The recent widely publicized cases of two young women kept on life support despite being declared brain dead have highlighted concerns about whether physicians, hospital leaders and the public fully understand the term “brain death” and whether physicians are effectively communicating what it means to patients’ families.
Experts say poor communication can contribute to serious public relations and legal problems for hospitals, as it did in these two cases.
One case involves a pregnant woman, raising unique issues because at least a dozen states have laws restricting the ability of healthcare providers to end life support for terminally ill pregnant women, regardless of the wishes of the patient or the family. “Patients and even some doctors are mixed up about the proper use of concepts like coma, brain dead, and persistent vegetative state,” said Art Caplan, a professor of bioethics at NYU Langone Medical Center, New York. As a result, he said the terms are often communicated to patients’ families in ways that are confusing and misleading. “I think doctors should simply say, ‘Susie is dead’ and shouldn’t use the term brain death.” Otherwise, he added, families may think their loved one’s “brain has died but the body may come back.” Michael Silhol, a Dallas healthcare attorney and former board member of the American Health Lawyers Association, said hospitals should develop specific policies on how to engage patients’ families in discussing withdrawal of life support for brain-dead patients or transferring the patient to a different facility.
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