Prioritization of Ethical Themes When Surrogates Object to Technology Removal After Brain Death Determination

Area of Science:

• Medical Ethics
• Neurology
• Healthcare Policy

Background:

• Hospitals are revising policies for brain death/death by neurologic criteria (BD/DNC).
• National guidelines offer limited direction on handling surrogate requests to continue technology post-declaration.
• Ethical considerations surrounding continued support after BD/DNC determination are complex and debated.

Purpose of the Study:

• To analyze ethical values relevant to institutional responses to surrogate objections regarding BD/DNC.
• To propose frameworks for hospitals developing or revising BD/DNC policies.
• To emphasize the need for transparent policies addressing surrogate requests post-BD/DNC.

Main Methods:

• A narrative literature review was conducted.
• Identified six key ethical values influencing institutional responses to objections.
• Articulated three potential policy paths forward for institutions.

Main Results:

• Six ethical values identified: inappropriate treatment, distributive justice, BD/DNC as philosophical/legal vs. biological death, dignity/respect, surrogate authority, and medical mistrust.
• Different prioritization of these values leads to distinct institutional approaches.
• Institutions must understand the ethical tensions inherent in their chosen policy path.

Conclusions:

• Hospitals must develop clear, transparent policies for surrogate requests concerning technology use after BD/DNC.
• Policy decisions should be informed by local constraints and a thorough understanding of ethical values.
• Systems should be designed to honor diverse beliefs and experiences, even when not prioritized.