Understanding the differences between brain death and other disorders of consciousness is critical for medical personnel as well as patients’ loved ones. According to the article, “Brain Death: What Health Professionals Should Know” the first step in clarifying misconceptions about brain death is informing the public on what brain death is. Dr. Vukov attempts to do just this in his talk about the differences between death and brain death.
Dr. Vukov begins by defining brain death as an irreversible coma. These patients lack brainstem function as well as spontaneous respiration. Brain death is often confused with vegetative state, where patients are capable of development but lack awareness. Awareness is one of two key aspects of consciousness. The other component being arousal or being awake. Brain death is also compared with locked in syndrome where patients have awareness but lack the ability to move. While these patients may appear to be similar to brain death patients from the outside, Dr. Vukov explains that locked in syndrome can be easily diagnosed with an EEG or fMRI.
Even with all of these key distinctions between disorders of consciousness, there continues to be confusion and misunderstandings, as demonstrated in the media. The article by Dr. Powell gives two examples of how families as well as healthcare facilities may misunderstand what brain death really is. The first example is of an adolescent whose family refused to believe that their child was dead. This led them to place their child in a facility where she will continue to receive care. The other example is of a pregnant woman who was diagnosed with brain death due to a blood clot. In this case, the facility would not declare her dead and wished to provide care to the mother in order to keep the fetus alive.
Dr. Vukov explains that cases such as the ones presented in Dr. Powell’s article are why it is absolutely necessary to have an accurate understanding of the definition of death. Currently the Uniform Declaration of Death Act includes two standards required to declare someone dead. The first being the cardiopulmonary standard which is the termination of circulatory and respiratory functions. The second is the neurological standard where one’s brain functions and more specifically, their brainstem function is terminated.
An article by Scientific American discusses how Bioquark is working towards bringing brain-dead patients back to life. This biotech group is working to “inject stem cells into the spinal cords of people who have been declared clinically brain dead. The subjects will also receive an injected protein blend, electrical nerve stimulation, and laser therapy directed at the brain” in hopes to “grow new neurons and spur them to connect to each other, and thereby bring the brain back to life”.
The success of Bioquark appears to be perceived as impossible in the neuroscience community. The article quotes Dr. Cooper, “there is no way this technique could work on someone who is brain-dead. The technique…relies on there being a functional brain stem…If there’s no functional brain stem, then it can’t work”. Dr. Coopers statement relates to Dr. Vukov’s explanation of brain death. As stated earlier, Dr. Vukov defines brain death as the absence of brainstem function, a definition he believes is synonymous with death. According to Drs. Cooper and Vukov, stimulating a brain-dead patient back to life by injecting stem cells would not bring revive the patient. The author of the Scientific American article also brings up questions such as, “if the person did regain brain activity, what kind of functional abilities would he or she have? Are families getting their hopes up for an incredibly long-shot cure?” These questions also relate to the ethical issues that Dr. Vukov presents in his talk. Dr. Vukov discussed how families’ hopes for spontaneous improvement can drive them to keep brain dead patients on ventilators. He also discussed how this can lead to a waste of resources as these patients are technically dead. Studies such as the one by Bioquark may lead families to continue care on their loved ones in hopes of one day bringing them back.
As Dr. Vukov states, the definition of death and brain death are not always black and white. As both Dr. Vukov and Dr. Powell explain, the first step in having a better understanding of brain death may be to continue having these types of conversations in order to tackle misconceptions around brain death.
Powell, T. (2014, May 01). Brain Death: What Health Professionals Should Know. Retrieved from http://ajcc.aacnjournals.org/content/23/3/263.short
Sheridan, K. (2017, June 01). Resurrected: A Controversial Trial to Bring the Dead Back to Life. Retrieved from https://www.scientificamerican.com/article/resurrected-a-controversial-trial-to-bring-the-dead-back-to-life/
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