Do People Come Back from Brain Death?
Brain Death Overview: Law, Life & Death
Ancient wisdom says:
“The revelation awaits an appointed time … Though it linger, wait for it; it will certainly come and will not delay.”
Do people come back from brain death? Technically, the short answer is YES. There have been medically published cases of infant and adult brain death recovery in medically-recognized peer review journals.
Brain Death Laws
The definition of brain death occurrence, according to the Uniform Determination of Death Act (UDDA), states that brain death has occurred when an individual who has sustained either irreversible cessation of circulatory and respiratory functions, or sustained irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.
What does this legal definition mean? According to the National Conference of Commissioners on Uniform State Laws, this law applies to doctors and other professionals who use intent and interpretation of the law when making medical decisions. This definition is approved by the American Medical Association and the American Bar Association.
About “Intent and Interpretation” of the Law
The UDDA law states: “the entire brain must cease to function irreversibly. The entire brain includes the brain stem, as well as the neocortex. The concept of the entire brain distinguishes determination of death under the Act from neocortical death, or a persistent vegetative state.” Neocortical death and a persistent vegetative state are not deemed valid medical or legal bases for determining death.
This intent and interpretation is an agreement with the whole-brain standard and dead donor rule guidelines. The Stanford Medical Dictionary states, “according to the whole-brain standard, human death is the irreversible cessation of functioning of the entire brain, including the brainstem.” This is the medical definition of whole brain death.
According to the American Academy of Neurology Guidelines used by doctors for determining brain death in adults “many of the details of the clinical neurological examination to determine brain death cannot be established by evidence-based methods. It must be emphasized that this guidance is (physician) opinion –based. (Commonly known as an educated guess.) Alternative protocols may be equally informative. Brain Death is normally determined only by a bedside determination without using any evidence based ancillary testing.”
Of the five major recommendations by the AAN Guidelines, as published by the Department of Health and Human Services, used to determine brain death, 4 out of 5 are rated Level U as inadequate and conflicting.
It is important to note that a determination of brain death is done by a bedside examination, using the 2010 American Association of Neurology Guidelines, and should include confirmatory testing to determine brain death beyond all reasonable doubt.
Brain death is defined differently in every state. As a result, every hospital has its own policies for determining brain death. When an authorization for medical treatment has been signed, the decision-making power regarding medical treatment is legally changed to one of agency, meaning that power now resides with the doctors.
Brain Death: Understanding Your Rights
The UDDA is not a federal statute; however, state regulations cannot supersede a citizen’s declared fundamental, unalienable and constitutional rights, as outlined in our country’s founding documents. Moreover, doctors cannot ignore a patient’s proportional rights to supportive comfort care, even when under their duty of agency. This support is not medically futile because ventilation support could result in the patient recovering vegetative brain stem function and the possibility of respiration.
From the Institute of Neurology in Queen Square, London, Tom Sears has intensively studied this subject. He states:
“Whilst the cerebrum is absolutely essential for sensory perception and conscious, willed behavior, the brain stem is absolutely essential for life in the absence of artificial life support. Even should the entire brain be destroyed above the midbrain, the brain stem itself, providing the motor pathways to the respiratory motor neurons in the spinal cord are intact, will sustain a living body (though not a ‘life’ as we normally know it) until death ensues due to starvation, infection, or cardiac arrest.”
A physician who takes a brain dead (coma dépassé) patient, who is breathing on their own off a ventilator, may face civil prosecution for wrongful death. This is the one area where the debate about medical futility becomes confusing.
“Being on a ventilator ethically, is not a “medically futile action,” when ventilation treatment that provides only minor benefit… (or)… the benefit is unlikely … (or)… if the cost is disproportionate to the benefits that might accrue to the patient.”
Butcher says you need to only ask if the ventilator will keep the patient alive. If the answer is “yes” then it is not a medically futile action, as it will do what it was developed to do … keep the patient alive.
