Brain Death, the Pediatric Patient, and the Nurse
Brain Death, the Pediatric Patient, and the Nurse
At the level of statutory law and clinical practice, brain death is regarded as one of the few relatively settled issues of contemporary bioethics, yet for some, the conceptual basis for equating an irreversibly non-functioning brain with a dead human being remains controversial and puzzling (Shewmon, 2001). Brain death in children can make the issue even more troublesome because of underlying psychosocial and physiological differences between children and adults. One basis of this disagreement resides in the lack of a universally agreed upon scientific definition of what constitutes the death of a human being. Some health practitioners believe that a human is clinically dead when the brain, understood by some as "the master regulating organ," has irreversibly stopped functioning (Bernat, 2006, p. 38). Conversely, McMahan (2006) argues that this definition lacks clarity and is fundamentally flawed because loss of integrative unity of the person as a whole is not a tenable reason for equating brain death with clinical death. McMahon (2006) believes that focusing solely on the brain raises more questions than provides answers.
In addition to the controversy related to definition, not much literature examines the issue of brain death in pediatrics; most research involves an adult population. However, children are different than adults in many ways. Psychosocially and physically, children are cared for differently, with the resulting difference in how brain function is assessed, and their dependence and inability to speak for themselves may contribute to their seeming more vulnerable and in need of advocacy and protection. Pediatric nurses also assist families through difficult circumstances and have important roles in helping families understand their child's condition. This article will provide pediatric nurses with a brief history of brain death, examine how this issue is currently being addressed (with particular attention to the roots of the controversy), and explain why the issue should be approached philosophically.
Abstract and Introduction
Introduction
At the level of statutory law and clinical practice, brain death is regarded as one of the few relatively settled issues of contemporary bioethics, yet for some, the conceptual basis for equating an irreversibly non-functioning brain with a dead human being remains controversial and puzzling (Shewmon, 2001). Brain death in children can make the issue even more troublesome because of underlying psychosocial and physiological differences between children and adults. One basis of this disagreement resides in the lack of a universally agreed upon scientific definition of what constitutes the death of a human being. Some health practitioners believe that a human is clinically dead when the brain, understood by some as "the master regulating organ," has irreversibly stopped functioning (Bernat, 2006, p. 38). Conversely, McMahan (2006) argues that this definition lacks clarity and is fundamentally flawed because loss of integrative unity of the person as a whole is not a tenable reason for equating brain death with clinical death. McMahon (2006) believes that focusing solely on the brain raises more questions than provides answers.
In addition to the controversy related to definition, not much literature examines the issue of brain death in pediatrics; most research involves an adult population. However, children are different than adults in many ways. Psychosocially and physically, children are cared for differently, with the resulting difference in how brain function is assessed, and their dependence and inability to speak for themselves may contribute to their seeming more vulnerable and in need of advocacy and protection. Pediatric nurses also assist families through difficult circumstances and have important roles in helping families understand their child's condition. This article will provide pediatric nurses with a brief history of brain death, examine how this issue is currently being addressed (with particular attention to the roots of the controversy), and explain why the issue should be approached philosophically.