TY - JOUR
T1 - The Least Bad Option
T2 - Unilateral Extubation after Declaration of Death by Neurological Criteria
AU - Bliss, Sally E.
AU - Macauley, Robert C.
N1 - Publisher Copyright:
Copyright 2015 The Journal of Clinical Ethics. All rights reserved.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - 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 An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to "say goodbye," and at such a time to permit organ retrieval (with authorization of the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."
AB - 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 An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to "say goodbye," and at such a time to permit organ retrieval (with authorization of the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."
UR - http://www.scopus.com/inward/record.url?scp=84953345260&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84953345260&partnerID=8YFLogxK
M3 - Article
C2 - 26399676
AN - SCOPUS:84953345260
SN - 1046-7890
VL - 26
SP - 260
EP - 265
JO - The Journal of clinical ethics
JF - The Journal of clinical ethics
IS - 3
ER -