. I hate to say this but, with all the evidence gathered here you should just pull the plug and let the person die. It is a criterion for death because it is a standred rule when the brain is dead the life of the person is also gone.
From : Aarti Patel
I think there is no need to have a whole brain death. It is enough to have cortical and thalamus death. It's not easy to say always these things happened. But sometimes we can say, based on medical evidence that those things happened beyond any reasonable doubt. So, if you can not have any sort of conscious relationship you are not anymore a person. And that establishes you are not alive. Because not being is equivalent to death.
I belive that brain death is same as complete (somatic death) and there is nothing really to discuss about?
I agree with the argument made on your website. I believe that a person is dead when they are brain dead. Even though they may be breathing and have a heartbeat, if their brain is not functioning, how can they be determined to be alive? The brain is the control organ of the body that tells all the other organs how to function via the nervous system. I do not believe in "life suppport" systems unless they are supporting an organ donor.
Amy Costner, Nursing Student
I think that if a person is medically determined to be brain dead then let the person go. Being kept alive is only causing possible pain and suffering to this person and the family. Let the grieving process begin...............
A person that is brain dead isnt really dead he/she just cant respond to anything a person say's to mthem or does. technology has gone only so far why not just let the person suffer, for all we know they cant feel any of the paine we think that they are feeling?All in all, it doesent matter if they end the persons life or not , it just matters if in the end they will be able to save some of these peoples lifes one day.
Sheila Cyboron, firstname.lastname@example.org J. B. Castle High School, 45-386 Kaneohe Bay Dr., Kaneohe, HI 96744
The actual diagnosis of brain death, as defined, includes the total and irreversable cesation of brain function and activity in both the cerebrum and brain stem. As written in many states, that diagnosis is determined by the doctor that is in charge of the patients care. It is my given opinion that if all of the brain is destroyed, by whatever mechanism, the body will not be able to live on its own without continued life support, and then for only a short period of time. In talking with many religious persons, the soul of the individual is contained in the upper portion of the brain, the area that controlls emotion, thought and intelligence. If this area is destroyed to a point that no blood, "the life" of the body cannot reach this portion for an extended period of time, then the metabolism is shut down and all electrical and biochemical responses are stopped thus terminating the function of the soul. When diagnosing brain death it is important to determine that no blood is reaching the upper portion of the brain, this should be done by confirmatory testing, and can only be accomplished by cereberal blood flow. At present this test is not required by law, but for myself, I would encourage all individual to request this test. I justify my decision in that clinical exam, no matter how skilled the doctor is, has a very minimal chance for error. I do believe that if all reflexes from the brain are absent then that brain is dead, as long as no paralytics,cold body temps,hypovolemia etc are present. But as for myself, I need to see that all blood flow is stopped, not just speculate due to abscence of reflexes.
It is really hard to believe that a person labeled as "braindead" could make any recovery at all. It would be a tough decision, but I believe that it would be easier to pull the plug than to sit back and watch (a family member, or whoever) waste away motionless and non responsive. Hopefully in the future we will have the technology to repair major brain injuries or even brain death, but until we do, their will always be a strong debate over this issue.
I think that once a person has been declared brain dead, then the person is dead. There is no hope for a normal life after brain death has been declared. The person should be allowed to die, not forced to linger on life supports.
I believe that if one is found brain dead, then they are officially dead. Number 1 they are unable to think, talk or anything else. They are costing their families money for nothing. If there is no hope then keeping them alive is only painful. I am open for any thoughts or comments.
I just read your comments and would like to add some outlook. I also have some questions of people who are reading this and are in medical profession. What is the exact scientific definition of Death? If it happens to be either the stopping of the brain or the stopping of the heart either one of them can be replaced. Would a brain transplant change the whole personality of a person? Has it ever been tried before by doctors in experiments? Maybe in future people use the process of cloning to use cloned ones as scape goats to grow organs and replace those organs in actual humans. Can one of you explain me what is the scientific definition of death? And if it is the death of the brain or death of heart I don't think it is a valid reason to loose a loved one if you could replace those with donated organs to save other people.
Question is that is it that simple. And if so then why donot doctors do it??
