What Does It Mean To Be “Brain Dead”?

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BY: ALLISON BROWN

Over the last few weeks, we have heard about Taquisha McKitty, the 27-year-old mother, daughter, sister, granddaughter, and friend who as a result of a drug overdose was deemed brain dead.  Mr. Stanley Stewart and Alyson McKitty, Taquisha’s parents believe “she’s still alive,” according to an article written by Pam Douglas of the Brampton Guardian.

In order for the determination to be made according to a spokesperson for William Osler Health System, “there are a number of processes that physicians and care teams must adhere to so as to ensure that decisions are made appropriately and are in the best interest of the patient”.  It was also stated in the Guardian article, that “the hospital follows a recognized standard of practice and criteria for neurological determination of death…all neurological death determinations are determined by two experienced physicians in this field according to Alineh Haidery spokesperson for the hospital.

The family has obtained a court injunction temporarily preventing the hospital from removing the respirator (that is currently breathing for Taquisha) and is hoping to obtain a second opinion as to her “brain dead” status. This article will attempt to provide information about brain death.

According to webmd.com,  “ brain death starts with some sort of devastating neurologic injury, that can include traumatic brain injury, a stroke caused by a ruptured blood vessel in the brain, or if the heart has stopped and the brain goes without oxygen and other nutrients it needs to survive for a long period of time. “…brain-stem reflexes are often the last to go. These reflexes include the dilation of pupils when someone shines a light in the eyes and coughing or gagging when the vocal chords are tickled.  When there’s no evidence of higher brain function or brain-stem reflexes, and when other factors that could mimic brain death, such as drugs or low blood pressure … the need for a formal brain-death evaluation will occur.

A formal brain-death evaluation takes about twenty minutes.  First, the doctor will check to see if the patient flinches in response to something that can cause pain, like pinching the skin. Next, the doctor will make sure that there are no brain stem reflexes. Finally, the doctor will disconnect the patient from the respirator and check to see whether rising carbon dioxide levels in the blood stimulate the brain.  If none of these three findings is present, a second doctor is called to confirm brain death.

Today, with ventilators, blood-pressure augmentation and hormones, the body of a brain-dead person could, in theory, be kept functioning for a long time, perhaps indefinitely, but with time, the body of a brain-dead person becomes increasingly difficult to maintain, and the tissue is at high risk for infection as per an article at www.livescience.com.

Being a healthcare professional for many years, this is a very tragic story and our thoughts and prayers are with the family at this time. They wait for a decision by the Consent and Capacity Board, and they wait for another physician’s opinion. The family is doing what they can within the limits of what they can do and the hospital is following its processes. The question is, “how can the family advocate on behalf of Taquisa and come away feeling that the often challenging healthcare system worked with them and not against them”?

In this case, numerous stakeholders are involved.  A bioethicist helps the hospital and the family to make some tough decisions.  While Taquisa cannot make decisions for herself we trust the system and all those involved will make decisions based on Taquisa’s best interest. This article is dedicated to all of the healthcare professionals who have to work with challenging situations on a daily basis and to the Stewart and McKitty family who have been called to take this journey.

Your faith is what will see you through…

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