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The Shifting Landscape of Death by Neurologic Criteria in Pediatrics: Current Controversies and Persistent Questions
Rebecca F P Long1, Jenny Kingsley2, Sabrina F Derrington2
1Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Insights
Brain death (death by neurologic criteria) remains controversial despite legal and professional support. This review examines pediatric DNC controversies, including diagnostic inconsistencies and ethical concerns, to improve family care.
Area of Science:
- Neurology
- Bioethics
- Medical Law
Background:
- The concept of death by neurologic criteria (DNC), or brain death, was established in 1968.
- Despite widespread adoption in legislation and policy, DNC remains a subject of debate among experts and the public.
Approach:
- This focused review examines current points of contention in the diagnosis of DNC specifically in pediatric patients.
- It analyzes inconsistencies and controversies from physiologic, legal, and philosophical perspectives.
Key Points:
- Key areas of controversy include definition inconsistencies, clinical examination components, practice variability, and ethical issues like justice and informed consent.
- Understanding these pediatric DNC controversies is crucial for effective and equitable care.
Conclusions:
- Addressing the multifaceted controversies surrounding pediatric DNC is essential for improving clinical practice and family support.
- Enhanced understanding can lead to more compassionate and equitable care for families facing DNC diagnoses.
Abstract:
Since the concept of death by neurologic criteria (DNC) or "brain death" was articulated by the Harvard Ad Hoc Committee in 1968, efforts to establish and uphold DNC as equivalent to biologic death have been supported through federal and state legislation, professional guidelines, and hospital policies. Despite these endeavors, DNC remains controversial among bioethics scholars and clinicians and is not universally accepted by patient families and the public. In this focused review, we outline the current points of contention surrounding the diagnosis of DNC in pediatric patients. These include physiologic, legal, and philosophical inconsistencies in the definition of DNC, controversy regarding the components of the clinical exam, variability in clinical practice, and ethical concerns regarding justice and role of informed consent. By better understanding these controversies, clinicians may serve families grappling with the diagnosis of DNC more effectively, compassionately, and equitably.
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