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Respiratory test
There is no spontaneous breathing when PCO2 is >6.6kPa
Discussion points
Explain that the patient is dead
The ventilator is keeping the patients lungs moving and his/her heart beating
There may be occasional reflex twitches or movement even after brainstem death. There may also be occasional but irregular, laboured
gasps of breath (agonal breaths).
The pons and medulla, which have cranial nerve nuclei, also contain the reticular activating formation and the respiratory centre, responsible
for consciousness and breathing.
There is no legal definition of death in the UK, but since 1976, the courts have accepted brainstem death as death of an individual.
No EEG or imaging is needed to diagnose brainstem death.
Ethical issues
Should we use the criteria to define death?
Beneficence: It could be argued that defining death may help preserve the dignity of the patient rather than continuing futile, invasive
treatment indefinitely (intubation, IV access, catheterisation, etc).
Non-maleficence: Tiny chance that the patient may be conscious despite brainstem death, as we cannot directly test the reticular activating
system itself. Therefore we may be harming a person with the potential for consciousness (even though unlikely, and they would not be able to
breathe unaided)
Autonomy: There is no autonomy in this situation. Remember that even if a person has previously stated they would like ventilation or active
treatment in all circumstances, the decision to continue treatment is a medical decision, only if it is considered to benefit the patient.
Social justice: Defining brainstem death allows patients with no hope of recovery to be diagnosed and disconnected from ventilators more
quickly, freeing up resources in intensive care. Also it allows the possibility of organ donation.
Further reading
For details on brainstem death criteria and testing:
A Code of Practice for the Diagnosis and Confirmation of Death by the Academy of Medical Royal Colleges. Available
at: http://www.aomrc.org.uk//42-a-code-of-practice-for-the-dia