The problem with PVS is that the time scale used at least in the U.K. to determine the persistancy of the state is not fixed and will change from the diagnosis of one consultant to another. 6 mnths is typical for those consultants keen on an early organ harvest ( or on proving the point that no one recovers after that time - of course they won't if you kill them ). The main criteria in such cases is often the absence of improvement during a given time period, although the likeklyhood of any degree of improvement decreases accordingly, there are many documented cases of patients achieving marked degrees of recovery and functioning after having been diagnosed as being in a progressive vegetative state. The doctors concerned are in the awfull position of having to make a probabistic diagnoses that may be wrong and may deprive someone of the chance of recovery. If they don't make the decision those waiting for organs may die. Wot do ya do???
The best standard to use for determining when death occurs is the traditional one: cessation of heartbeat and breathing.
No artificial means should ever be used in the attempt to stave off death. All artificial means can only be use when and if the person is, well, already dead. That's why they need CPR or a respirator; they're dead. Once the traditional standard is rejected, we open the door to technology, and technology has no ethics per se. Our technological abilities will increase and we will keep people alive by any means necessary. Whatever can be done will be done and no one, NO ONE, will be permitted to draw any ethical limits. Why should they?
This is our problem, having rejected the traditional standard, we have opened the door to technology and it has become impossible to determine now when death occurs. It occurs now when our abilities to keep dead people alive through machines fails (or fails to bring them back from the dead). But our technological expertise will only increase, and push that limit ever farther.
Alex Mac Donald, Little Rock, AR
My neice was in a car wreck a year and a half ago. She was labeled brain dead and we "pulled the plug" two hours later. If a person is considered brain dead there just doesn't seem to be any hope for a fruitful life should recovery occur. It was a difficult decision.
I feel that if the person who was braindead was going to die anyway and had signed all the forms than his/her organs should be given to people whose lives they might save
Brain death as a criterion for death is fine in deciding on a fairly acute basis when to disconnect artificial life support mechanisms in an intensive care unit or hospital situation. This definition has served us well in that regard. The obvious implication of using this definition is that there are many transplantation opportunities which are missed with this definition when a person must be dead in order to harvest critical tissues. It seems to me that the best way to avoid this implication would be change the circumstances in which harvesting is allowed rather than to change the definition of death. In an earlier poll conducted by Dr. Bernstein, the term "permanent vegetative state" was defined. The poll showed that a majority of the respondents did not accept this definition as meaning death. I do not believe that this will be accepted as death by any other group. A more useful designation to allow for more harvesting would be something like "acutely dying without chance of recovery". A definition would include elements suggesting that there is no appreciable chance of survival and a short time limit until death is assuredly expected eg. 12 to 48 hours. Studies could be made to determine the "LD100" and the time limits until death. Organs could then be harvested with the consent of the individual if the individual is conscious or by the family if the individual is not expected to ever have a period of consciousness before death. This change in law would allow for the definition of death not to interfere with harvesting opportunities. Of course, the people in a permanent vegetative state (those without cortical functioning) are not included in this definition.
Yes, I was wondering if someone would give me a statement or an argument from a respected source dealing with the fact that, brain death is used for patients who do not have the possibility of recovery, it was a safegaurd for those who did have that possibility. However, anencephalic babies have no possibility of recovery and therefore should not need the requirements of brain death, so as to use their organs for transplantation. If any information or statements could be found on this topic, I would appreciate it if some one would contact me. Thank you.
As a student nurse and a mother it is my hope to never have to make the decision of death for a patient or my child. However, when the loss of one life, that will never really be a life, can save one or more other lives, it is my opinion to preserve the life of the one who will actually have life. As a health care worker it is my responsibility to not only provide the best quality care for a person, but to do so in a manner that will perserve dignity. Death with dignity is a right that all patients have, to keep a person in a constant vegitative state when there is no hope for life is neither quality care or perserving dignity.
This is my opinion at this time. As I face new situations in my career, I am sure that my opinion will change. That is one of the greatest things about health care it is always changing.
Trisha Taylor OU College of Nursing
International Network for the Definition of Death
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