Brain Dead is Dead?

SandraGandarez's picture

Sandra Gandarez
Neurobiology and Behavior
February 24, 2009

It is a moral obligation of hospitals protocol and physicians to remove a "brain-dead" individual from life support since they are already technically dead.

Before discussing the moral issues some basic information and view points are necessary to understand certain stances. Brain death is defined in several articles as the complete and irreversible loss of brain stem function. In brain death, all the brain stem functions, including those that maintain breathing, stop working. (1, 2) There is an absence of blood flow to the entire brain which in turn causes the deprivation that enables brain death. (3)

The brain is set up in a way that the unconscious actions that we take for granted (including walking, breathing and balance) are closest to the base of the brain and brain stem. More complex functions (including speech, imagination and language) are positioned closer to the outer and upper surfaces. The entire brain does not always die as a whole because the cerebral cortex (which needs a lot of oxygen and energy to function) can die in a matter of minutes if oxygen is cut off whereas the brain stem can still live. When there is still activity in the brain stem then it is brain damage rather than brain death; even if many functions are lost, such as speech and language skills. Even some "vegetables" are not considered brain dead because they can still breathe on their own and may respond to certain stimuli including pain and noise. The only thing that prolongs the life of a brain dead person is the use of life support machines and there is no chance of recovery. (1) A person can be pronounced legally dead even if the heart continues to beat due to life support measures. (2)

There must be a few critical points that mark a person as brain dead rather than severely brain damaged. Those points are:
 1. There is no question of deep intoxication from drugs, poisons or other chemical agents.
2. The condition is not due to the effects of paralyzing drugs.
3. It is not the result of lowered body temperature (hypothermia).
4. There is no question of any neurological condition that could simulate brain death.
5. There are no spontaneous breathing movements.
6. The pupils are round or oval and dilated 4-6mm.
7. The pupils do not change size when a bright light is projected into them.
8. There are no reflex responses above the neck: no response to corneal contact (touching of the surface of the eye), no gag reflex when the back of the soft palate is touched, no coughing in response to tube suction of the windpipe.
 9. There are no eye movements when the outer ear canal is irrigated with warm or cold water (caloric test).
10. The electroencephalogram shows no sign of electrical activity in the brain, as recorded from a minimum of 8 points. All channels must be flat. (2)

The loss of spontaneous respiration and lack of pupil dilation were the most commonly mentioned in readings as being indicators of brain death. Several physical aspects are also listed such as coexistent coma and apnea and a complete loss of volitional activity and consciousness. (4) Brain-death is often confused with the state of vegetation because it is not a necessity to be brain dead to be a "vegetable". Severely brain damaged individuals can be considered "vegetables" as well which is why the assumption is so misleading. (2) 

Morality of pulling an individual off of life support is still a very controversial issue among religions and political stances. Some of the very definite terminology I found in my research was amazingly blunt, a few are:
1. If the brain is dead there is no chance that the person will recover, and therefore no reason to continue with life support. (1)
2. Thus anencephaly, in which there is no higher brain present, is generally not considered brain death, although it is certainly an irreversible condition in which it may be appropriate to withdraw life support. (2)
3. These professionals agree that the death of the brain is equivalent to the death of the person. The view that brain death signifies the death of the person is an important societal decision that should be endorsed by legislation in the individual states. (3)
4. If someone is brain dead, the person is dead, period. (5)
Most medically minded people believe that once you are declared brain dead then you are gone for good.  The fact is that many families do not grasp the gone for good concept because they see their family member's chest rise and the heart beat and believe that it is still possible for them to wake up and be back to normal.
Another issue with the declaration of brain dead is that most families do not want organs harvested while there is "false hope." (5) The mentality is that why give them away when they are still needed here. The religious and moral decisions tend to clash quite violently when thinking about an individual being brain dead and having to make the decision of what to do. To top it off is the donor decision for that individual. In some countries (Portugal, Poland and Belgium) everyone is automatically a donor, taking a lot of difficult decisions out of people's hands. (2)
Something that should be considered and that has been brought into the limelight in recent years is the manner in which these people should be allowed to die. A well known case of that is Terri Schiavo, who was taken off her feeding tube which subjected her to die of starvation rather than something much quicker and less painful. Death row inmates die within minutes for their capital crimes yet an innocent woman was left to starve to death for almost two weeks. (6) Even dogs are put to sleep in an ethical manner but a human being is not. The matter of moral obligations to these people must be met to prevent this from happening regularly. 

