The conceptual confusion shown in this investigation included illogical statements, such as the claim that a person died because he is about to die, and philosophical disagreements, such as the claim that loss of consciousness is death. It is not possible to answer in this survey the question of whether philosophical disagreements reflect the consideration of all the nuances of the different arguments. However, it seems that doctors are not well informed about philosophical debates about the concept of comics. This is supported by the conclusion that 20 respondents (37%) would continue to provide support in the face of a brain-dead patient who has no cerebral blood flow, but a family that insists on continued “life support.” This is remarkably similar to a recent survey that asked 25 pediatric ICU doctors whether “a child who is legally brain dead should be deprived of life support, even if the parents disagree”; 34% responded that they disagreed or were unsure.30 If similar support in a patient did not continue after irreversible circulatory death, it suggests that BD is different from death. Conclusions There is considerable confusion about the concept of BD among pediatric critical care physicians in Canada. The medical community should reconsider whether comics equate to death. Results Of the 64 surveys, 54 (84%) were returned. When asked if they should choose a conceptual reason for why comics correspond to death, 26 (48%) chose a higher brain concept, 17 (31%) a prognostic concept and only 19 (35%) a loss of integration of the concept of organism. More than half of the respondents responded that BD is not compatible with electroencephalographic activity, potential activity evoked by the brain stem or cerebral blood flow. More than a third of respondents responded that a brain stem with minimal microscopic damage was not compatible with BD.
Of the 36 respondents who responded, they felt comfortable diagnosing BD because “the conceptual basis of brain death equates it with patient death,” in their own words, only 8 (22%) used a concept of loss of body integration, 9 (25%) used a prognostic concept, 7 (19%) used a higher brain concept, and 13 (36%) did not articulate any concept. The physician interviewed, Dr. Hayani, and four other physicians concluded that Ms. McKitty met the criteria for neurological brain death. Despite these diagnoses, Ms. McKitty`s family claimed she was alive because of the physical movements they observed at her bedside. Wife. McKitty`s parents, as assistant decision-makers, sought an injunction that prevented Dr. Hayani from removing their daughter`s mechanical ventilation.
They were able to obtain an injunction, which remained in effect until the date of Justice Shaw`s final decision. British Columbia is one of many jurisdictions in Canada without legislation defining death. The Human Tissue Gift Act simply requires that a person`s death for the purposes of a post-mortem transplant be determined by at least two physicians “in accordance with recognized medical practice.” The Vital Statistics Act requires physicians to complete a medical certificate after death without specifying when the death occurs. As a result, the McKitty decision provides important guidance to physicians and health authorities in British Columbia. Ouanounou`s family is trying to keep him on a ventilator until his heart collapses, as Orthodox Judaism defines death, their lawyer Hugh Scher said. Finally, Justice Shaw concluded that the CEA is not responsible for resolving disputes between physicians and alternate decision-makers when the former has declared a person deceased. A person who has been declared brain dead is not a person who needs treatment because they are dead and are not incapable. First, Justice Shaw concluded that death includes brain death, which must be defined in accordance with CMAJ guidelines. Second, Justice Shaw accepted expert evidence from both parties that Ms. McKitty`s bodily movements came from the spinal cord and not from the brain.
She concluded that Ms. McKitty was brain dead despite these movements. As regards the Charter`s arguments, the General Court first considered the question referred for a preliminary ruling as to whether the Charter confers personality on a person declared brain dead. Since McKitty was brain dead, not only was she unable to exercise Charter rights and freedoms, but “she is not a person and that would be a mistake. the Charter which confers legal personality on it. Under Article 32 of the Charter, doctors may be subject to the control of the Charter only in certain limited circumstances, in particular if they are representatives of the Government. In determining whether the Charter is based on the Hayani, the court considered whether he was fulfilling a government function or fulfilling his medical duty by declaring McKitty dead. A distinction was made between the determination of death and the registration of death (the former is a medical role that involves diagnosis, and the latter is a government function). It was therefore found that the Charter was not applicable to Dr. Hayani in the circumstances. • A new examination at a different time is recommended to ensure independent confirmation by another qualified doctor, regardless of the main mechanism of brain injury. It is advisable to conduct an independent review, because in this age group there is a lack of collective experience and research on brain death.
There is no recommended minimum time interval between determinations. If problems of uncertainty or confusion arise that cannot be resolved, the time interval may be extended at the discretion of the physician, or an additional test may be used to prove the absence of intracerebral blood flow. We recommend that the mechanism for reporting NDDs be the medical death certificate and that hospitals be responsible for forwarding the information provided to the appropriate authorities, such as the Canadian Institute for Health Information. We found that 36 (67%) respondents felt comfortable diagnosing death based on BD tests because “the conceptual basis of bd equates it with patient death.” This subset of respondents showed similar confusion about the concept of comics. Only 8 respondents (22%) used a concept of loss of integration, 9 (25%) used a prognostic concept, 7 (19%) used a higher brain concept, and 13 (36%) did not articulate a concept (i.e., used a statement of the BD criterion or left no answer). Brain death (BD) is medically and legally synonymous with patient death in most developed countries of the world.1 Brain death is defined as the irreversible loss of critical functions throughout the brain, including the brain stem.2 This, according to many proponents of bd, is considered conceptually equivalent to death because the brain is necessary to maintain the integrative unity of the body.3 Without brain functions, it is claimed that bodily functions will disintegrate. There are 2 justifications used to confirm that bd is irreversible and synonymous with death: the inevitability of cardiac arrest and somatic death in a few days and the pathological verification of the complete destruction of the brain in BD.4,5 Superior BD or neocortical death with the death of the “essence” or “soul” of man or consciousness (but with the preservation of brainstem function) is not BD, and is not medically or legally accepted in any country as equivalent to the patient`s death.3 Even allowing religious shelters, as the states of New York and New Jersey have done, would not really change the definition of death, she said. It allows patients considered brain dead to stay on ventilators until their hearts break down, which “saves the family some time,” she said. It is important to highlight the category of patients to whom the McKitty decision applies: patients who met the criteria for brain death, including lack of ability to conceive, lack of respiratory capacity, and lack of brain stem function. This is to be distinguished from patients who are in a persistent or little vegetative state, in whom a certain function of the brain stem remains. • Skills and knowledge in the treatment of patients with severe brain injury and NDD.
• The absence of brainstem reflexes, as defined by the absence of gag reflexes and coughing, and the bilateral absence of brain death are best understood as cerebral arrest or the final clinical expression of complete and irreversible neurological impairment. Despite the widespread national, international and legal acceptance of the concept of death as defined by neurological criteria, there are significant differences in the standards and their application.1 to 5 In all Canadian provinces and territories, the legal definition of brain death is “according to recognized medical practice.” These practices are largely determined by hospitals or regions. Guidelines established in 19886 by the Canadian Congress Committee on Brain Death and in 1997 by the Canadian Neurocritical Care Group clarified the criteria, but did not lead to consistent practice.