Brain DeathBrain Death

Courtney Bartel,Courtney Bartel,Vishruth ReddyVishruth Reddy

What is Brain Death? What is Brain Death? Brain DeathBrain Death is defined as irreversible is defined as irreversible

unconsciousness with complete loss of brain unconsciousness with complete loss of brain function, although the heartbeat may function, although the heartbeat may continue; the cessation of detectable electric continue; the cessation of detectable electric activity in the cerebral cortex.activity in the cerebral cortex. Not to be confused with a persistent, Not to be confused with a persistent,

vegetative state.vegetative state.

Demonstrating Brain DeathDemonstrating Brain Death Demonstration of brain death is the accepted criterion for Demonstration of brain death is the accepted criterion for

establishing the fact and time of death. Factors in diagnosing brain establishing the fact and time of death. Factors in diagnosing brain death include:death include: Irreversible cessation of brain function as demonstrated by fixed Irreversible cessation of brain function as demonstrated by fixed

and dilated pupils, lack of eye movement, absence of respiratory and dilated pupils, lack of eye movement, absence of respiratory reflexes (apnea), and unresponsiveness to painful stimuli. reflexes (apnea), and unresponsiveness to painful stimuli.

In addition, there should be evidence that the patient has In addition, there should be evidence that the patient has experienced a disease or injury that could cause brain death. experienced a disease or injury that could cause brain death.

A final determination of brain death must involve demonstration A final determination of brain death must involve demonstration of the total lack of electrical activity in the brain by two of the total lack of electrical activity in the brain by two electroencephalographs (EEGs) taken twelve to twenty-four electroencephalographs (EEGs) taken twelve to twenty-four hours apart. hours apart.

Finally, the physician must rule out the possibilities of Finally, the physician must rule out the possibilities of hypothermia or drug toxicities, the symptoms of which may hypothermia or drug toxicities, the symptoms of which may mimic brain death. (Some central nervous system functions such mimic brain death. (Some central nervous system functions such as spinal reflexes that can result in movement of the limbs or as spinal reflexes that can result in movement of the limbs or trunk may persist in brain death.) trunk may persist in brain death.)

Defining DeathDefining Death For many centuries death has been thought to occur when the vital For many centuries death has been thought to occur when the vital

functions cease—breathing and circulation (as evidenced by the functions cease—breathing and circulation (as evidenced by the beating of the heart). This view has been challenged, however, as beating of the heart). This view has been challenged, however, as medical advances have made it possible to sustain respiration and medical advances have made it possible to sustain respiration and cardiac functioning through mechanical means. cardiac functioning through mechanical means.

Thus, more recently, the concept of brain death has gained Thus, more recently, the concept of brain death has gained acceptance. In this view, the irreversible loss of brain activity is the acceptance. In this view, the irreversible loss of brain activity is the sign that death has occurred. sign that death has occurred.

French neurologists were the first to describe brain death in 1958. French neurologists were the first to describe brain death in 1958. Patients with Patients with coma depassecoma depasse were unresponsive to external stimuli were unresponsive to external stimuli and unable to maintain homeostasis. and unable to maintain homeostasis.

In 1968 the "Harvard criteria" for determining brain death were In 1968 the "Harvard criteria" for determining brain death were published in the Journal of the American Medical Association, published in the Journal of the American Medical Association, under the title of "A Definition of Irreversible Coma.“under the title of "A Definition of Irreversible Coma.“

A majority of the states in the United States had accepted brain A majority of the states in the United States had accepted brain death as an essential sign of death by the late 1980s.death as an essential sign of death by the late 1980s.

Defining Brain Death Defining Brain Death Brain death is not medically or legally equivalent to severe vegetative Brain death is not medically or legally equivalent to severe vegetative

state. In a severe vegetative state, the cerebral cortex, the center of state. In a severe vegetative state, the cerebral cortex, the center of cognitive functions including consciousness and intelligence, may be cognitive functions including consciousness and intelligence, may be dead while the brain stem, which controls basic life support functions dead while the brain stem, which controls basic life support functions such as respiration, is still functioning. such as respiration, is still functioning.

Death is equivalent to brain stem death. The brain stem, which is Death is equivalent to brain stem death. The brain stem, which is less sensitive to anoxia (loss of adequate oxygen) than the less sensitive to anoxia (loss of adequate oxygen) than the cerebrum, dies from cessation of circulation for periods exceeding cerebrum, dies from cessation of circulation for periods exceeding three to four minutes or from intracranial catastrophe, such as a three to four minutes or from intracranial catastrophe, such as a violent accident.violent accident.

Even the concept of brain death has been challenged in recent Even the concept of brain death has been challenged in recent years, because a person can lose all capacity for higher mental years, because a person can lose all capacity for higher mental functioning while lower-brain functions, such as spontaneous functioning while lower-brain functions, such as spontaneous respiration, continue. respiration, continue.

