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Why brain dead means really dead

Smeagol

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I usually get in trouble in this section but I'll give it another shot.

(CNN) -- A person who is brain dead may appear alive -- there may be a heartbeat, they may look like they're breathing, their skin may still be warm to the touch. But doctors say there is no life when brain activity ceases.

Why brain dead is really dead - CNN.com


I'm sure you've heard the story of the little girl from California who went in for minor tonsil surgery and due to complications was eventually declared "brain dead." A very sad event indeed but further complicating the tragedy is her parents don't seem to understand what brain dead means.

About 10 years ago a elderly family friend experienced a similar fate. A blood clot in his leg traveled through his body, lodged in his lungs and his wife found him passed out on the floor. He'd apparently gone about 20 minutes with no oxygen getting to his brain, was on a ventilator at the hospital and declared brain dead. He looked like he was sleeping and would even toss and turn a little but according to the doctors his brain had died and absent a miracle he could not regain consciousness. From a medical science perspective, respirators and feeding tubes only keep organs alive although the person is in all other respects deceased.

Its not a pleasant topic to discuss but Jahi McMath's passing, as tragic as it is, I think presents a teaching opportunity.
 
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I am not sure what the girls parents are trying to achieve.

Maybe they are waiting for brain transplants to become the norm.

Miracles happen, but not that often, I am told.
 
I am not sure what the girls parents are trying to achieve.

Maybe they are waiting for brain transplants to become the norm.

Miracles happen, but not that often, I am told.

I honestly think they are terribly grief stricken, see their little girl "looking alive" but what appears to be asleep and even tossing and turning here and there. When I saw the guy from our church was in the hospital I couldn't believe he was "brain dead." I even think he yawned a few times or it might have been cough. A doctor friend of mine not involved in the case actually explained the medical science of it all to me and how minor movements happen spontaneously when a person is brain dead because of minor stem cell activity. Unless you understand the science behind it, its difficult to see a brain dead person on a ventilator as not being alive. Add to that the emotional component these loving parents are going through and I fully understand.
 
Here's a case of someone who did recover from being brain dead but as it turned out the original diagnosis was wrong and he was only in a coma, which is not the same thing.



Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off. Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him. Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.

'Miracle recovery' of teen declared brain dead by four doctors - Telegraph
 
I honestly think they are terribly grief stricken, see their little girl "looking alive" but what appears to be asleep and even tossing and turning here and there. When I saw the guy from our church was in the hospital I couldn't believe he was "brain dead." I even think he yawned a few times or it might have been cough. A doctor friend of mine not involved in the case actually explained the medical science of it all to me and how minor movements happen spontaneously when a person is brain dead because of minor stem cell activity. Unless you understand the science behind it, its difficult to see a brain dead person on a ventilator as not being alive. Add to that the emotional component these loving parents are going through and I fully understand.

I understand that but there has to be somebody in the family that sees there is no coming back from this. It is going to be a lot harder down the road to stop the care that to do it right now.

I can't even imaging the care that will have to be given to her for all of her bodily functions for as long as they want to keep her that way.

Who is going to pay for the care? Does anybody know?
 
Here's a case of someone who did recover from being brain dead but as it turned out the original diagnosis was wrong and he was only in a coma, which is not the same thing.



Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off. Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him. Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.

'Miracle recovery' of teen declared brain dead by four doctors - Telegraph

I saw a medical ethicist on CNN who was asked specifically about people who've recovered from brain death. His comment was that there has never been a single documented case of a brain dead person recovering. There have been cases of misdiagnoses as in the case you cite but none where someone who's brain has stopped functioning has recovered.

Once the brain stops working the person ceases to exist. All that's left is a shell. The heart may beat and there may be some movement but the person is gone and won't ever come back. I don't fault the parents. What parent wouldn't hold out a miracle? The people advising them are another matter.
 
Here's a case of someone who did recover from being brain dead but as it turned out the original diagnosis was wrong and he was only in a coma, which is not the same thing.



Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off. Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him. Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.

'Miracle recovery' of teen declared brain dead by four doctors - Telegraph

Well sure, but the problem is that the argument of "brain dead is really dead" doesn't account for bad diagnosis. The fact that the diagnosis could be wrong means that a brain dead diagnosis shouldn't be treated as really dead.

Or in other words, brain dead isn't really dead because brain dead isn't even necessarily brain dead.
 
These cases are terrible to deal with on many, many levels. This one sounds as though the family is simply in denial. From the circumstances of the case, who could blame them. The child went in for a tonsilectomy and is now dead, pretty shocking. The doctors and nurses should have been educating this family all along, but sometimes family members just dont hear. Very sad case.
 
According to the video clip in the OP, the unlike a "persistent vegetative state" or even a coma, with brain death the body's organs eventually start to deteriorate so its apparently just a matter of time before not even a ventilator and feeding tube will help. How long, I don't know.

I'm getting choked up for this family and don't even know them. No parent expects to take their kid to get a tonsillectomy, excited about all the popsicles and ice cream they've been promised and later that day have to pick up their death certificate and make funeral arrangements.
 
