The Least Bad Option

Unilateral Extubation after Declaration of Death by Neurological Criteria

Sally E. Bliss, Robert Macauley

Research output: Contribution to journalArticle

Abstract

Typically, the determination of death by neurological criteria follows a very specific protocol. An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to "say goodbye," and at such a time to permit organ retrieval (with authorization of the patient or consent of the next of kin). Such a process maximizes transparency and ensures generalizability. In exceptional circumstances, however, it may be necessary to deviate from this protocol in order to spare family members unnecessary suffering and to reduce moral distress felt by clinical staff. It may also be appropriate, we argue, to refrain from even inquiring about organ donation when the next-of-kin is not only certain to refuse, but lacks the decision-making capacity to potentially consent. The case described in this article calls into question generally reliable assumptions about determination of death by neurological criteria, where the best the clinical team could do for the patient and his family was "the least bad option."

Original languageEnglish (US)
Pages (from-to)260-265
Number of pages6
JournalThe Journal of clinical ethics
Volume26
Issue number3
StatePublished - Sep 1 2015
Externally publishedYes

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death
organ donation
authorization
Tissue and Organ Harvesting
transparency
family member
Tissue and Organ Procurement
Apnea
staff
Psychological Stress
Artificial Respiration
decision making
lack
Decision Making
time

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Health Policy

Cite this

The Least Bad Option : Unilateral Extubation after Declaration of Death by Neurological Criteria. / Bliss, Sally E.; Macauley, Robert.

In: The Journal of clinical ethics, Vol. 26, No. 3, 01.09.2015, p. 260-265.

Research output: Contribution to journalArticle

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