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Consent to testing for brain death
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  • Published on:
    Decision to test is a medical one
    • Piotr Szawarski, Consultant in Intensive Care Medicine Wexham Park Hospital

    Dear Editor,

    Brain death remains a much discussed and perhaps even a controversial topic since its inception in 1968. It is good to see an addition to this debate in the form of an article on “Consent to testing for brain death” (1). The authors of this article note lack of uniformity of this construct across different jurisdictions which, despite reasonably strict codes of practice and different legal frameworks, implies that brain death is perhaps as much social or legal as biological concept. The elephant in the room however, as far as this article is concerned, is the lack of consent when admitting to ICU in the first place. There is an overarching duty to protect life even though prior values are not known at the outset of treatment. Consent in the UK can only be provided by an adult with capacity. Otherwise, treatment is provided based on the best interests framework. Consent on someone’s behalf is not possible in this jurisdiction. The authors repeatedly point out the invasiveness of brain death testing and distress of apnoea testing omitting to highlight the invasiveness of ICU care and distress associated with ventilatory or other interventions. Furthermore, the argument being made about moral distress misses the point: the distress is about ongoing interventions in the face of catastrophic brain injury to which formal diagnosis of death puts an end. Religious and conceptual barriers to withholding critical care interventions can be overcome even in most d...

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    Conflict of Interest:
    None declared.

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