At a pivotal point in the 1987 fantasy film, The Princess Bride, a comic-relief character played by comedian Billy Crystal declares that the story’s protagonist is “only mostly dead,” and that “mostly dead is slightly alive.” In the context of the movie, of course, the exchange was meant to be humorous, setting the stage for a miraculous return from the brink of death. However, in real life, there is nothing funny about the declaration of death. As such, it would stand to reason that guidelines for determining whether a patient is actually brain-dead would be standardized in hospitals throughout the country. A recent study suggests, though, that the standards in place in certain facilities may be vastly different from those in others, leading to potential confusion and possible dangers.

Updated Guidelines

In 2010, the American Academy of Neurology updated its published standards for determining brain death in adults. These included tests of the patient’s core body temperature, systolic blood pressure, neurological functions, and more. The guidelines were subsequently adopted by a vast majority of hospitals and other medical facilities throughout the country. Implementation, it seems, is a different story.

Disturbing Differences

A recently-released study suggests that many facilities are not exactly on the same page when it comes to determining brain death, despite having adopted the updated standards. After a review of nearly 500 hospitals, the researchers published their findings in JAMA Neurology. The inconsistencies begin with something as simple as the physician’s qualifications for determining brain-death: only about a third of the studied facilities require the determination to be made by a neurologist or neurosurgeon.

Similarly, many of the physical tests required also differed between facilities. For example, while about nine of ten hospitals mandated the absence of patient’s pupil response, only six in ten require the inability of the patient to breath without assistance. Only about half have implemented blood pressure requirements and less than a quarter require an absence of reflexive jaw movement.

Possible Implications

With implemented standards differing to such a wide degree, there is obvious concern regarding which facilities are correct and which are not. The most serious danger, of course, is that a patient could be declared brain-dead under substandard policies, and thus altering decisions regarding his or her treatment, when the restoration of brain function was actually still possible. Thus, a patient could be allowed to die prematurely and unnecessarily.

Legal Help for Planning Ahead

There are some steps you can take to help prevent uncertainty regarding your future medical care or that of a loved one. With the help of an experienced Orland Park elder law attorney, you can draft advance medical directives or establish a power of attorney for health care decisions that can be used in the event they are ever necessary. Call 708-518-8200 to schedule your free consultation today.

Sources:

https://www.washingtonpost.com/national/health-science/do-doctors-really-know-when-someone-is-brain-dead/2016/01/04/59a09410-ae3f-11e5-b820-eea4d64be2a1_story.html

http://www.neurology.org/content/74/23/1911.full.html

http://www.scpr.org/programs/airtalk/2015/12/29/45734/when-are-you-really-dead-new-study-finds-hospital/