References
1. NHS 24 Health Library http://www.nhs24.com/content/default.asp?page=s5_4&articleID=60&sectionID=1
2. NationMaster - Encyclopedia
http://www.nationmaster.com/encyclopedia/brain-death
3. Crawford, Ronald, and Barbara Patrick. "Confirmatory Tests in the Diagnoses of Brain Death: The Role of the Radioisotope Brain Scan." Bioethics Quarterly 3(1981): 67-72.
4. eMedicine
http://emedicine.medscape.com/article/1177999-overview
5. Brain Dead Means Dead
http://www.wired.com/science/discoveries/news/2001/04/42847
6. CNN
http://www.cnn.com/2005/US/03/31/schiavo/


 

Comments

Q's picture

12 percent brain activity

What are the pro's and con's of have only 12 percent of your brain active. My cousin had a MRI scan done and the results says the she only have 12 percent of her brain functional what does that mean for her she is 45 year old

Jacob Johnson's picture

brain dead people

If a person who has been declared brain dead on life support can the person who has been declared brain try to open their eyes and try to say something if they are really brain dead?

Hanna's picture

my mom

my mom was 31 weeks pregnant and felt fine, she was found at the bottom of the stairs in the middle of the night on the 24th of july, she had 2 operations on her brain and had a cacerian to save the baby, we was told my mum may not make it. on the life support machine she was warm and her heart was beating thanks to the machine, she had swollen up and had a black eye. she didn't move at all and was 38, the baby is fine. sadly they turned her life support machine off cus she failed all the tests, I just feel if they had left her on a bit longer she would of responded, when I spoke to her I started crying and water came out her eyes(they were shut)..I thought it could of been tears as it only happened when she was being spoken too. does any body know where I can get some support as I have only just turned 16, I now have to help my moms boyfriend with the new born and my 9 year old brother and 14 year old brother, also my moms boyfriend is a first time dad and doesn't have a clue how to do this, I just need advice/help/support. please get back too me

Serendip Visitor's picture

Dear Hanna, I am so very

Dear Hanna,

I am so very sorry to hear about your mom.

As a rule, doctors fight for the lives of their patients, and would not prematurely turn off life support nor do so if there is any doubt about the patient's prognosis / condition.

Please do your best to find a support group for teenagers who have lost their parents / loved ones and also seek out a trusted school counsellor to help you through this very difficult time.

You are a beautiful and also clearly a strong young lady. Your mother's presence and loving guidance will be with you always. Whenever you need, find a quiet place and remember the most important things that she has taught you, also remember her love, it is still with you.

The best way to help others is to be the best that you can be - learn, develop and use your talents / gifts as best you can. Love and be kind to yourself.

You are in my prayers.

A Mom's picture

He/She is still alive

No matter what the doctor has told you, a person must meet three criteria LEGALLY to be declared brain dead:

1. Unresponsive
- This means they do not respond to anything. No voice, no touch, heat, cold, discomfort, pain, light, NOTHING. No movement, no NOTHING.

2. Absence of Reflexes
- This means they do not have normal human reflexes. Such as blinking when something comes to the eye, yanking a hand or foot
in response to pain, etc. If your loved one is hiccuping, coughing (a reflex due to something being stuck in the chest, lungs, or throat), pulling back when pinched, blinking, etc. they have reflexes and are NOT brain dead.

3. Apnea
- This means your loved one can not breathe without a machine. To declare a person brain dead, an apnea test MUST be
performed. This means the doctor will turn off the machine. A brain dead person will not attempt to breathe. Their brain will
be unable to tell them to do so. A person in a vegetative state will attempt to breathe on their own. If your loved one
attempts to breathe when taken off the machine, he/she is NOT brain dead. If your loved one initiates his/her own breaths
when on the machine, he/she is NOT brain dead.

NO DOCTOR CAN LEGALLY WITHDRAW LIFE SUPPORT IF YOUR LOVED ONE DOES NOT MEET ALL THREE OF THESE CRITERIA nor can they force you to do so. If they try or refuse to care for your loved one, I suggest you contact an attorney and sue.

If your loved one does not meet all three of these criteria, he/she is either in a vegetative state or a coma. Both of which there is a SLIM but very possible chance of recovery, and I suggest you do your own research to determine which one they are in. If your loved one meets ALL three of these criteria, he/she is brain dead and there is NO chance of recovery whatsoever.

