Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Journal of Medical Ethics 2017; 43: 679-683.
Author: Stephen D Brown
“The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor’s requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.”
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Donation after brain circulation determination of death

BMC Medical Ethics 2017 18:15
Authors: Anne L. Dalle Ave, James L. Bernat
“In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death.”
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Response to ‘A matter of life and death: controversy at the interface between clinical and legal decision-making in prolonged disorders of consciousness’

BMJ Blogs, 3 March 2017
Author: Julian Sheather
“The law has to work in generalities. The prohibitions it imposes and the liberties it describes are set for all of us, or for large classes of us. But we live – like we sicken and die – as individuals. Lynne Turner-Stokes gives a vivid account of an area of clinical practice where these truisms come into conflict. Practice Direction 9E (PD9E) doesn’t sound like much, a piece of dry-as-dust procedure for the Court of Protection, but it governs an area of keen moral concern: for our purposes, decisions relating to the withdrawing or withholding of clinically-assisted nutrition and hydration (CANH) from patients in a persistent vegetative state (PVS) or a minimally conscious state (MCS). According to PD9E, all such decisions should be bought before the Court of Protection.”
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Dying well with reduced agency: a scoping review and thematic synthesis of the decision-making process in dementia, traumatic brain injury and frailty

BMC Medical Ethics, 2016 17:46
Authors: Giles Birchley, Kerry Jones, Richard Huxtable, Jeremy Dixon, Jenny Kitzinger, Linda Clare
“In most Anglophone nations, policy and law increasingly foster an autonomy-based model, raising issues for large numbers of people who fail to fit the paradigm, and indicating problems in translating practical and theoretical understandings of ‘good death’ to policy. Three exemplar populations are frail older people, people with dementia and people with severe traumatic brain injury. We hypothesise that these groups face some over-lapping challenges in securing good end-of-life care linked to their limited agency.”
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Mental Illness, Natural Death, and Non-Voluntary Passive Euthanasia

Ethical Theory and Moral Practice, June 2016, Volume 19, Issue 3, pp 635-648
Author: Jukka Varelius
“When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated to try to stop her. …In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not.”
Find abstract here.

The “Conflicted Dying”: The Active Search for Life Extension in Advanced Cancer Through Biomedical Treatment

Qual Health Res March 2016 vol. 26 no. 4 555-567
Authors:  Shan Mohammed, Elizabeth Peter, Denise Gastaldo, Doris Howell
“Using a poststructural perspective, we examine the subjectivities that are produced when advanced cancer patients seek life extension through biomedical treatments. Seven case studies were developed that included 20 interviews with patients, family, nurses, and physicians recruited from a tertiary hospital in Canada…We characterize the “conflicted dying,” a contemporary figure who holds multiple perspectives about seeking curative treatment despite the acknowledgment of death. Using active strategies to gain access to treatment, this figure resists traditional arrangements of power/knowledge established by health care providers.”
Find abstract here.

From ‘right to die’ to ‘right to choose the way you die’ – the shifting euthanasia debate

The Conversation, 10 November 2015
Author: Peter Saul
“ABC’s Q&A program took on euthanasia last night, and in the process reinforced its reputation as the leading television forum for political and social debate. Former broadcaster and television producer Andrew Denton led with a strongly held and persuasively (if at times abrasively) argued position in favour of assisted dying. He moved the issue’s debate platform from the “right to die” to the “right to choose the way you die”. This subtly but importantly changed the nature of the debate.”
Find article here.

Increasing Transplant Organ Supply Through Uncontrolled Donation After Cardiac Death

Health Affairs, blog September 16, 2015
Authors: Anji Wall and Sunil Geevarghese
“Given the need for additional donors to meet the demand for organs, the US should consider adopting this practice [uncontrolled donation after cardiac death (uDCD) protocols]. In doing so, we should be aware of the ethical and legal issues associated with uDCD.”
Find article here.

Addressing Consent Issues in Donation After Circulatory Determination of Death

Authors: Kim J. Overby, Michael S. Weinstein & Autumn Fiester
The American Journal of Bioethics, Volume 15, Issue 8, 2015
“Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria (i.e., brain death), there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death.”
Find abstract here and links to related commentary articles here.