SCCM Resource Library-When Parents Disagree With the Diagnosis of Death by Neurologic Criteria

Pdf Summary

The document explores the complex ethical and medical challenges that arise when parents disagree with a diagnosis of death by neurologic criteria (DNC) for their child. The case of Jesse Koochin serves as an example, highlighting tensions between healthcare providers and parents who cling to hope that their child, diagnosed as brain dead, might recover through alternative treatments. The document discusses the ethical implications and the diverse societal perspectives regarding DNC, which does not always require the loss of all brain functions, leading to conflicts about its equivalence to circulatory death.<br /><br />The article identifies three potential benefits of diagnosing DNC: relieving parents of difficult decision-making, allowing consideration for controlled organ donation, and resolving clinical tensions by terminating futile organ support. However, these benefits often do not materialize if parents object to the DNC diagnosis, leaving them feeling disrespected and marginalized, and distrustful of the medical establishment, sometimes perceiving an ulterior motive related to organ donation.<br /><br />The discourse highlights a lack of consensus in the medical and bioethics communities about DNC. Some experts support its use, while others argue it is conceptually flawed, primarily established to circumvent ethical concerns regarding organ donation. When handling objections, the document recommends open communication with empathic understanding and shared decision-making over unilateral actions.<br /><br />Finally, the text suggests employing healthcare ethics consultants and following structured, fair processes to address disputes over potentially inappropriate medical interventions, arguing that this approach is better than imposing a DNC diagnosis against parental objections, which often results in legal battles and heightened moral distress among clinicians.

Asset Subtitle

Ethics End of Life, Pediatrics, 2022, 0:10:05

Asset Caption

"This article was first published in the Fall 2022 issue of Critical Connections.

When a child dies, it is devastating for parents, families, and often for ICU staff. End-of-life care for children is especially distressing when parents and clinicians disagree, cannot communicate effectively, or lack mutual trust.

Critical Connections, the critical care industry's only magazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team."

Meta Tag

Content Type Article

Knowledge Area Ethics End of Life

Knowledge Area Pediatrics

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Ethics and End of Life

Tag Pediatrics

Year 2022

Keywords

neurologic criteria

brain death

ethical challenges

Jesse Koochin

parental objections

organ donation

medical ethics

shared decision-making

healthcare ethics consultants

clinical tensions

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