Jahi McMath: Lessons Learned

Scott, Maya

doi:10.1542/peds.2020-0818p

Cited by 5 publications

(1 citation statement)

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“…Those who had experienced mistrust were more likely to want not to give up, wait on a miracle or not believe in DNC. In considering how to manage refusals, it is important to recognize that not accommodating refusals is likely to have disparate impact on already marginalized groups, as the role for trauma and bias in such groups has been acknowledged (16, 17).…”

Section: Discussionmentioning

confidence: 99%

Refusals of the Determination of Death by Neurologic Criteria: A Mixed Methods Study of Physician Perspectives on Refusals Cases*

Paquette¹,

Ross

Chavez

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: Refusals to allow examination for determination of death by neurologic criteria (DNC) challenge pediatric physicians and create distress for medical teams and families of patients suspected to meet criteria for DNC. The objective of this study was to inquire about and assess experiences with such refusals from the perspective of physicians. DESIGN: We conducted a mixed-methods survey and interview-based study to understand physicians’ experiences with refusals. SETTING: An online survey was sent to pediatric intensivists and neurologists; phone interviews were conducted in a subset. PATIENTS/PARTICIPANTS: The study included 80 physician survey respondents and 12 interview physician respondents. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Refusals occur for many reasons regarding patients with both acute and progressive brain injury. The most common reasons were consistent in surveys and interviews and include “waiting on a miracle,” not wanting to give up, religious objections and disbelief in brain death. Time was an important mediator in many cases. Physicians described several approaches to managing refusals, highlighting the impact on medical teams, distraction from other patients, and need for resources to support physicians. CONCLUSIONS: Refusals may have important sociodemographic associations that should be considered in managing complex cases. Physicians seek more guidance in law and policies to manage refusals.

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Section: Discussionmentioning

confidence: 99%