Ethical dilemma: Discontinuation of ventilation after brain stem death   To whom is our duty of care?   Policy should be balanced with concern for the family   Brain stem death defines death in law

Jm, Swinburn; Sm, Ali; Dj, Banerjee; Zp, Khan

doi:10.1136/bmj.318.7200.1753

Cited by 20 publications

(3 citation statements)

References 6 publications

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“…60 Thoughtful guidelines have been developed to negotiate and compassionately resolve this conflict. 61,62 Inviting family members to observe the patient's complete unresponsiveness during the brain death examination has been advocated as a solution, 63 but is difficult to manage in practice. 64 Opposition on religious grounds Religious opposition to brain death is an uncommon issue in most communities.…”

Section: Requirementsmentioning

confidence: 99%

Controversies in defining and determining death in critical care

Bernat

2013

Nat Rev Neurol

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Circulatory-respiratory or brain tests are widely accepted for definition and determination of death, but have several controversial issues. Both determinations have been stimulated by organ donation, but must be valid independently of this process. Current controversies in brain death include whether the definition is conceptually coherent, whether the whole-brain or brainstem criterion is correct, whether one neurological examination or two should be required, and when to conduct the examination following therapeutic hypothermia. Controversies about the circulatory determination of death include the minimum duration of asystole that is sufficient for death to be declared, and whether the distinction between permanent and irreversible cessation of circulatory functioning is important. In addition, the goal of organ donation raises issues such as the optimal way to time and conduct the request conversation with family members of the patient, and whether the Dead Donor Rule should be abandoned.

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Section: Requirementsmentioning

confidence: 99%

Controversies in defining and determining death in critical care

Bernat

2013

Nat Rev Neurol

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“…Family's presence during performance of brain stem tests is encouraged as it can help in strengthening the concept of brain death [2,6]. Involvement of family physicians while communicating with the families has been seen to help them understand the situation better [6].…”

Section: Is There a Solution?mentioning

confidence: 99%

“…This principal is questioned when a brain dead patient occupies a ventilated bed that could be used for a salvageable patient. In addition, treating a brain dead patient is wastage of HCWs energies that can be utilized for patients with better chances of recovery [5,6].…”

Section: Distributive Justicementioning

confidence: 99%