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Informed consent for the diagnosis of brain death: a conceptual argument
BACKGROUND: This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2016
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062821/ https://www.ncbi.nlm.nih.gov/pubmed/27737717 http://dx.doi.org/10.1186/s13010-016-0042-4 |
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author | Muramoto, Osamu |
author_facet | Muramoto, Osamu |
author_sort | Muramoto, Osamu |
collection | PubMed |
description | BACKGROUND: This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference. METHODS: Conceptual, philosophical, and ethical analysis. RESULTS: I first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act. CONCLUSIONS: My intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death. |
format | Online Article Text |
id | pubmed-5062821 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-50628212016-10-17 Informed consent for the diagnosis of brain death: a conceptual argument Muramoto, Osamu Philos Ethics Humanit Med Commentary BACKGROUND: This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference. METHODS: Conceptual, philosophical, and ethical analysis. RESULTS: I first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act. CONCLUSIONS: My intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death. BioMed Central 2016-10-13 /pmc/articles/PMC5062821/ /pubmed/27737717 http://dx.doi.org/10.1186/s13010-016-0042-4 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Commentary Muramoto, Osamu Informed consent for the diagnosis of brain death: a conceptual argument |
title | Informed consent for the diagnosis of brain death: a conceptual argument |
title_full | Informed consent for the diagnosis of brain death: a conceptual argument |
title_fullStr | Informed consent for the diagnosis of brain death: a conceptual argument |
title_full_unstemmed | Informed consent for the diagnosis of brain death: a conceptual argument |
title_short | Informed consent for the diagnosis of brain death: a conceptual argument |
title_sort | informed consent for the diagnosis of brain death: a conceptual argument |
topic | Commentary |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062821/ https://www.ncbi.nlm.nih.gov/pubmed/27737717 http://dx.doi.org/10.1186/s13010-016-0042-4 |
work_keys_str_mv | AT muramotoosamu informedconsentforthediagnosisofbraindeathaconceptualargument |