0
Correspondence |

Controversies After Brain Death: When Families Ask for More FREE TO VIEW

Ariane Lewis, MD; Panayiotis Varelas, MD, PhD; David Greer, MD, MA
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: P. V. is a member of the advisory board of Gift of Life in Michigan. D. G. is the editor-in-chief of Seminars in Neurology. None declared (A. L.).

CORRESPONDENCE TO: Ariane Lewis, MD, Division of Neurocritical Care, Department of Neurology, NYU Langone Medical Center, 530 First Ave, HCC-5A, New York, NY 10016


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):607-608. doi:10.1016/j.chest.2015.09.040
Text Size: A A A
Published online

Luce described the case of Jahi McMath, a teenager whose family requested organ support be continued after she was declared brain dead, citing religious objection to death by neurologic criteria. Only four states (California, Illinois, New Jersey, New York) have laws about how to handle religious objection to brain death. Whereas New Jersey’s statute is very clear about how to manage situations like the McMath case, the laws in the other three states are vague (Table 1).,,, Thus, there is no concrete guidance for physicians in 98% of the country (49 states) about how to behave in situations like the McMath case.

Table Graphic Jump Location
Table 1 Accommodation Laws by State

Should a brain death evaluation be performed in spite of a family’s objection to determination of death by neurologic criteria? Once an evaluation has been performed and a patient is determined to be brain dead, is family permission necessary to discontinue organ support? If support is continued, should vasopressors, hormones, or antibiotics be started if clinically indicated? Should a do-not-resuscitate order automatically be issued, or should the family be allowed to determine code status? Should the patient be kept in an intensive care unit or transferred to a regular floor or long-term care facility? Should a time frame for discontinuation of support be mandated, or should support be continued until the patient exhibits a terminal cardiac rhythm? If support is continued until the patient becomes asystolic, should the death certificate reflect the time of death by neurologic criteria or the time of asystole? Who should be fiscally responsible for the patient’s care after brain death determination?

These controversies are particularly challenging because they produce emotional distress for both the family and the medical team at a time that is already wrought with raw emotion. The ethical responsibilities of physicians facing these circumstances are gray given the competing desires to (1) respect families, (2) maintain a patient’s dignity, and (3) optimize intensive care resources and health-care dollars. Furthermore, physicians may fear repercussions of ignoring a family’s wishes, such as legal action, negative publicity, or job loss.

Because solving these controversies is a formidable task for individuals or institutions, we recommend the creation of guidelines on management of these complex situations. Additionally, families may request continuation of organ support after brain death because of nonacceptance of death or the desire to await arrival of other family members, so physicians also need guidance to manage these scenarios.

References

Luce J.M. . The uncommon case of Jahi McMath. Chest. 2015;147:1144-1151 [PubMed]journal. [CrossRef] [PubMed]
 
California AB 2565 Assembly Bill. 2008.http://www.leginfo.ca.gov/pub/07-08/bill/asm/ab_2551-2600/ab_2565_bill_20080927_chaptered.html. Accessed November 17, 2015.
 
Illinois Compiled Statutes 210 ILCS 85 Hospital Licensing Act. Section 6.24—Illinois Attorney Resources—Illinois Laws. 2008 [cited 2015 Aug 13].http://law.onecle.com/illinois/210ilcs85/6.24.html. Accessed November 17, 2015.
 
Halperin JJ, Sori A, Grossman BJ, Rokosz GJ, Strong C. Guidelines for determining death based on neurological criteria: New Jersey. 2014.http://www.njsharingnetwork.org/file/Brain-Death-Guidelines-July-27-2014sq-2.pdf. Accessed November 17, 2015.
 
New York State Department of Health and New York State Task Force on Life and the Law. Guidelines for Determining Brain Death. 2011.http://www.health.ny.gov/professionals/hospital_administrator/letters/2011/brain_death_guidelines.htm. Accessed November 17, 2015.
 

Figures

Tables

Table Graphic Jump Location
Table 1 Accommodation Laws by State

References

Luce J.M. . The uncommon case of Jahi McMath. Chest. 2015;147:1144-1151 [PubMed]journal. [CrossRef] [PubMed]
 
California AB 2565 Assembly Bill. 2008.http://www.leginfo.ca.gov/pub/07-08/bill/asm/ab_2551-2600/ab_2565_bill_20080927_chaptered.html. Accessed November 17, 2015.
 
Illinois Compiled Statutes 210 ILCS 85 Hospital Licensing Act. Section 6.24—Illinois Attorney Resources—Illinois Laws. 2008 [cited 2015 Aug 13].http://law.onecle.com/illinois/210ilcs85/6.24.html. Accessed November 17, 2015.
 
Halperin JJ, Sori A, Grossman BJ, Rokosz GJ, Strong C. Guidelines for determining death based on neurological criteria: New Jersey. 2014.http://www.njsharingnetwork.org/file/Brain-Death-Guidelines-July-27-2014sq-2.pdf. Accessed November 17, 2015.
 
New York State Department of Health and New York State Task Force on Life and the Law. Guidelines for Determining Brain Death. 2011.http://www.health.ny.gov/professionals/hospital_administrator/letters/2011/brain_death_guidelines.htm. Accessed November 17, 2015.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543