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The Problem of Death in Critical Care Medicine

  • David W. CrippenEmail author
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Abstract

Treatment plans in critical care medicine have pushed the envelope of debilitating disease by reversing organ dysfunction before it proceeds to organ failure. For a select population of patients with a strong potential for reanimation, such care plans have been remarkably successful. However, because the patient is given the benefit of any doubt regarding the possibility of resuscitation, critical care sometimes fails to reanimate an acceptable quality of life, creating dependence on life-supporting technology [1]. Critical care life-support systems are quite capable of, and even effective in, supporting isolated organ systems, even in the presence of brain death.

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References

  1. 1.
    Crippen D. Medical treatment for the terminally ill: the ‘risk of unacceptable badness. Crit Care. 2005;9:317–8.CrossRefGoogle Scholar
  2. 2.
    Bernat JL, Culver CM, Gert B. On the definition and criteria of death. Ann Intern Med. 1981;94:389–94.CrossRefGoogle Scholar
  3. 3.
    Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the study of ethical problems in medicine and biomedical and behavioral research. JAMA. 1981;246:2184–6.Google Scholar
  4. 4.
    Crippen DW, Whetstine LM. Ethics review: dark angels—the problem of death in intensive care. Crit Care. 2007;11:202.CrossRefGoogle Scholar
  5. 5.
    Wertheimer P, Jouvet M, Descotes J. À propos du diagnostic de la mort du système nerveux dans les comas avec arrêt respiratoire traités par respiration artificielle. Presse Med. 1959;67:87–8.PubMedGoogle Scholar
  6. 6.
    A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205:337–40.Google Scholar
  7. 7.
    Bernat JL. A defense of the whole-brain concept of death. Hast Cent Rep. 1998;28:14–23.CrossRefGoogle Scholar
  8. 8.
    Izac SM. Quality assurance in determinations of brain death. Am J Electroneurodiagnostic Technol. 2004;44:159.CrossRefGoogle Scholar
  9. 9.
    Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995;45:1012–4.Google Scholar
  10. 10.
    Whetstine L. Bench-to-bedside review: when is dead really dead—on the legitimacy of using neurologic criteria to determine death. Crit Care. 2007;11:208.CrossRefGoogle Scholar
  11. 11.
    Uniform determination of death act. 12 Uniform laws annotated. 320 (1990 Supp). http://www.lchc.ucsd.edu/cogn_150/Readings/death_act.pdf.
  12. 12.
    Hammer MD, Crippen D. Brain death and withdrawal of support. Surg Clin North Am. 2006;86:1541–51.CrossRefGoogle Scholar
  13. 13.
    Morenski JD, Oro JJ, Tobias JD, et al. Determination of death by neurological criteria. J Intensive Care Med. 2003;18:211.CrossRefGoogle Scholar
  14. 14.
    Whetstine L, Streat S, Darwin M, et al. Pro/con ethics debate: when is dead really dead? Crit Care. 2005;9:538–42.CrossRefGoogle Scholar
  15. 15.
    Safar P, Bircher N. Cardiopulmonary cerebral resuscitation. 3rd ed. Philadelphia: WB Saunders; 1988.Google Scholar
  16. 16.
    Segura T, Jimenez P, Jerez P, et al. Prolonged clinical pattern of brain death in patients under barbiturate sedation. Neurologia. 2002;17:219.PubMedGoogle Scholar
  17. 17.
    Grigg MM, Kelly MA, Celesia GG, et al. Electroencephalographic activity after brain death. Arch Neurol. 1987;44:948.CrossRefGoogle Scholar
  18. 18.
    Wang JT, Young GB, Connolly JF. Prognostic value of evoked responses and event-related brain potentials in coma. Can J Neurol Sci. 2004;31:438–50.CrossRefGoogle Scholar
  19. 19.
    Hassler W, Steinmetr H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and intracranial circulatory arrest. J Neurosurg. 1988;68:745.PubMedGoogle Scholar
  20. 20.
    Feri M, Ralli L, Felici M, et al. Transcranial Doppler and brain death diagnosis. Crit Care Med. 1994;22:1120.CrossRefGoogle Scholar
  21. 21.
    Petty GW, Mohr JP, Pedleym TR, et al. The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation. Neurology. 1990;40:300–3.CrossRefGoogle Scholar
  22. 22.
    Saposnik G, Basile VS, Young GB. Movements in brain death: a systematic review. Can J Neurol Sci. 2009;36:154–60.CrossRefGoogle Scholar
  23. 23.
    Jain S, DeGeorgia M. Brain death-associated reflexes and automatisms. Neurocrit Care. 2005;3:122–6.CrossRefGoogle Scholar
  24. 24.
    Crippen D. Donation after cardiac death: perceptions versus reality. J Intensive Care Med. 2008;23:347–8.CrossRefGoogle Scholar
  25. 25.
    Whetstine L. On the definition and criteria of death: when is dead dead and why some donation after cardiac death donors are not [PhD Dissertation]. Duquesne University, Department of Health Care Ethics; 2006.Google Scholar
  26. 26.
    Bernat JL. The biophilosophical basis of whole-brain death. Soc Philos Public Policy. 2002;19:337.Google Scholar
  27. 27.
    Crippen D. Changing interpretations of death by neurologic criteria: the McMath case. J Crit Care. 2014;29:870–1.CrossRefGoogle Scholar
  28. 28.
    Darwin MG, Leaf JD, Hixon H. Neuropreservation of Alcor patient A-106 (from Cryonics, February and March, 1986).Google Scholar
  29. 29.
    Wowk B, Darwin M. ‘Realistic’ scenario for nanotechnological repair of the frozen human brain. Reprinted from cryonics: reaching for tommorow. Scottsdale: Alcor Life Extension Foundation; 1991.Google Scholar
  30. 30.
    Olick RS. Brain death, religious freedom, and public policy: New Jersey’s landmark legislative initiative. Kennedy Inst Ethics J. 1991;1:275.CrossRefGoogle Scholar
  31. 31.
    Wijdicks EF, Varelas PN, Gronseth GS, Greer DM, American Academy of Neurology. Evidence-based guideline update: determining brain death in adults. Report of the quality standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911–8.CrossRefGoogle Scholar
  32. 32.
    Powner DJ, Bernstein IM. Extended somatic support for pregnant women after brain death. Crit Care Med. 2003;31:1241.CrossRefGoogle Scholar

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© The Author(s) 2019

Authors and Affiliations

  1. 1.Departments of Emergency MedicineCritical Care Medicine and Neurological Surgery University of Pittsburgh Medical (UPMC)PittsburghUSA

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