What to do when families won’t accept brain death as final word

The Uniform Determination of Death Act (UDDA) defines death as an irreversible cessation of circulatory and respiratory functions or irreversible cessation of fall functions of the entire brain, including the brain stem. This is in accordance with accepted medical standards. While interpreting the UDDA definition and applying neurological criteria for diagnosing brain death seems straightforward, it is not. Brain death is socially situated, not observer-independent, and ethically fraught.

The December issue of AMA Journal of Ethics® (@JournalofEthics) investigates growing ethical, social and legal complexities of determining brain death. It also gives you an opportunity to earn CME credit.

Articles include:

1. What should we do when families refuse testing for brain death?

   Two commentaries respond to a case about apnea testing to confirm death by neurologic criteria.

2. How should clinicians respond when patients’ loved ones do not see ‘brain death’ as death?

   Religious and cultural values can conflict with clinical standard practice and law.

3. How educators can help prevent false brain death diagnoses

   For many physicians, lack of understanding about brain death leads to confusion and muddles interactions with patients’ loved ones at the end of life.

4. Inconsistency in brain death determination should not be tolerated

   Since 1995, the American Academy of Neurology has provided guidelines for brain death determination, but nationwide adherence to these guidelines has been incomplete.

In the journal’s December podcast, Ariane Lewis, MD, discusses how to navigate uncertainties around brain death by understanding the clinical criteria for death determination and the way our relationship to death is culturally and socially situated. Dr. Lewis directs neurocritical care at New York University Langone Medical Center.

Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

These AMA Journal of Ethics CME modules are each designated by the AMA for a maximum of 1 AMA PRA Category 1 Credit™:

• How should clinicians respond when patients' loved ones do not see 'brain death' as death?
• What does the public need to know about brain death?
• Death's troubled relationship with the law
• What should we do about the mismatch between the legal criteria for death and how brain death is diagnosed?
• Should a patient who is pregnant and brain dead receive life support, despite objection from her appointed surrogate?

Additionally, the CME module, “Ethics talk: How do we know who's dead?,” is designated by the AMA for a maximum of 0.25 AMA PRA Category 1 Credit™.

The offering is part of the AMA Ed Hub™, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content—in one place—with relevant learning activities, automated credit tracking and reporting for some states and specialty boards.

Learn more about AMA CME accreditation. 

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication.

Upcoming issues of the AMA Journal of Ethics will focus on legacies of the holocaust in health care as well as part one of a two part series on racial and ethnic health equity in the U.S. Sign up to receive email alerts when new issues are published.