COMMENTARY

Calling It Like It Is: 'Brain Death' Is Death

Arthur L. Caplan, PhD

Disclosures

October 04, 2016

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Hi. I'm Art Caplan at the Division of Medical Ethics at the New York University (NYU) Langone Medical Center.

Death. It's something that we have to talk about with patients and families, and we are often confused when it comes to the pronouncement of death.

There have been a series of cases around the United States in which families who have had a child who has died have been reluctant to accept it because clinicians use the term "brain death." Brain death is something that families often do not understand, and when they learn that their child has brain death, they often do not want to understand it. They want to have hope. They want to believe that something can be done to turn the situation around. When you see situations where a child is dying or you know that death may come for a family you are caring for, a few things are very important to keep in mind.

First, the media commonly confuse people about brain death and coma. I recently did a study[1] with a couple of colleagues of mine at NYU on how brain death is presented in the media. The answer is: very poorly. They mix it up with coma (being unconscious but with the possibility of recovery) and permanent vegetative state (loss of consciousness but not death). Brain death means total and irreversible loss of all organized brain function. Your brain cannot make your heart beat anymore. You cannot breathe anymore—it can only be done artificially. People still see in the media that people allegedly recover from brain death, which is false. They mix it up with things like coma, where people can get better—but that is not brain death. You need to understand that people have biases and they want to hear hope.

When a patient dies or when you are talking to someone about how a loved one may soon die, my recommendation is: Do not use the term "brain death." Say, "They have died." Say the person has "passed away." The reason is because their brain has totally and irreversibly ceased to function. Brain death is one way to die. Cardiopulmonary death is another way to die. But in both instances, they are death. Legally and ethically, they are sufficient. If you use a term like "brain death" with a patient's family, they are going to hear that the brain has died but maybe the rest of the person is still alive. They may hope that somehow the brain can come back. They do not really understand that brain death is death.

We need to be careful in our language. We have to presume that the world of messages about brain death is not accurate, because it's not being well portrayed in movies, television shows, fiction, and other places that people hear about this idea. Death is death. Let's call it that. If someone asks, "How do you know they have died?"—whether it's a child or an adult—you can say, "It's because their heart has stopped" or "Sadly, their brain has ceased to function."

Language matters, and we need to understand this when we come to an area as sensitive as death.

I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center. Thank you for watching.

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