What We Do When We Allow Families to Decline Brain Death Exams
Friday, October 13, 2023
9:30 AM – 10:45 AM ET
Location: Galena (Fourth Floor)
Clinical obligations to a patient cease when that patient dies. As such, it is crucial to confirm death via a brain death exam in a patient suspected to meet relevant criteria. In the US, in most jurisdictions, permission from the family is not legally required to perform such an exam. At times, however, families emphatically object to brain death exams. Sometimes, clinicians abide by the family's wishes, despite their strong suspicion that the patient is dead. What are the ethical ramifications of allowing families to decline a brain death exam? I present four vignettes, based off of clinical ethics experiences, that represent four different possible outcomes of acquiescing to wishes of the family. In considering these four representative cases, it becomes clear that it may sometimes be ethically appropriate, even desirable, to allow a family to decline the exam, while other times it may not. I delineate the different characteristics of the four vignettes that arguably determine the differences in ethical outcomes. Finally, I sketch out the beginnings of what might be a guideline in determining when we ought to allow families to decline brain death exams.