When patients do not recognize “families” “brain death” as “death”

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Dr. Frank Brodkey explains why it is absolutely necessary that he is determined according to neurological criteria according to medical standards.

“All stories, if they are continued far enough, end in death, and he is no wonder of the true story that would prevent them from.”

Ernest Hemingway Death in the afternoon

In my last post, I have checked the possible pitfalls of the determination of “brain death/death by neurological criteria (BD/DNC) and the reasons why families and the public have given” brain death “as” death “as a” death “. As already mentioned Reject extubation and consider further aggressive medical treatments by a legally dead patient.

It is both ethically and legally necessary that BD/DNC will be determined in accordance with the recognized medical standards without a doubt. Every remaining doubt among the family should be freed from time, repeated examinations and second opinions. Additional tests, although they are usually not necessary for the determination of the BD/DNC, can still be calming to the family.

Families and hospital employees who are faced with this dilemma require emotional support. A feeling of cultural humility should be maintained by the employees, which corresponds to ethical responsibilities. A hospital-wide ethics committee or a similar group, which is involved with the ICU care, should be set up in order to unanimously serve as an official reaction of the hospital to this problem, which demonstrates the family's seriousness and severity of the hospital in these and related matters. There is BD/DNC A medical Determination can be or can not Be suitable for playing a role in this process; However, they should be involved in the family. Depending on the wishes and comfort of the family and the staff, the intensive careist present can be part of the committee or not.

A significant percentage of the BD/DNC patients will spontaneously develop cardiac arrest, even if these considerations take place. It is therefore important to try to arrange an agreement not to speed up the treatments (e.g. CPR). This is often acceptable for families, even if the withdrawal of care is not the case. As a rule, it is easier for families to agree, not to advance therapies than to stop the starters that have already started.

Applications for additional time for the decision are common and should be granted freely. However, extended periods (more than a few days) seem to be inappropriate and disrespectful for both the patient and the caregiver and should be avoided.

The personal, religious or cultural beliefs of a family should be accepted with reasonable respect. However, there is no obligation by the nursing team to agree to non -scientific or non -legal doctrines. The language is of crucial importance in these discussions, and unfortunately patients are properly mentioned in the past. In addition, BD/DNC patients should always be called “dead”, not “brain dead”, “potentially dead” or “probably dead”. Similarly, fans, pressors and other supportive treatments and devices should be called names and function and never described as “life maintenance”.

In order to avoid confusion about goals and conflicts of interest, it is important that potential organ donation never plays a role in these discussions, unless the family is expressly requested. Of course, families also have to understand that previously authorized donations, such as being made during the driving license notation, have to be honored ethically and legally.

It is to be hoped that the procedure in these fixed, but conscious and respectful manners will lead to a reasonable course that is free from the need for legal intervention.