When are you really dead? Hospitals still vary in their criteria.

It’s the most final diagnosis a caregiver can make. So why, as a newly published study discloses, are there variances and lapses in how hospitals determine whether a patient is brain dead?

The American Academy of Neurology recognized five years ago the complexity of the decision-making in determining brain death, issuing a national practice policy to assist practitioners and institutions. But the Yale neurologist who helped write those recommendations has found significant variances in how almost 500 hospitals and health care systems have put brain-death policies in place and how they use them.

Researchers, fortunately, found no legitimate reports of any patient ever being declared brain dead when they weren’t. But the authors, in the careful language of scientific publishing, reported that  “Hospital policies in the United States for the determination of brain death are still widely variable and not fully congruent with contemporary practice parameters.”

As National Public Radio describes the crucial call of a patient’s brain death:

More than 20 percent of the policies don’t require doctors to check that patients’ temperatures are high enough to make the assessment, as the guidelines call for. … Almost half of policies don’t require doctors to ensure patients’ blood pressure is adequate for assessment of brain function. And some say doctors can skip tests that the guidelines recommend. In addition, most of the policies don’t require that a neurologist, neurosurgeon, or even a fully trained doctor make the call. In some hospitals, they actually allowed for a nurse practitioner or a physician assistant to do it.

A Boston University bioethicist called the findings “unconscionable.” The great policy variance, said another bioethicist, could erode public trust, which could make individuals reluctant to become organ donors or families to donate their loved ones’ organs.

I’ve written before about our collective need to engage, while we’re healthy, in candid conversations about dying and doing it with dignity and as well as is possible.  I can’t imagine more unseemly, tragic public controversies than those that erupted over patients like Karen Ann Quinlan and Terri Schiavo.  Having the right policies and practices in place to decide if someone is brain-dead goes a long way toward preventing those kind of events and ensuring that this final medical pronouncement is done right.

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