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Pediatric Death by Neurologic Criteria: The Ever-Changing Landscape and the Expanding Role of Palliative Care

Kimberly E Sawyer1, Stephanie A Kraft2, Aaron G Wightman3

  • 1St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Journal of Pain and Symptom Management
|May 13, 2021
PubMed

Insights

Pediatric palliative care teams can effectively support families and medical staff when a child faces brain death, or death by neurologic criteria (DNC). This article details DNC determination, ethical debates, and legal challenges, highlighting palliative care

Area of Science:

  • Medical Ethics
  • Pediatric Neurology
  • Palliative Care

Background:

  • Determining brain death, or death by neurologic criteria (DNC), in children presents unique ethical and legal challenges.
  • Families may hold differing concepts of death, leading to disputes over DNC diagnosis.
  • Existing literature lacks comprehensive guidance for pediatric palliative care providers in navigating DNC cases.

Purpose of the Study:

  • To elucidate the clinical determination of death by neurologic criteria (DNC) in pediatric cases.
  • To explore the evolution of ethical and legal controversies surrounding DNC.
  • To identify reasons for family disputes in DNC determinations and inform palliative care interventions.

Main Methods:

  • Review of clinical guidelines for DNC determination.
  • Analysis of legal cases and ethical debates concerning DNC.
  • Exploration of conceptual definitions of death and family perspectives.

Main Results:

  • DNC determination involves complex clinical criteria and ongoing ethical/legal debate.
  • Families' conceptualizations of death and religious beliefs can lead to challenges against DNC.
  • Disputes often stem from differing understandings of death and legal rights.

Conclusions:

  • Pediatric palliative care teams are uniquely positioned to support families and medical teams through the DNC process.
  • Interdisciplinary palliative care is crucial for addressing the complex emotional, ethical, and legal aspects of DNC.
  • Effective communication and support are vital for navigating family challenges in DNC cases.

Keywords:
Death by neurologic criteriabrain deathethicslegalpediatrics

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