Physician Authority to Make the Determination of Death: Why It Matters

This guest post is part of The Bioethics Program’s Online Symposium on the Munoz and McMath cases. To see all symposium contributions, click here.

by James Zisfein, M.D.
Chief, Division of Neurology, and Chair, Ethics Committee, Lincoln Medical Center

Why does it matter, to those of us involved in clinical ethics, that physicians are losing the authority to determine that a person has died?

I offer several reasons, in increasing order of importance:

Firstly, there is the (wasted) financial cost of maintaining dead people in critical care beds. However, even with the loss of physician authority to determine death becoming more common (due to publicity surrounding the Jahi McMath case), this cost is but a small fraction of our national health expenditures.

A more important reason is damage to professional integrity. The damage cannot be easily measured, but it’s real. The most bitter complaint I hear from critical care nurses is regarding their wasted efforts to prolong the lives of the imminently dying, and how that infringes on their time available to help patients with a chance to recover. (I don’t think they’ll be much happier ministering to the already dead.) And we have to also acknowledge the feelings of us neurologists and intensivists who use our extensive training and skill to make a correct determination of death only to see it nullified by angry but ignorant families, inept hospital administrators, and [unprintable] court rulings. Personally, it makes me wonder why the hell I’m doing this.

Thirdly, there will be inevitable loss of transplantable organs. As more and more families doubt the accuracy of determinations of death and assert dubious religious objections, and get supported by courts, there will be more and more lives lost on transplant waiting lists. It is already a far too common heartbreak when a child or young adult dies from liver failure, and the death could have been prevented. Prepare for a lot more heartbreak.

But the most important reason for allowing physicians to do their jobs — to determine death properly by medical standards — is for the sake of bereaved families. They have already suffered a tremendous loss, and introducing doubt about the fact of death or possibility of recovery does not change the outcome. It only intensifies and prolongs their anguish.

That’s why I think it matters. Any other takers?


3 thoughts on “Physician Authority to Make the Determination of Death: Why It Matters

  1. In my NOT so professional opinion, I think it comes down to the wording.

    The terms we as a nation use for such cases. The Media was NOT clear on how BRAIN Dead
    Mrs. Munoz was. Also, the word Life Support, is a gross misnomer in this case, as this was not life support, it was death support, yet, Life Support was used over and over in our media describing this case.

    People in general do not understand that a dead person can’t be left on a ventilator indefinitely.
    That once dead, a ventilator can not properly replicate the respiratory and circulatory system to sustain vital organs. That even on a respirator she was decomposing.

    The general public does not understand the difference between a coma, vegetative state and brain dead.
    This is where people were confused in this case, as Mrs. Munoz was DEAD, not just brain dead, but clinically dead.
    I say this because many people think of Terri Schiavo, when they hear the term brain dead, therefore confusing brain dead with persistent vegetative state.

    The words we use in these conversations have confused the public a great deal.
    Not to mention, preventing grieving families from understanding what brain DEAD actually means.

  2. Agree completely that a national conversation and further education are needed, and concur with Dr. Zifstein’s remarks. Maintaining the newly deceased on mechanical ventilation for purposes other than organ donation or to provide reasonable accommodation for grieving families compromises dignity, personal and professional integrity and is an unacceptable use of scarce resources.

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