With actress Natasha Richardson said to have suffered brain death yesterday and to have been on a ventilator or “life support” to enable her family to say goodbye, many fans are praying for a reversal of her medical condition as they await the promised Wednesday afternoon statement on Natasha Richardson’s condition from her family. If Richardson indeed suffered brain death yesterday as many media sources reported, is she already deceased? Is reversal of brain death medically possible?
Since brain death (then called permanent coma) was advocated in a 1968 Harvard Medical School paper as a basis for determining death, all states have accepted brain death- the cessation of all brain function- as a sole basis for declaration that a person has died. The conflicting reports yesterday stating that Natasha Richardson had suffered brain death but was not yet dead because she was being kept alive on a respirator- are not medically or legally possible. Once a declaration of brain death is made, the patient is legally and medically dead, despite the fact that the heart may continue to beat.
A study involving patients who died from 1992-2001 in Kuwait, where brain death is not accepted as the definition of life’s end, found that the mean survival time between the declaration of brain death and the heart’s cessation was 8.20 days with the median suvival time 6 days. None of the patients in the Kuwait study’s hearts beat longer than 30 days after brain death occurred.
Journalist Liz Smith, longtime friend of Natasha Richardson and her family, reported that the family removed Richardson from life support at 1:30 p.m. today.
Is there any chance at all, if the reports of brain death are correct, that Natasha Richardson is not dead, that brain death could be reversed?
Brain death occurs when the doctors determine that the patient suffers coma or unresponsiveness, absence of cerebral motor responses to pain in all extremities, absence of brain stem reflexes, and apnea. Once the brain has ceased functioning, doctors say that a return of brain function is impossible.
Professor Allan Kellehear from the Centre for Death & Society at the University of Bath noted in Science Daily in 2007 that there is a discrepancy between how doctors and patients’ families view brain death.
The discrepancies between laymen views of death and medical declarations of brain death is leading some medical institutions to reconsider the terminology used with patients’ families. Substituting the term “mechanical ventilation” for “life support” may help convey that both legally and medically, the patient is already dead. The time of death in brain death cases is recorded when the determination that the brain is no longer functioning is made, not when the heart stops, even if the heart beats on for days.
Sources: http://classic.aacn.org/aacn/jrnlccn.nsf/0/5ebf8de743ead0fa8825674e005a8950?OpenDocument; http://www.sciencedaily.com/releases/2007/09/070911202516.htm; http://content.karger.com/ProdukteDB/produkte.asp?Doi=68506; http://health.howstuffworks.com/brain-death.htm/printable; http://www.apaonline.org/publications/newsletters/v97n2_Medicine_04.aspx; http://www.newsday.com/news/local/newyork/ny-etrichardson0319,0,202671.story.