+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

The Least Bad Option: Unilateral Extubation after Declaration of Death by Neurological Criteria

The Least Bad Option: Unilateral Extubation after Declaration of Death by Neurological Criteria

Journal of Clinical Ethics 26(3): 260-265

Typically, the determination of death by neurological criteria follows a very specific protocol. An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to "say goodbye," and at such a time to permit organ retrieval (with authorization of the patient or consent of the next of kin). Such a process maximizes transparency and ensures generalizability. In exceptional circumstances, however, it may be necessary to deviate from this protocol in order to spare family members unnecessary suffering and to reduce moral distress felt by clinical staff. It may also be appropriate, we argue, to refrain from even inquiring about organ donation when the next-of-kin is not only certain to refuse, but lacks the decision-making capacity to potentially consent. The case described in this article calls into question generally reliable assumptions about determination of death by neurological criteria, where the best the clinical team could do for the patient and his family was "the least bad option."

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 059016256

Download citation: RISBibTeXText

PMID: 26399676

Related references

Ventilatory management and extubation criteria of the neurological/neurosurgical patient. Neurohospitalist 3(1): 39-45, 2013

Declaration of Brain Death in Neurosurgical and Neurological Practice. Neurosurgery 15(2): 170-174, 1984

Declaration of brain death in neurosurgical and neurological practice. Neurosurgery 15(2): 170-174, 1984

Heart transplantation after declaration of death by cardiorespiratory criteria. Journal of Heart and Lung Transplantation 29(2): 232-3; Author Reply 233-4, 2010

Conceptual and practical issues in the declaration of death by brain criteria. Neurosurgery Clinics of North America 2(2): 493-501, 1991

Early declaration of death by neurologic criteria results in greater organ donor potential. Journal of Surgical Research 218: 29-34, 2017

Loss of faith in brain death Catholic controversy over the determination of death by neurological criteria. Clinical Ethics 7(3): 133-141, 2012

Death according to neurological criteria. Death certification in Argentina. Revista de Neurologia 41(5): 313-314, 2005

Brain death criteria. The neurological determination of death. Neurosciences 13(4): 350-355, 2008

Difficult extubation: extubation criteria and management of risk situations: question 6. Société Française d'Anesthésie et de Réanimation. Annales Francaises d'Anesthesie et de Reanimation 27(1): 46-53, 2008

A prospective trial of elective extubation in brain injured patients meeting extubation criteria for ventilatory support: a feasibility study. Critical Care 12(6): R138, 2008

Determination of death by neurological criteria. Missouri Medicine 86(9): 628-631, 1989

Determination of death by neurological criteria. Journal of Intensive Care Medicine 18(4): 211-221, 2004

Death determined by neurological criteria: the next steps. Intensive Care Medicine 43(9): 1383-1385, 2017

Further discussion: determination of death by neurological criteria. National Catholic Bioethics Quarterly 3(4): 667-669, 2003