PHIL103: Moral and Political Philosophy

Even apart from confusion over the use of the term 'brain death' it can be very difficult for families to fully understand the reality of death based on a brain function criterion. To casual observation, patients fulfilling the brain function criterion for death appear to be sleeping rather than dead. The skin is warm. The chest rises and falls with mechanical ventilation. The heart and the kidneys continue to function. There are even reports that pregnancy may be maintained in patients fulfilling the brain function criterion for death. This ambiguity is reflected in the way medical and paramedical staff relates to the beating-heart cadaver in the period before organ donation. Nurses will often talk to such a cadaver as they carry out their nursing care as if the body retained the ability to hear. Acceptance of death by the brain function criterion in the context of organ donation asks much more of a family than does the same diagnosis with a view to cessation of treatment. Community education programs might go part way in helping families understand the issues involved. Detailed explanations with appropriate written material should be provided. Practitioners dealing with families should be trained in the process of explaining the brain function criterion and in grief counseling in general. Families should be provided with the opportunity to ask relevant questions and to have their questions answered in a genuinely sympathetic environment. Sufficient time should be provided to ensure that families really understand the brain function criterion before the issue of organ donation is broached. Families should then be allowed whatever time and assistance are necessary to make a decision concerning organ donation and then to deal with the particular grieving problems over the ensuing days and weeks. They should be offered the opportunity to view the body after the retrieval process has occurred when it has the appearance of being dead.