Well sure, but the problem is that the argument of "brain dead is really dead" doesn't account for bad diagnosis. The fact that the diagnosis could be wrong means that a brain dead diagnosis shouldn't be treated as really dead.

Or in other words, brain dead isn't really dead because brain dead isn't even necessarily brain dead.

But how far do you go with that skepticism? At what point do you concede that the person is dead? And you have to keep in mind that the medical resources are finite and the resources you expend on the person who's declared brain dead but is being argued over aren't being used by someone who in all probability needs them more.
 
But how far do you go with that skepticism? At what point do you concede that the person is dead? And you have to keep in mind that the medical resources are finite and the resources you expend on the person who's declared brain dead but is being argued over aren't being used by someone who in all probability needs them more.

I think the competition for respirators and feeding tubes is a bit over played there. How many people die due to unavailability of respirators? How many of that group were in hospitals where a patient diagnosed with brain death was using a respirator?

I think the decision on when to concede that the person is dead should be left to the family. Having the state step in to pull the plug is not the best PR move.
 
Some families will never do it, in the mean time a veggie is costing thousands and thousands of dollars a day. It is a horribly sad situation, and its very ethically complicated. Some stuff is just more important than PR. It aint really good for the family pretending the patitent is still alive either, situations like this are all bad. they would terminally wean the patient and the patient may or may not breath on their own. I am bettting if declared brain dead she would not. Terrible situation.
I think the competition for respirators and feeding tubes is a bit over played there. How many people die due to unavailability of respirators? How many of that group were in hospitals where a patient diagnosed with brain death was using a respirator?

I think the decision on when to concede that the person is dead should be left to the family. Having the state step in to pull the plug is not the best PR move.
 
Some families will never do it, in the mean time a veggie is costing thousands and thousands of dollars a day. It is a horribly sad situation, and its very ethically complicated. Some stuff is just more important than PR. It aint really good for the family pretending the patitent is still alive either, situations like this are all bad. they would terminally wean the patient and the patient may or may not breath on their own. I am bettting if declared brain dead she would not. Terrible situation.


As the article states, a brain dead person's heart will usually stop within 3 days of becoming brain dead. So on that alone the family has hope because it is now into the third or fourth week and the heart is still beating on its own. It's certainly an indicator of some brain stem activity.

If she is truly brain dead then she will die soon from heart failure, which is all that the mother is asking for. A brain dead person is not like someone in a coma or even in a vegetative state because in those cases the brain still regulates the body. We aren't talking about months on a respirator if she truly is brain dead.
 
I think the competition for respirators and feeding tubes is a bit over played there. How many people die due to unavailability of respirators? How many of that group were in hospitals where a patient diagnosed with brain death was using a respirator?

I think the decision on when to concede that the person is dead should be left to the family. Having the state step in to pull the plug is not the best PR move.

Not only respirators, but beds and doctor and nursing time and the costs associated with all of those. It costs thousands of dollars a day to keep someone in the hospital - my mother in law's recent 3 week stay was billed at $200,000 - that's about 10K a day and there was no surgery involved, that was just tests, nursing, pills and doctor visits.

Parents are too emotionally involved and don't have the expertise in any case to determine when someone's died in non-obvious cases. Doctors do. They're the one pulling the plug not the state.

It's not clear to me that her body would fail on it's own, though I only read a couple of short articles on brain death.
 
I see this as pure tragedy - I cannot bring myself to judge these people at all. Some people are responding much too harshly and should be ashamed of their callousness.

I can't imagine how I would have handled it if my two sons, who both had surgeries, would have ended up in this situation.

Or my other son who was fine in the morning and then near death just 18 hours later and being rushed to the ER. That was over a year ago and I still can't get through a single night without a nightmare about one of the kids dying or something.

So if I was in their shoes I'd be borderline insanity, most likely. Facing this situation is more difficult than most people seem capable of comprehending.

Modern science GIVES hope - and I can't fault anyone for clinging to that hope. When your child is dying that's all you've got.
 
I see this as pure tragedy - I cannot bring myself to judge these people at all. Some people are responding much too harshly and should be ashamed of their callousness.

Thanks for this post, this is spot on. This is an extremely sad situation and I cannot even fathom of what this family is going through. I can't empathize and try to put myself in their scenario but its one where you can truly understand unless you've experienced it.

The way I see it, if the family wants a little more time with this girl, let em have it. Considering the reports of her condition, I doubt it will be much longer.
 
I usually get in trouble in this section but I'll give it another shot.

(CNN) -- A person who is brain dead may appear alive -- there may be a heartbeat, they may look like they're breathing, their skin may still be warm to the touch. But doctors say there is no life when brain activity ceases.

Why brain dead is really dead - CNN.com


I'm sure you've heard the story of the little girl from California who went in for minor tonsil surgery and due to complications was eventually declared "brain dead." A very sad event indeed but further complicating the tragedy is her parents don't seem to understand what brain dead means.

