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Brain death hard to understand, even for doctors

Two heartbreaking medical cases have been making headlines over the past few weeks. One patient is a young woman who is about three months pregnant; the other is a 13-year-old girl. Both have been declared brain dead, and their families have taken very different but equally adamant stands on what should be done next.

Doctors believe the pregnant woman suffered a pulmonary embolism, a blood clot or similar arterial blockage in the lung that can stop blood flow to the lung which in turn can lead to cardiac arrest. Her husband has asked that she be taken off life support. It is, he argues, what she would have wanted. The hospital's answer is a firm "no." The husband has turned to the courts, but the issue is not just his wife's right to make decisions about her life.

The court could end up addressing the constitutionality of a law in that state that requires hospitals to keep pregnant patients on life support even if their health care directives say otherwise. (According to Westlaw, there is no such law in New York.)

The teenager suffered complications following a tonsillectomy that resulted in cardiac arrest. When the medical team informed her family that she was brain dead, the family insisted -- and a court agreed -- on keeping her on life support. There is hope, they say. She is still alive, somewhere, in that body. The court order was necessary because the hospital has a policy that requires life support to be removed after a patient has been declared brain dead. The family recently moved her to another facility.

While the families struggle with their own tragedies, many of us struggle with the concept of brain death. Even doctors don't fully understand what it means, according to Art Caplan, a professor of bioethics at New York University-Langone. And because they don't understand, they cannot explain it -- and that can be a problem for patients' loved ones.

In our next post, we will discuss the definition of brain death and how doctors' confusion can hurt families and expose the hospital and the doctor to negligence claims.

Sources: 

Modern Healthcare, "Not all docs clear on meaning of 'brain death'," Sabriya Rice, Jan. 14, 2014

WFFA-TV, "Husband sues to remove pregnant wife from life support," Marjorie Owens, Jan. 14, 2014

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