For this reason, some authorities now argue that death should be For this reason, some authorities now argue that death should be considered the loss of the capacity for consciousness or social considered the loss of the capacity for consciousness or social interaction. The sign of death, according to this view, is the absence interaction. The sign of death, according to this view, is the absence of activity in the higher centers of the brain, principally the neocortex.of activity in the higher centers of the brain, principally the neocortex.

Defining Brain Death Defining Brain Death Difficulties with ethics and decision making may arise if it is Difficulties with ethics and decision making may arise if it is

not made clear to the family that brain stem death is not made clear to the family that brain stem death is equivalent to death. equivalent to death.

According to research conducted by Jacqueline Sullivan and According to research conducted by Jacqueline Sullivan and colleagues in 1999 at Thomas Jefferson University Hospital, colleagues in 1999 at Thomas Jefferson University Hospital, roughly one-third to one-half of physicians and nurses roughly one-third to one-half of physicians and nurses surveyed do not adequately explain to relatives that brain surveyed do not adequately explain to relatives that brain dead patients are, in fact, dead. dead patients are, in fact, dead.

Unless medical personnel provide family members with Unless medical personnel provide family members with information that all cognitive and life support functions have information that all cognitive and life support functions have irreversibly stopped, the family may harbor false hopes for the irreversibly stopped, the family may harbor false hopes for the loved one's recovery. loved one's recovery.

The heartbeat may continue or the patient may be on a The heartbeat may continue or the patient may be on a respirator (often inaccurately called "life support") to maintain respirator (often inaccurately called "life support") to maintain vital organs because brain dead individuals who were vital organs because brain dead individuals who were otherwise healthyotherwise healthy

Ethical QuestionsEthical Questions Who shall decide the criteria for death—physicians, legislatures,

or each person for him- or herself? Is advancement of the moment of death by cutting off artificial

support morally and legally permissible? Do people have the right to demand that extraordinary measures

be stopped so that they may die in peace? Can the next of kin or a legal guardian act for the comatose

dying person under such circumstances? All these questions have acquired new urgency with the advent

of human tissue transplantation. The need for organs must be weighed against the rights of the dying donor.

End Of Life IssuesEnd Of Life Issues

Money Spent of End-of-life CareMoney Spent of End-of-life Care Organ DonationOrgan Donation Right to DieRight to Die Living WillsLiving Wills

Terri Schiavo CaseTerri Schiavo Case

NOT BRAIN DEATHNOT BRAIN DEATH Terri was in a Persistent Vegetative State Terri was in a Persistent Vegetative State

(PVS) for 15 yrs(PVS) for 15 yrs PVS is wakefulness without awarenessPVS is wakefulness without awareness

Collapsed in 1990-respiratory and cardiac Collapsed in 1990-respiratory and cardiac arrest caused brain damagearrest caused brain damage

Her husband, Michael, fought for 7 years Her husband, Michael, fought for 7 years to have her feeding tube removed. Her to have her feeding tube removed. Her parents were opposed to the removal. parents were opposed to the removal.

Terri had no living will.Terri had no living will. Years of court battle created a high profile case.Years of court battle created a high profile case. Congress actually passed a bill to get federal Congress actually passed a bill to get federal

jurisdiction over the case.jurisdiction over the case. President Bush flew into DC to sign the bill at 1am. President Bush flew into DC to sign the bill at 1am. Ultimately proved to be ineffectiveUltimately proved to be ineffective

Terri’s feeding tube was ultimately removed in Terri’s feeding tube was ultimately removed in March 2005 and she died 2 days later. March 2005 and she died 2 days later.

Autopsy reports showed she would have never Autopsy reports showed she would have never recovered (Left, Normal Brain Right, Terri’s Brain)recovered (Left, Normal Brain Right, Terri’s Brain)

Ethical QuestionsEthical Questions Who shall decide the criteria for death—physicians,

legislatures, or each person for him- or herself? Is advancement of the moment of death by cutting

off artificial support morally and legally permissible? Do people have the right to demand that

extraordinary measures be stopped so that they may die in peace?

Can the next of kin or a legal guardian act for the comatose dying person under such circumstances?

All these questions have acquired new urgency with the advent of human tissue transplantation. The need for organs must be weighed against the rights of the dying donor.

End Of Life IssuesEnd Of Life Issues

Money Spent of End-of-life CareMoney Spent of End-of-life Care Organ DonationOrgan Donation Right to DieRight to Die Living WillsLiving Wills

Works ConsultedWorks Consulted

Microsoft® Encarta® Encyclopedia 2002.Microsoft® Encarta® Encyclopedia 2002. http://www.deathreference.com/Bl-Ce/Braihttp://www.deathreference.com/Bl-Ce/Brai

n-Death.htmln-Death.html