Gayani's picture

Brain dead but heart is working

My sister is having a brain cancer (chorio carsinoma in brain) and day by day she lost her balance , cannot walk , cannot see properly . 7 days ago suddenly she stop all the movements and still breathing well by her own. cannot talk,walk,eyes are closed but sometimes closing the eye lids bit hard,no movements in body ,we can notice a very mild movement in one hand fingers sometimes.lips are sometimes slowly moving . Her doctor said her brain is dead . but what are these slight movements. I cannot understand , is she dead , how is she breathing her own.how long will she servive like this.can she feel any pain. Please someone reply to me .What best I can do for her.

David's picture

Brain Dead

Gayani,

Back in 2005 my father passed away and had been on life support for 3 days after a heart surgery that was a last attempt after his having a heart problem that was determined would cause his death 4 years prior.

After the surgery he was on the respirator, heart was beating etc, and I went to hold his hand. His eyelids were snapped shut and his hand and arm was cold to the touch. I could feel no real pulse but the machines etc said he was alive. I instantly knew he was dead even though it was decided three days later that after having to revive him several times that each time they did this was causing him more brain damage from the amount of time oxygen hadn't been getting to the brain. I was only of concern asking if it was inhumane to keep him alive or to pull the medication plug to let him die right away as we finally decided to do. I wasn't too sad about the decision, although I loved my father very much. I felt he had been dead for three days and on that third morning I even wore a black shirt to the hospital knowing that day was probably going to be his last "pretend' day of living. Before they stopped the machines, my step mom went over and told him it was okay to go. When they did stop his vitals from functioning, my step mother went over to him and said she noticed a tear had come out of one of his eyes. To this day I know he was actually still in there albeit barely. In his case, his heart wasn't going to let him live as it had met it's time, so I don't feel it was a wrong decision to let him die. Was his brain still alive? Probably slightly and for a while I thought maybe he would have had a chance to come back for a bit, but more than likely not. If he had a healthy heart or a heart transplant, it's possible and he asked to not be on life support so he answered his wishes, but say they were able to give him a functioning heart. Yes, I think he would have survived even though we will never know the condition of his brain after going through all he did.

Situation two here which is why i'm writing to you is more why I decided to write you. I had a cat named Drew Barrymore, Google "drew barrymore, cutest cat video in the world" and you'll see the youtube video I made of her. Anyway, she got sick one day and the vet took advantage of me since she was peeing on the floor and she needed to be re-hydrated. I brought her in and the vet gal said instantly when picking her up, "OH something is inside her that's hard and we should operate. (Barely even touched her, sounded like a lie). I had later discovered some of her hard food had turned quite bad and she had probably just gotten very sick. After a day in the animal hospital, we had to go on vacation and she convinced me to let them keep her and operate. (Total in all was like $3k and they had to give her a blood transfusion or something as they told me all while I was on vacation, that she was anemic and needed new blood.)

When I got back she was basically blind and would step carefully walking around until her head touched a wall. She would stand there for almost a full minute then turn and walk another way. (Nice job doc.) I took her home and had an afternoon with her on my lap where she purred and seemed to almost still be able to see me.

Anyway, here she was blind and she was a runt with a tiny body that wasn't able to handle all the trauma they had put her through. So here she was blind and I had to care for her daily for all her needs, kept her in a penned area. Her eating was that of a retarded brain, but she knew what food was. Two days later she was walking and her front feet gave out. She acted like she didn't know what was going on and was pushing her body around. The kids were laughing, but I was obviously very upset. I think maybe she had had a stroke (or another stroke). So then I had to use a syringe to give her water and her eating was that of a retarded brain and she was no longer able to see at all. I bathed her once in the bathroom sink, cleaning her paws and such. She was still in there I could tell. Then maybe another day or two later, her hearing started to go. Her ears wouldn't respond to snapping in one ear, but one kind of worked (twitched to the sound). I found her head first in her kitty box (which we had used newspaper by now to keep her clean), and she was just standing there like that. The next morning, I held her in my lap. She looked pretty much dead, just layed there barely breathing. I knew she was both deaf and blind and without either of those senses her brain was probably mostly gone. I brought her to the vet who euthanized her in front of me free of charge which was nice. I was sincerely very very sad. I still have Cameron Diaz kitty though for about 14 years now. Anyway, even though she couldn't hear or see, her attitude to not move at all told me she wanted to die. Mainly her jaw was kind of dropped open and her body was limp. I believe without these senses she lost her will or need to live.