About 10 years ago a elderly family friend experienced a similar fate. A blood clot in his leg traveled through his body, lodged in his lungs and his wife found him passed out on the floor. He'd apparently gone about 20 minutes with no oxygen getting to his brain, was on a ventilator at the hospital and declared brain dead. He looked like he was sleeping and would even toss and turn a little but according to the doctors his brain had died and absent a miracle he could not regain consciousness. From a medical science perspective, respirators and feeding tubes only keep organs alive although the person is in all other respects deceased.

Its not a pleasant topic to discuss but Jahi McMath's passing, as tragic as it is, I think presents a teaching opportunity.

Oh, I understand brain dead. When you need a ventilator and feeding tube? That's pretty much brain dead unless you've been put into a drug-induced coma for one reason or another. I'd guess there are times when someone is in a coma that they'll come out of it when, for example, brain swelling subsides.

But when doctors, who are profit motivated, say it's time? Believe them. Stop torturing yourself and others.
 
Look up heart failure.
As the article states, a brain dead person's heart will usually stop within 3 days of becoming brain dead. So on that alone the family has hope because it is now into the third or fourth week and the heart is still beating on its own. It's certainly an indicator of some brain stem activity.

If she is truly brain dead then she will die soon from heart failure, which is all that the mother is asking for. A brain dead person is not like someone in a coma or even in a vegetative state because in those cases the brain still regulates the body. We aren't talking about months on a respirator if she truly is brain dead.
 
Here's a case of someone who did recover from being brain dead but as it turned out the original diagnosis was wrong and he was only in a coma, which is not the same thing.



Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off. Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him. Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.

'Miracle recovery' of teen declared brain dead by four doctors - Telegraph

How can you diagnosis brain death properly in a medically induced coma?
 
An empirical EEG analysis in brain death diagnosis for adults then read this.
As the article states, a brain dead person's heart will usually stop within 3 days of becoming brain dead. So on that alone the family has hope because it is now into the third or fourth week and the heart is still beating on its own. It's certainly an indicator of some brain stem activity.

If she is truly brain dead then she will die soon from heart failure, which is all that the mother is asking for. A brain dead person is not like someone in a coma or even in a vegetative state because in those cases the brain still regulates the body. We aren't talking about months on a respirator if she truly is brain dead.
 
Some families will never do it, in the mean time a veggie is costing thousands and thousands of dollars a day. It is a horribly sad situation, and its very ethically complicated. Some stuff is just more important than PR. It aint really good for the family pretending the patitent is still alive either, situations like this are all bad. they would terminally wean the patient and the patient may or may not breath on their own. I am bettting if declared brain dead she would not. Terrible situation.

I don't think it's ethically complicated at all. A court should be able to have the plug pulled and the *body* (because her conscious/personhood is gone) removed, whether the parents agree or not.

I know in the UK, there are cases where courts will do exactly this.
 
Well yea, I agree kinda. In these cases, I think the family is really the patient. Sure, intellectually the doc should walk in, say the patient is dead,pull the plug and walk out. But I think in these cases the family is the real patient.
I don't think it's ethically complicated at all. A court should be able to have the plug pulled and the *body* (because her conscious/personhood is gone) removed, whether the parents agree or not.
 
Well yea, I agree kinda. In these cases, I think the family is really the patient. Sure, intellectually the doc should walk in, say the patient is dead,pull the plug and walk out. But I think in these cases the family is the real patient.

Since when do we spend untold millions on medically pointless hospitalization just to protect someone's feelings? Even the living, including mentally ill and the elderly, get nickel and dimed and booted out with the quickness. Should mothers who just gave birth get to stay in their bed with their newborn indefinitely because it "feels right"? What you're describing is not at all what i've come to understand as standard operating procedure - "managed care" - in the american health care system.

We become such hypocrites when it comes time to honor "parents' rights" and religious scruples.
 
Oh, I understand brain dead. When you need a ventilator and feeding tube? That's pretty much brain dead unless you've been put into a drug-induced coma for one reason or another. I'd guess there are times when someone is in a coma that they'll come out of it when, for example, brain swelling subsides.

But when doctors, who are profit motivated, say it's time? Believe them. Stop torturing yourself and others.

Doctors are all profit motivated? They're all right?

Which ones - the ones that created this situation to begin with or the ones who created the methods by which life can be sustained artificially?

Doctors are humans - and can be wrong. No doubt, those incidences in which they are wrong are central to the family's thoughts and feelings, here. As is the fact that Doctors committed the child to the surgery and Doctors did the surgery . . . you know, it's a round Robin of Doctors this and Doctors that.
 
Yea, I am not saying you are wrong, I have just seen many of these cases, you wanna come in a pull the plug?
Since when do we spend untold millions on medically pointless hospitalization just to protect someone's feelings? Even the living, including mentally ill and the elderly, get nickel and dimed and booted out with the quickness. Should mothers who just gave birth get to stay in their bed with their newborn indefinitely because it "feels right"? What you're describing is not at all what i've come to understand as standard operating procedure - "managed care" - in the american health care system.

We become such hypocrites when it comes time to honor "parents' rights" and religious scruples.
 
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