Dr. Germ: brain death vs. true death 

Many people are very vocal about their wishes regarding death and brain death. Brain death occurs when a person loses brain function in which they will not be able to regain consciousness or breathe without support. This usually happens as a result of head trauma, a complication in which the person loses oxygen, or as a result of another traumatic event. 

Brain death is considered one of the worst possible scenarios because it depends on the decisions outlined in an advanced directive, which details one’s end of life wishes, or based on family’s decision whether or not an individual’s life should be sustained.

One of the discussions around brain death is that medical professionals may never know if someone has completely lost all of their brain function and perception. Many studies have indicated that those under life support have some level of consciousness and brain activity. This activity however is very minimal, which is why it may not be indicated on any electroencephalograms, as it does not cross the threshold for conscious cognitive function. 

Due to this gray area of whether or not a person retains some level of brain activity after being pronounced brain dead, it raises ethical issues for those without an outlined advanced directive. For these individuals, since their wishes were not previously outlined, their family members or close individuals will have to make tough decisions about their continuation of life support, or end of life care, in which they will be removed from any supportive device, leaving the body to die completely. 

For the body to die completely this means that all physiological functions have ceased. This includes breathing, the heart pumping blood, and regulation of homeostasis. Once removed from life support, and supportive machines, the brain is no longer able to sustain these bodily processes, and with time, they will completely stop. 

 A notable case in which the decisions regarding brain death and sustaining life brought on ethical issues is the case of Terri Schiavo, who was pronounced brain dead after a cardiac event in which she was resuscitated but never regained consciousness after losing oxygen. Schiavo was in a persistent vegetative state as a result of the incident, however her husband argued that she had not wanted to be placed on life support, whereas her family members wanted to keep her on supportive devices. The conflicting decisions gained national attention as the case went to court, ultimately resulting in the removal of Schiavo from life support as she had wished. 

This case, like many others, brings up the dilemma of being unsure whether or not someone should be purposefully removed from life support. If it is their wish to be removed from supportive devices, then that should be honored. In cases where there is not any predetermined wish, then no conclusions should be made without consulting others who were close to the individual. Assumptions shouldn’t be made that an individual has no brain activity whatsoever, or that there is no chance for improvement as that is highly unknown in the current knowledge of neurological medicine. In future years, more research can be conducted about the implications of brain death, and whether it can truly ever be known when there is absolutely no function in the brain.