We are picking up our discussion of brain death. The subject has made headlines in the past few weeks as two very different cases played out in national media. Neither case involves patients or providers from New York.
We discussed them in our Jan. 21 post, but it makes sense to review the facts. In the first case, a pregnant woman had been declared brain dead, but the hospital refused to take her off life support; state law prohibits ending life support for pregnant patients. In the other case, the family of a teenager held out hope for her recovery after the hospital declared her brain dead.
The courts got involved in both cases. The teen's family was able to keep her alive long enough to move her to another facility. Her condition is unknown. The husband of the pregnant woman was present when the hospital took his wife off life support; both doctors and family members knew that the fetus would not survive, and tests had revealed some significant developmental problems.
Brain death is different from a coma or persistent vegetative state. According to the American Academy of Neurology, a person is brain dead when he or she loses all of the brain's clinical functions. The condition is irreversible; "life" is only possible with the use of technology.
In contrast, a coma or persistent vegetative state -- the terms are interchangeable -- is "a profound or deep state of unconsciousness," according to the National Institutes of Health. The patient is alive but cannot move and cannot respond to whatever is going on around him. While thinking abilities and awareness are compromised, the patient retains non-cognitive function, including breathing and blood circulation.
Assuming that doctors understand the difference, they have to be able to communicate clearly what the prognosis is. We'll talk more about that in our next post.
Modern Healthcare, "Not all docs clear on meaning of 'brain death'," Sabriya Rice, Jan. 14, 2014
CNN, "Brain-dead Texas woman taken off ventilator," Caleb Hellerman. Jason Morris and Matt Smith, Jan. 27, 2014