Ethics Committee Core Curriculum

Determination of Death
Consensus Conference

Consensus Guidelines Attachment C

RESPONSIBILITY OF HOSPITALS AND HEALTH CARE PROFESSIONALS IN DETERMINATION OF DEATH

1. If a patient has been determined to be brain dead and the ventilator is to be disconnected, the family should be treated with sensitivity and respect. If family members wish, they should be given the opportunity to be present when the ventilator is disconnected. Some families will ask to be present when the ventilator is disconnected. This often becomes a long remembered, painful moment. If they insist on being present, however, they should be advised of the possible occurrence of isolated spinal automatic movements as described in Attachment A, #4.

   a. It is the responsibility of the attending physician to discontinue the respirator;

   b. It is the responsibility of the nursing members of the treatment team to prepare the body for the morgue and to offer family members the opportunity to view the body prior to morgue transfer. Bereavement support to the family shall be provided.

2. A patient determined to be brain dead is legally dead. If a family has no moral or religious objection to brain death as a determination of death, but psychologically cannot accept that the patient is dead and objects to discontinuation of the ventilator, efforts should be made to be sensitive to these concerns through discussion and consultation with all members of the health care team. An appropriate member of the chaplain's office, the patient representative's office, or a member of the bioethics committee of the hospital may be helpful in resolving these issues.
3. Hospitals must have a written policy regarding the reasonable accommodation of religious or moral objections to the brain death standard in the event that such an objection has been expressed by the patient in advance or by family members or others close to the patient on the patient's behalf.

   Hospitals may consider whether certain services will not be provided to brain death patients as part of the policy regarding reasonable accommodation of religious or moral objections to the brain death standard. For example, hospital policies may include a statement regarding the duty to discontinue artificial respiration for a brain death patient in the event that continued utilization of the respirator would cause harm to another patient who needs that resource.