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Brain Dead

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Submitted By bpennix
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When a person is born it is an immediately known that one day they will die. You go through life carefree not considering that one day that could instantly change. Often times persons of a particularly older age tend to have measure in place that dictates their final wishes such as wills, DNRs, and their desire to donate organs or not. At twenty or even thirty you aren’t considering your demise. The most you may have is life insurance. If something happens that daunting task is often left to your loved ones. Hospitals are faced with the grueling task of ethically ensure their duty to do no harm while also trying to respect the patients and loved ones wishes. When it comes to traumatic unforeseen brain injuries it can be hard to let go. One day the person was perfectly normal, then instantly you are faced with deciding how they will ultimately spend their last living moments. You must consider the how the person’s life was before the injury as well as the quality of life they would have if treatment was continued.
A patient’s death dictates a cease of treatment and allows those who have made their wishes known can begin the process for donating organs for transplantation to help save the life of others. A determination between life and death is essential due to the physician’s inability to waste limited medical resources or to potentially violating medical ethics by inflicting treatment after the patient is considered medically dead. With a precise diagnosis, families may be better able to cope with the passing of their loved one and can begin the mourning process. The National Conference of Commissioners on Uniform State Laws approved the Uniform Determination of Death Act in 1981(Wijdicks, 2010). This law outlined brain death as an irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem (Wijdicks, 2010). With regards to this case from both an ethical and legal stand point as the hospital administrator I think that it is imperative to determine the current status of the patient. The patient has not met the criteria for brain death. The physician must determine if the patient is in a coma, vegetative state, or in minimally conscious state (Wijdicks, 2010). Coma suggests that the patient though alive has eyes-closed, experiencing a depressed consciousness state that they cannot be aroused from, and still exhibit brain stem responses. Vegetative states suggest that the patient has severely impaired consciousness. Minimally conscious state patients experience occasional purposeful movements, and at times are able to move eyes as well as speak.
As the hospital administrator, as well a medical staff, have a duty of care (Pozgar, 2011). And would act on behalf of the patient to ensure their best interest was always the main focus. Medical staff and personnel would be available to answer any questions the family could have. Since the family seems to be somewhat divided on the manner in which they want care to be provided. After speaking with the hospital’s legal advisers, it would be important to work with both sides to set time frames. We would monitor the patient vital for the next 48 hours, repeating neurological test to determine if the patient status has improved or not. The doctors would run an extensive examination, including following a step-by-step checklist including about 25 tests and criteria used to determine if a patient is brain dead. These tests can include establishing the immediate cause and the irreversibility of the coma. Imitating the hospital’s policy on notifying the patient's Surrogate Decision-maker, conducting and ensuring documentation of brain stem reflex assessments, performing ancillary and apnea test, ensuring responsible accommodation have been implemented, certify brain death and then discontinuation of life support (Greer et al., 2008). Presently hospitals are required to have two different physicians’ direct clinical assessments. This is done by attempting to arouse the patient and determining whether or not there is any response. Besides the previously mentioned Ancillary and apnea test, other test include shinning a light in a patient’s eyes, creating noises near their ears, checking for gag reflex as well as a removal of respiratory device to see if the patient is able to breathe on their own. Lastly the patient will be checked to see if they respond to pain. As the hospital administrator I would ascertain written protocols for the reasonable accommodation for the patient based on their religious or moral objections. I would consult with and have available staff resources and personnel such as clergy members, ethics committees, bereavement counselors, and conflict mediators to help answer any oppositions or demurrals.
In conclusion it is important as a hospital administrator to be firm but fair. To consider the patient suffering and the families as well. Ensure protocols are in place that set times frames that allow the hospital to refrain from legal and ethical violation. But also allows the family time to make decisions and say final goodbyes.
References
Greer DM, Panayiotis V, Haque S, Wijdicks EF. Variability of brain death determination guidelines in leading US neurologic institutions. Neurology. 2008.
Pozgar, G. D. (2011). Legal aspects of healthcare administration (11th ed.). Sudbury.
Wijdicks EF. Determining brain death in adults. Neurology. 2010.…...

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