How Educators Can Help Prevent False Brain Death Diagnoses

Fourcand, Farah; Barratt, Diana

doi:10.1001/amajethics.2020.1010

AMA Journal of Ethics

2020

DOI: 10.1001/amajethics.2020.1010

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How Educators Can Help Prevent False Brain Death Diagnoses

Farah Fourcand

Diana Barratt

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Cited by 3 publications

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“…This has motivated a call for widespread educational initiatives that better prepare medical professionals to diagnose and discuss WBD. 12,13 Furthermore, although there is a growing literature on medical students' knowledge about WBD, there is scant evidence related to students' attitudes toward different views of death.…”

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confidence: 99%

Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

Ludka

Brummett

Wasserman

2023

Neurology Education

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Background and ObjectivesVaried meanings of death within medicine, bioethics, and society at large often produce disagreement and frustration between physicians and surrogate decision makers. We investigated whether teaching medical students about the philosophical aspects of death would change their attitude toward surrogate decision makers who assert nonstandard views of death.MethodsAn 80-minute lecture covering philosophical debates surrounding medico-legal standards of death was given to second-year medical students at Oakland University William Beaumont School of Medicine during a neuroscience course. Participants completed a questionnaire containing Likert scale and open-ended questions before and after the intervention assessing their acceptance of, frustration toward, and likelihood of accommodating a request for surrogate decision makers who posited either a whole-brain, high-brain, or circulatory view of death. Change in knowledge was analyzed using the McNemar test, whereas attitudinal scores were compared with pairedttests. Open-ended responses were narratively analyzed to identify themes that elaborate quantitative findings.ResultsA total of 43 paired responses were analyzed from second-year medical students. Following the intervention, students expressed less frustration (χ¯diff= −0.64, 95% CI −0.15 to −1.15), greater likelihood of accommodating ventilator removal (χ¯diff= 0.60, 95% CI 0.41–0.85), and greater acceptance (χ¯diff= 0.63, 95% CI 0.28–0.91) of surrogates who endorsed a whole-brain view of death. Although students rated the high-brain view as more acceptable after the lecture (χ¯diff= 0.63, 95% CI 0.28–0.91), they were not more likely to remove a ventilator from a patient who had experienced high-brain death (χ¯diff= 0.19, 95% CI −0.30 to 0.67). Students were less likely to continue artificial ventilation for a brain-dead patient (χ¯diff= −0.61, 95% CI −0.91 to −0.30) despite no change in frustration toward the surrogate (χ¯diff= −0.26, 95% CI 0.20 to −0.70).DiscussionChanges in attitudes across the 3 views of death suggest that increased awareness of the philosophical debate facilitates reflection of students' understanding and opinion of death. These findings support implementation of educational interventions to prepare students for future work with surrogate decision makers holding diverse sets of views on death.

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confidence: 99%

Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

Ludka

Brummett

Wasserman

2023

Neurology Education

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Can Cotard Syndrome Be Induced?

et al. 2023

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Cotard syndrome is a rare condition characterized by delusions ranging from a belief that one has lost organs to insisting that one has lost one's soul or is dead. This is the report a case of a 45-year-old man who was comatose after an attempted suicide. This was initially diagnosed as brain death and use of his organs for transplantation was actively considered. However, he awakened days later with new-onset Cotard syndrome. It remains difficult to know the link, unconscious or conscious, between this patient's delusions and the fleeting intention of doctors who intended to transplant his organs. This is the first description of a coincidence between delusional denial of an organ and the potential medico-surgical act of having an organ removed. This case is an opportunity to revisit the philosophical concepts of negation and nihilism. A multidisciplinary reflection is needed to give meaning to other clinical presentations.

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A Simulation to Improve Understanding and Communication of Ethical Dilemmas That Surround Brain Death

Ludka,

Nguyen,

Menkes

et al. 2024

MedEdPORTAL

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Introduction Providers across multiple specialties may be called upon to perform brain death assessments at hospitals that lack specialty neurology or critical care services. To address this need, we developed a brain death curriculum involving simulation and group discussion to prepare medical trainees for brain death testing and communication with surrogate decision-makers. Methods A 1-hour session was delivered to trainees rotating through the intensive care unit at William Beaumont University Hospital. One trainee per session participated in a simulation involving a brain-dead patient (SimMan 3G Mannequin) and spouse (confederate) while the remainder of the cohort observed from a separate room. The trainee briefed the spouse about the brain death examination, performed the examination, and communicated their findings. Afterward, the cohort discussed the history, law, and common ethical and communication issues that surround brain death. Results A total of 35 trainees participated from August 2022 to March 2023. After the session, trainees were more comfortable performing brain death testing ( p < .001), responding to ethical issues ( p < .001), and communicating with families ( p < .001). However, the session did not change their frustration with family members who have a circulatory ( p = .72) or high brain ( p = .52) view of death. Discussion The simulation had a positive impact on medical trainees’ ability to perform brain death testing and their comfort level in discussing complex ethical issues that surround brain death. Our results support continued simulation training for medical trainees to better prepare them for clinical practice.

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How Educators Can Help Prevent False Brain Death Diagnoses

Cited by 3 publications

References 22 publications

Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

Can Cotard Syndrome Be Induced?

A Simulation to Improve Understanding and Communication of Ethical Dilemmas That Surround Brain Death

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