Cessation of therapy in terminal illness and brain death

The decision making process regarding the withdrawal or withholding of potential life-saving treatments in a children's hospital

“…In more recent years, studies have shown that 35-85% of deaths in intensive care units (ICU) now follow a decision to withdraw or withhold life support. [2][3][4][5][6][7][8] In these situations most of the patients will be acutely incapacitated and therefore few contribute directly to the decision making process. 4 6 In some cases patients have written "advance directives" and there is a continuing debate about the validity of these.…”

Religious and Secular Death: A Parting of the Ways

“…There are numerous articles in the literature indicating similar lists of continued functions of the brain in persons who are diagnosed as dead by the clinical criteria. 27 Concern has been raised by some intensivists that the apnoea test, in which ventilation is reduced to cause carbon dioxide levels to rise, in fact causes damage to the brain. 28 The Apnoea test would never be done on someone who was not thought to already have sustained brain death.…”

Reevaluating the Dead Donor Rule

“…surely the regulation of vital physiologic parameters such as the maintenance of free water homeostasis is a function of the brain. As it turns out, many patients who have been diagnosed as brain dead either do not develop diabetes insipidus or develop nephrogenic and not central diabetes insipidus (Grenvik, 1978;schrader et al, 1980;Outwater and Rockoff, 1984;Fiser et al, 1987;Fackler, Troncoso, and Gioia, 1988;Hohnegger et al, 1990). This provides essentially incontrovertible evidence that individuals might meet the diagnostic requirements for brain death in terms of unresponsiveness, apnea, and loss of cranial nerve reflexes, yet those patients are clearly not brain dead: It is not the case that all functions of the brain have ceased irreversibly since the hypothalamus still maintains vital physiologic parameters through the regulation of neuroendocrine secretion.…”