Your sister is also probably still in there just fine to some degree and her brains energy is probably just very faint which is how she can still breath and make extremely small movements. So in answer to your question, no, she isn't dead. She is mostly dead however and her quality of life is non-existent as she doesn't have any senses to our world anymore. I'm sincerely sorry for what you are going through as it must be difficult, but it's important to know that there's nothing wrong with loving her for her entire time and that every breath of life is still a living experience for her. The world she has left is probably dreams she lives in and until she finally passes, it's important to spend as much time with her as you can since having love nearby is still felt beyond the normal five senses and it will help her to move to the next phase of the process when you tell her it's okay to go when she's ready (even if she can't hear).
Holding her hand is probably still sensed in her dream state, and I don't care how 'brain dead' a doctor my declare a person is, if they have even the smallest brain function, they are still alive and in there somewhere with a projected body. (The one you have in your dreams of yourself.) Most of her brain energy left is more than likely doing a lot in that place, so share the time with her, pray with her if that's helpful to you, and know she's still there as long as she's breathing. Again, my sincerest prayers for your situation. This may be way after she's gone as you wrote more than two months ago, but I wanted you to know what I believe to be true. The brain is a huge place and has lots of things it can do, including using senses we aren't aware of, which wake up when the others depart. Imagine with her while you can if she is still around. If not, it sounds like you were a really great sister and friend to her. She is or has returned home, where we all go eventually.

Many Blessings:
David Garfield.

Serendip Visitor's picture

my son

my 15year old son died just over one month ago from Brain Death secondary to Hypoxic Encephalopathy;cardiac arrest and asthma attack,and still today i am puzzled.We were told his brain was no longer alive as he had suffered a servere case of brain damage,due to a 20minute c p r attempt about an hour after his arrival at the Hamilton hospital here in New Zealand.During this time of meny meetings with the doctors and neuros,still i never understood the seriousness of a brain dead patient.I read the critical points that mark a person brain dead,and there is one out of all that makes me question my sons diagnosis,he was coughing while the tube was in him,does that mean he wasnt completley brain dead??? I have another question WHY DID MY SON HAVE EPILEPTIC FITS?????when he had no diagnosis of being epilipsy at all or ever,i dont understand,sorry i dont know how to spell it.

Pam  ( guest )'s picture

brain dead and holding his own

Dont understand that yesterday they did a electrocardiogram on my Brothers brain and said there were no straight lines at all, but yet I got a call this morning saying he was being taken off life support , due to being brain dead,,,As of now, he is still breathing on his own, I have read all of the above , and still dont understand, would you please help me understand this,,Thank you ever so much,,,It has been nearly 6 hours now, that they took him off the machine, and he is still holding his own

tracey duncan's picture

brother in law

My brother had an aneurysms and the doctors said his brain stem is dead. what I like to know is if his brain stem is dead, how can he answer a question with the moving of a finger and when feet are tickel his toes open up.I asked him questions and told him if he can hear me move his fingers and he did just that. im lost and dont understand how can that happen if his brain stem are dead

Anonymous's picture

brain death

My brother in law is currently in the hospital they say he has no brain activity and i kno that the heart still beats when a person is brain dead but he is breathing on his own does this still mean hes brain dead??

helen Ray's picture

They said my brother was brain dead, but he breathe on hs own

My Brother went to a diebetic coma, they said he was brain dead, but his heart beat and he breathed on his own.They gave him no nurishment or drips, only pain meds.He never woke up and died on the 9 day.Im making myself sick, if he was brain dead , then how did he breathe, how did his heart beat....

Paul Grobstein's picture

death and the brain ....

If different parts of the brain ("boxes"?) can be separately, what exactly does one mean by "brain dead" and how good an indicator is that of death?
Theresa's picture

Brain Death

My mother died on May 25, 2008. She had a brain anuerysm. The doctors said that her brain stem was dead and she had blood all over her brain. I am having a hard time dealing with her death. They had her on life support when she got to Parma Hospital and they ended up life-flighting her from Parma to Metro Hospital. I knew she didn't want to be on life support, so I took her off of it early that morning and she died very quickly. I would say within 30 minutes after I took her off of life support. I just feel like if I would of left her on a little longer maybe she would of lived. I just feel like i ended her life and i feel really bad.

Anonymous's picture

Your mother

You should really read up on brain aneurysms.. Most people that have one die not only that but they tend to go in to a coma and if they wake from there they tend to have massive brain damage. My mother fell into the 2 to five percent. She stayed awake the whole time and felt the pain. Her aneurysm ruptured. After a day and a half it stopped bleeding and managed have surgery. to have only minor nerve damage in the hand and slight memory problems. the nost you would have got was your mother just suffering.

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