Table 1.

Scenarios describing two approaches to death determination

Scenario 1: A case of death determination by neurologic criteria A 50-year-old man is admitted to the intensive care unit (ICU) following a severe head injury from a motorbike crash. He is on a breathing machine and is being given intensive care medications and treatments that keep his heart beating and his other organs working. Scans and other tests show a lot of brain damage. The following day, two doctors perform a clinical exam that shows that he has become “brain dead” because his brain has permanently stopped functioning. He cannot possibly ever recover. The intensive care doctors explain to the family that the machines are breathing for him and these machines and medications are keeping his heart beating and his other organs working. Without these machines and intensive care medications, his heart and organs would stop working.

Scenario 2: A case of death determination by circulatory criteria A 50-year-old man has been in the ICU for 3 weeks following a severe head injury. He is on a breathing machine and is being given intensive care medications to help keep his heart beating and other organs working. His condition has continued to get worse over those 3 weeks. While he has a severe brain injury, there is still some very limited brain function and is not considered “brain dead.” The doctors explained to the family that he will not recover from this injury and the family decides that they believe he would not want to be kept alive on machine support. The decision was made with the family to take him off of the breathing machine and other intensive care medications and provide end-of-life care. One hour after the breathing machine is removed and other supportive treatments are stopped, the patient's breathing and heart stops. There is no longer blood flow to his body and brain. Five minutes later, an intensive care doctor performs a clinical exam and declares that the patient has died.