Brain Death

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Brain Death

• Courtney Bartel,Vishruth Reddy

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What is Brain Death?

• Brain Death is defined as irreversible
  unconsciousness with complete loss of brain
  function, although the heartbeat may continue
  the cessation of detectable electric activity in
  the cerebral cortex.
• Not to be confused with a persistent, vegetative
  state.

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Demonstrating Brain Death

• Demonstration of brain death is the accepted
  criterion for establishing the fact and time of
  death. Factors in diagnosing brain death include
• Irreversible cessation of brain function as
  demonstrated by fixed and dilated pupils, lack of
  eye movement, absence of respiratory reflexes
  (apnea), and unresponsiveness to painful stimuli.
  
• In addition, there should be evidence that the
  patient has experienced a disease or injury that
  could cause brain death.
• A final determination of brain death must involve
  demonstration of the total lack of electrical
  activity in the brain by two electroencephalograph
  s (EEGs) taken twelve to twenty-four hours apart.
  
• Finally, the physician must rule out the
  possibilities of hypothermia or drug toxicities,
  the symptoms of which may mimic brain death.
  (Some central nervous system functions such as
  spinal reflexes that can result in movement of
  the limbs or trunk may persist in brain death.)

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Defining Death

• For many centuries death has been thought to
  occur when the vital functions ceasebreathing
  and circulation (as evidenced by the beating of
  the heart). This view has been challenged,
  however, as medical advances have made it
  possible to sustain respiration and cardiac
  functioning through mechanical means.
• Thus, more recently, the concept of brain death
  has gained acceptance. In this view, the
  irreversible loss of brain activity is the sign
  that death has occurred.
• French neurologists were the first to describe
  brain death in 1958. Patients with coma depasse
  were unresponsive to external stimuli and unable
  to maintain homeostasis.
• In 1968 the "Harvard criteria" for determining
  brain death were published in the Journal of the
  American Medical Association, under the title of
  "A Definition of Irreversible Coma.
• A majority of the states in the United States had
  accepted brain death as an essential sign of
  death by the late 1980s.

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Defining Brain Death

• Brain death is not medically or legally
  equivalent to severe vegetative state. In a
  severe vegetative state, the cerebral cortex, the
  center of cognitive functions including
  consciousness and intelligence, may be dead while
  the brain stem, which controls basic life support
  functions such as respiration, is still
  functioning.
• Death is equivalent to brain stem death. The
  brain stem, which is less sensitive to anoxia
  (loss of adequate oxygen) than the cerebrum, dies
  from cessation of circulation for periods
  exceeding three to four minutes or from
  intracranial catastrophe, such as a violent
  accident.
• Even the concept of brain death has been
  challenged in recent years, because a person can
  lose all capacity for higher mental functioning
  while lower-brain functions, such as spontaneous
  respiration, continue.
• For this reason, some authorities now argue that
  death should be considered the loss of the
  capacity for consciousness or social interaction.
  The sign of death, according to this view, is the
  absence of activity in the higher centers of the
  brain, principally the neocortex.

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Defining Brain Death

• Difficulties with ethics and decision making may
  arise if it is not made clear to the family that
  brain stem death is equivalent to death.
• According to research conducted by Jacqueline
  Sullivan and colleagues in 1999 at Thomas
  Jefferson University Hospital, roughly one-third
  to one-half of physicians and nurses surveyed do
  not adequately explain to relatives that brain
  dead patients are, in fact, dead.
• Unless medical personnel provide family members
  with information that all cognitive and life
  support functions have irreversibly stopped, the
  family may harbor false hopes for the loved one's
  recovery.
• The heartbeat may continue or the patient may be
  on a respirator (often inaccurately called "life
  support") to maintain vital organs because brain
  dead individuals who were otherwise healthy

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Ethical Questions

• Who shall decide the criteria for
  deathphysicians, 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.

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End Of Life Issues

• Money Spent of End-of-life Care
• Organ Donation
• Right to Die
• Living Wills

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Terri Schiavo Case

• NOT BRAIN DEATH
• Terri was in a Persistent Vegetative State (PVS)
  for 15 yrs
• PVS is wakefulness without awareness
• Collapsed in 1990-respiratory and cardiac arrest
  caused brain damage
• Her husband, Michael, fought for 7 years to have
  her feeding tube removed. Her parents were
  opposed to the removal.

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• Terri had no living will.
• Years of court battle created a high profile
  case.
• Congress actually passed a bill to get federal
  jurisdiction over the case.
• President Bush flew into DC to sign the bill at
  1am.
• Ultimately proved to be ineffective
• Terris feeding tube was ultimately removed in
  March 2005 and she died 2 days later.
• Autopsy reports showed she would have never
  recovered (Left, Normal Brain Right, Terris
  Brain)

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Ethical Questions

• Who shall decide the criteria for
  deathphysicians, 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.

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End Of Life Issues

• Money Spent of End-of-life Care
• Organ Donation
• Right to Die
• Living Wills

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Works Consulted

• Microsoft Encarta Encyclopedia 2002.
• http//www.deathreference.com/Bl-Ce/Brain-Death.ht
  ml