Elsevier

Journal of Critical Care

Volume 29, Issue 5, October 2014, Pages 872-874
Journal of Critical Care

Special Section. "Death by Neurologic Criteria 1968 - 2014: Changing Interpretations"
“As good as dead” and is that good enough? Public attitudes toward brain death

https://doi.org/10.1016/j.jcrc.2014.06.018Get rights and content

Introduction

Death by neurologic criteria entered the language with the term, brain death. What is not clear is how much people truly understand or agree with the term even as they use it. Since 1978, state laws have established that a person dies after the irreversible loss of brainstem and higher function [1]. There is widespread public acceptance of the general idea, enough to allow the transfer of organs from the newly dead to the living. But the reality of brain death, especially to those able to observe it up close, is not so straightforward. As the debate over its authenticity rages among bioethicists [2], there is a parallel misgiving with the public that erupted recently with the case of Jahi McMath, a brain-dead teenager whose path to the morgue was blocked by court order [3]. More pervasively, the public’s trouble with neurologic death fuels other tensions in health care, such as mistrust of physicians and claims of inequity in the health care system. The transplant industry, meanwhile, faces a growing shortage of available organs. All they can hope to do is increase the rate of consent for donation, now ranging from 59% to 77% around the country [4]. This article will examine the public’s view of brain death, and how revising how we label the brain-injured patient may be just what the public wants.

Section snippets

Death as a social construct

Historically, death has been an observable part of daily life. It has been the subject of cultural ritual, beginning as early as the Cro-Magnon era, through the embalming techniques of the Egyptians, to the early Christian belief of the soul departing in the body’s last breath [5]. Death has always been an immediate event seen through the slow progression from rigor mortis (stiffening of the body), livor mortis (discoloring of the body), or algor mortis (changes to the eyes) [6]. In fact, death

The experience of the donor patient’s family

But unlike circulatory death, where the body loses heat and changes color, defining neurologic death demands specialized training and testing. More importantly, it requires a special explanation. The most authentic source of public attitudes toward brain death comes from studies of families faced with the decision to donate. This setting allows families to hear doctors explain the meaning of the term, where their questions and doubts can be addressed.

Despite this opportunity for clarity,

The media

Adding to the public’s haze has been the popular media. Evening entertainment regularly exploits people’s deepest fears that organs would be removed from people prematurely declared dead. One study examined how sensitive people were to mischaracterizations of brain death and the transplant industry based on their personal willingness to donate [16]. They found ample examples in popular medical shows, such as Grey’s Anatomy (eg, a bike race leaves a man brain dead and the medical staff debates

Public attitudes at large

Uncertainty about brain death exists more generally and can intertwine with people’s mistrust of the medical profession. In a meta-analysis of qualitative studies [18], individuals described their belief that doctors would deliberately remove a patient’s organs, before the patient had died, whereas others believed that life-saving medical care would be withheld so that patients could become eligible for organ donation. More than attributing unethical intent is the simple fear of error. The

How important is “death”?

All these findings fan the debate among bioethicists over the authenticity and necessity of brain death. Some have argued that uncertainty even among neurologists over brain death [22] not to mention the general public argues that we should do away with the “legal fiction” and allow patient and family consent to permit organ donation when a patient’s neurologic injury has left them profoundly and irreversibly disabled [23]. Others maintain that bioethicists’ preoccupation with the brain death

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