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Brain death hard to understand, even for doctors, p3

We are continuing our discussion from our last post. The subject, brain death, came up a couple of weeks ago when two very sad cases made national headlines. No one involved in those cases is from New York, but people here have certainly struggled to understand what it means when a doctor declares that a loved one is brain dead.

The challenge for hospitals and physicians is to communicate to families and loved ones that brain death is irreversible. According to Art Caplan, a professor of bioethics at New York University Langone Medical Center, including the term "life support" in the discussion can be a problem for families. They will focus on the "life" part, believing, as the teen's family did, that there is hope for recovery. The provider then has to backpedal and to explain what brain death really means. But, again, the family may still be focused on the "life" in "life support."

Caplan says, too, that many doctors find it hard to explain brain death because they personally don't fully understand the difference between brain death and a coma. Neurologists are schooled in the finer points of the brain's functions, and the American Academy of Neurology delivers training and has developed guidelines regarding brain death.

That information may not make it down to the emergency room doctors or the general surgeons who handle trauma cases, people injured in car accidents or football games. These physicians are put in the position of having to explain that someone who was just on the phone with her mom an hour ago is now breathing only with the assistance of a ventilator -- that both the medicine and the law agree that the patient is dead.

The husband of the pregnant woman understood this. He and his wife were paramedics, too. The family of the teenager must have felt only that the girl had gone in for routine surgery and was still breathing. Would the result have been the same if the doctors had been able to explain brain death in a way that the family could understand? Or would the family simply hold on to the idea that the girl could come back, regardless of what the doctors said?

Can communicating something clearly really make a difference when you're delivering such devastating news?

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

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