If life support is used, it is because it is ethically and legally in the patient’s best interest. If there is a mislabeling of the living brain-injured patient, it creates disrespect to the life forces and the patient’s individual unalienable rights to life. If brain death is declared, and the UDDA has not been strictly followed, the patient’s life rights have been violated.
This view was supported in the 2009 Presidential Council on Bioethics (PBCE). The PBCE stated:
“We cannot know with certainty that patients with total brain failure are dead or alive and as a result, such patients should be regarded as living until their heart stops.”
The patient’s proportional federal rights remain supreme. If a state receives any federal monies, it is the state’s duty to uphold a citizen’s federal right. However, if the patient’s rights are ignored and not voluntarily upheld, court intervention may be necessary in order to have the state enforce the law regarding the patients or family’s rights.
The only control the patient retains is through medical directives such as a(n):
- Living will
- Do not resuscitate (DNR) order
- Organ donor card or registry
- Life guardian card
- The family’s wishes
Brain Death Case Studies
Determination of brain death is psychologically and clinically difficult for all involved. How one arrives at a determination matters morally to all sides, as it will effect and implicate everyone involved: doctors, family, and most of all, the patient, their personhood, their principal right to autonomy and their moral right to exist.
There are 12 published cases in a 2009 edition of Pediatric Neurology of purported child brain death conditions that were reversed and one adult case was reported in Crit Care Med. This case was medically recognized in peer review journals as brain death. In addition, much anecdotal evidence exists, like the stories of Zack Dunlop, Kate Allatt, Colleen Burns and 37-year-old Anthony Yahle.
What Happens When the Body Encounters Brain Death
Brain death, known as irreversible deep coma or coma dépassé, is a state of diminished mental capacity caused by a brain injury resulting in what is thought to be total loss of all brain function, including cognitive thought and environmental awareness. This loss removes the brain’s ability to control all bodily responses, and leaves it unable to sustain any bodily functions on its own. Even on a ventilator the lungs may lose the ability to recoil, a function of respiration which allows one to breathe.
When there is no regulation of blood pressure even when a patient is on a respirator/ventilator, the normal body temperature causes the body to undergo auto digestion, which ends in liquefied brain matter, or widespread necrosis (oxygen deprivation in the brain that results in death).
This is the current legal standard of brain-based death which allows doctors to declare a ventilator-dependent patient dead before the heart stops beating as long as the determination of death has been proven beyond all reasonable doubt that no life exists. Yet, in some cases, the brain’s ability to regulate all bodily functions can be hidden when the body is on a ventilator. However, the UDDA law states for brain death to occur, requires irreversible cessation of all functions of the entire brain, including the brain stem which is Whole Brain Death.
Recent Scientific Discoveries
Scientists struggle with understanding human consciousness, but have made significant scientific discoveries in the last two years. Deep coma is a current medical condition that, given the most recent research, carries the possibility for improvement and maybe even reversal at some future point in time.
Scientist recently grew a primitive human brain by using a single human skin cell. Changes and results in current research published by Plosone in July 2011 show that brain cells can continue to live for weeks after decapitation, and states that a new definition of brain death is needed.
Another study conducted in September 2013 looked at deep coma activity beyond a flat line EEG, and a study on mammal hibernation—a form of deep coma—showed a new ability to turn mammal hibernation off and on at will, which scientist now say is a state much like that of the medically-induced deep coma.
Today doctors have the ability to wake patients from a coma for short periods of time to determine the extent of brain damage. It has been medically established that the outcome for patients who have ventilation extended allows some level of recovery of the vegetative function of the brainstem resulting in an impairment of consciousness, or a state of arousal but no awareness.
This raises the following questions:
- How are we alive if we are in deep coma and, therefore, not conscious?
- Who are we when we can no longer remain awake and aware due to severe impairment of the conscious state?
Current research in stem cells, hibernation, and the induction of hypometabolism suggest true consciousness. This research may be on the verge of new outcomes for patients with deep coma brain injuries–changing the limits of what medicine can do.