Brain Death: The Asian Perspective

Chua, H C; Kwek, Tong Kiat; Morihara, Hirofumi; Gao, Daiquan

doi:10.1055/s-0035-1547539

Cited by 23 publications

(15 citation statements)

References 16 publications

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“…There is no uniform neurological standard in death determination because of the variability in practices and perceptions of the global medical community about brain death (Wahlster et al 2015 ). The neurological determination of death varies among countries with regard to the use of whole brain criteria or brainstem criteria, and the mandatory performance of confirmatory tests (Ding et al 2015 ; Citerio and Murphy 2015 ; Chua et al 2015 ; Varelas 2016 ; Cameron et al 2016 ). Confirmatory tests include neuroimaging of cerebral blood flow and electrophysiological studies of the cerebral hemispheres and the brainstem.…”

Section: Introductionmentioning

confidence: 99%

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Choong

Rady

2016

HEC Forum

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The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A (A Child) [2015] EWHC 443 (Fam). Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: (1) the tests of brainstem function were not properly undertaken in this case; (2) the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and (3) absent authentication of the clinical criteria of death, the code of practice (in fact, although implicitly rather than explicitly) wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A (A Child) is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society.Electronic supplementary materialThe online version of this article (doi:10.1007/s10730-016-9307-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Choong

Rady

2016

HEC Forum

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“…1 2 3 4 5 6 However, some countries still do not have medical standards for BD/DNC, and there is also international and intranational variability between the protocols that do exist. 3 4 7 8 9 …”

Section: Introductionmentioning

confidence: 99%

“… 12 Despite this, the review of worldwide BD/DNC protocols reported by Wijdicks in 2002 included only 22 countries in Asia and the Pacific (39% of the countries in this region), 18 of which had protocols for BD/DNC (83% of countries reviewed in the region, 35% of countries in Asia and the Pacific). 4 Similarly, the international survey performed by Wahlster et al 3 in 2015 of physicians who are involved in declarations of BD/DNC included only 27 countries in Asia and the Pacific (47% of countries in the region), 17 of which had protocols for BD/DNC (63% of countries reviewed in the region, 30% of countries in the region), while the review by Chua et al 9 in 2015 of Asian protocols included protocols from only 14 countries (25% of countries in Asia and the Pacific).…”

Section: Introductionmentioning

confidence: 99%

“…Wijdicks, 4 Wahlster et al, 3 and Chua et al 9 all noted inconsistencies between protocols in the region in the criteria used for determining BD/DNC. However, these studies were all limited reviews, and while they addressed 1) the number of examiners, 2) observation time, 3) time between examinations, 4) concordance/discordance with the American Academy of Neurology (AAN) BD/DNC Practice Parameters, 5) target value and procedure of apnea testing, and 6) requirement for ancillary testing, they did not delve into the more-nuanced aspects of BD/DNC protocols, such as the 1) process used to rule out the effect of drugs on the evaluation, 2) minimum temperature and blood pressure for an evaluation to be performed, 3) technique used to assess each component of the examination and the findings of BD/DNC, 4) preparation for apnea testing, 5) reasons to end apnea testing, 6) accepted ancillary tests, 7) need for communication with a person's family, 8) time of death, and 9) discontinuation of organ support.…”

Section: Introductionmentioning

confidence: 99%

“… 13 The existence of a BD/DNC protocol in a given country is dependent on acceptance of BD/DNC as death, access to resources (including experts in the neurosciences/critical care), the presence of a transplant network, and local laws. 3 9 14 Religious beliefs markedly influence the acceptance of BD/DNC as death, and so it is noteworthy that there are various major religions in countries in Asia and the Pacific region (Buddhism, Catholicism, Confucianism, Hinduism, Islam, Shintoism, and Taoism), some of which are unique to the region. 9 Because of this, the perspectives on BD/DNC among residents of countries in Asia and the Pacific can differ from those among individuals in other parts of the world.…”

Section: Introductionmentioning

confidence: 99%

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Determination of Brain Death/Death by Neurologic Criteria in Countries in Asia and the Pacific

et al. 2020

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Background and Purpose We sought to 1) identify countries in Asia and the Pacific that have protocols for the determination of brain death/death by neurologic criteria (BD/DNC) and 2) review the similarities and differences of these protocols in different countries. Methods Between January 2018 and April 2019, we attempted to communicate with contacts in the 57 countries in Asia and the Pacific to determine if they had official national BD/ DNC protocols. We reviewed and compared the identified protocols. Results We identified contacts for 40 (70%) of the 57 countries in Asia and the Pacific, and successfully communicated with 37 of them (93% of countries with contacts identified, 65% of countries in Asia and the Pacific). We found that 24 of the 37 countries had BD/DNC protocols. Two (13%) of the 16 protocols that provided a definition of death referred to brainstem death. Kazakhstan and Israel required only 1 examination to declare BD/DNC, while 10 (71%) of the other 14 protocols required 2 examinations separated by 6-48 hours. The prerequisites, clinical examination, apnea testing procedure, and indications for/selection of ancillary tests varied. Ancillary testing was required for all determinations of BD/DNC in five (21%) countries. Thirteen (54%) of the protocols included information about the time of death, while 12 (50%) of them provided instructions about discontinuation of organ support. Conclusions The protocols for conducting a BD/DNC determination vary markedly among countries in Asia and the Pacific. Since it is optimal to have internationally and intranationally consistent BD/DNC protocols, efforts should be made to harmonize protocols both within this region and worldwide.

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Brain Death: Understanding the Process of Brain Death Declaration Through Real-Life Case Scenarios

Lele

Souter

2017

Challenging Topics in Neuroanesthesia and Neurocritical Care

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Brain Death: The Asian Perspective

Cited by 23 publications

References 16 publications

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

Determination of Brain Death/Death by Neurologic Criteria in Countries in Asia and the Pacific

Brain Death: Understanding the Process of Brain Death Declaration Through Real-Life Case Scenarios

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