NUR 2790 Discussion Brain Death Ethical Considerations

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NUR 2790 Discussion Brain Death Ethical Considerations

NUR 2790 Discussion Brain Death Ethical Considerations

patient is a 23-year-old female with a history of headaches. This morning she
was experiencing a really bad headache as her boyfriend was driving her to the
university. He thought she was sleeping and by the time they got to the school,
45 minutes later, she was not waking up. She was diagnosed with a cerebral
aneurysm and you are taking care of her in the Neurological ICU.

testing do you expect to be performed to diagnose brain death?

What is the
procedure when a patient is determined to be brain dead?

Who should
approach the family about organ donation?

The family
is approached about organ donation. The patient indicated on her driver’s
license that she wanted to be an organ donor. Her mother refuses to consent for
organ donation.

Do you
think donation should happen anyway? Why or why not?

What will
be the ethical consequences of your decision?

16-year-old (pronouns she/her) with a history of depression and ADHD who presents with coma. She was diagnosed with depression when she was 13 and had never attempted suicide before. Her parents are divorced and barely on speaking terms. She was at her mother’s place, talked to her father on the phone, who sent her grandparents to get her from her mother’s place. She had gotten into an argument with her mother about playing a video game. She was then found hung with a taekwondo belt around her neck tied to the bedpost. CPR was initiated by the mother. EMS found her to be in PEA arrest. She was given epinephrine. Circulation returned, but she was thereafter non-responsive. She was intubated and transferred to the ICU for care.

Over the next two days, she does not respond to painful stimuli or voice; does not grimace to pain; has no gag reflex; has no limb movements to pain; pupils are fixed and dilated; no spontaneous respirations; no volitional activity.

After she loses all brainstem reflexes, an apnea test is performed.  It confirms the absence of a respiratory drive when the patient is allowed to accumulate COwithout artificial ventilation.  A second brain death examination is needed per institutional policy, and is performed 24 hours later, confirming whole brain death.

The patient’s physicians in the ICU, palliative care, and neurology teams have been preparing the mother and father and their families for this possibility.

The neurologist explains that she has died and asks if they would like to have time with her before the ventilator is removed.  Her dad replies, “She’s warm. Her heart is beating. She’s breathing.  She’s not dead. We want a second opinion.  There must be more tests you can do.  She’s in there somewhere.  As long as she’s breathing, her soul has not left her body.”

While some religious traditions do not recognize brain death, her family simply genuinely believes she is not dead.  In their view, withdrawing the ventilator would cause her death, so when the time comes to extubate, they throw themselves over her body and say they will not let anyone ‘stop any of the machines’.

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*Pulseless electrical activity or PEA refers to a clinical diagnosis of cardiac arrest in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse, but is not.


  • What might hamper the clinician-patient/family relationships in this case?
  • How ought healthcare providers respond to this situation? What steps should they take and why (use the concepts of relational autonomy, beneficence/non-maleficence, virtue, etc. to guide you)?


CASE 2: Marlise Munoz:

“Marlise Muñoz was 33 years old and the mother of a 15-month-old when she collapsed on November 26, 2013, from what was later determined to be a massive pulmonary embolism. Initially described as apneic but alive, she was brought to the county hospital where her family was soon told that she was brain dead. Ms. Muñoz and her husband, both emergency medical technicians (EMTs), had discussed their feelings about such situations. So Erik Muñoz felt confident in asserting that his wife would not want continued support. Her other family members agreed, and they requested withdrawal of ventilation and other measures sustaining her body’s function. 

In most circumstances, this tragic case would have ended there, but Marlise was 14 weeks pregnant and lived in Fort Worth, Texas. Texas law states that a “person may not withhold cardiopulmonary resuscitation or certain other life-sustaining treatment designated . . . under this subchapter (the Texas advance directive law) . . . from a person known . . . to be pregnant.”1 The hospital caring for Ms. Muñoz interpreted this exception as compelling them to provide continued support and declined the family’s request to end such interventions. The attorney representing the hospital indicated that the law was meant to “protect the unborn child against the wishes of a decision maker who would terminate the child’s life along with the mother’s.” After weeks of discussion and media attention with the hospital remaining intransigent, Mr. Muñoz sued in state court to have his wife’s and family’s wishes respected.”

From: Ecker, J. Death in Pregnancy—An American Tragedy, NEJM, 2014,



  • What might hamper the clinician-patient/family relationships in this case?
  • How ought healthcare providers respond to this situation? What steps should they take and why (use the concepts of relational autonomy, beneficence/non-maleficence, virtue, etc. to guide you)?


Optional Further Investigation:

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