Assertion: Most people die because their heart stops beating, i.e. a circulatory determination of death

BECAUSE

Reason: because most people aren’t tested for brain death – if they were, then this would be the most common mode of death

Assertion: The doctrine of double effect has been adopted by the common law in end of life treatment

BECAUSE

Reason: It is the ethical and legal justification for using medications such as opioids in end-of-life care, when the intent that they are being used is primarily to relieve pain and suffering, even if an unintended consequence is shortening a patient’s life.

Assertion: Organ donation should be considered in very ventilated patient dying in the Emergency department or ICU

BECAUSE

Reason: This is the best way to ensure we fulfil the wishes of all patients who would want to be organ donors.

Assertion: An 80 year old man has just been brought to the ED having been found GCS 3 with fixed dilated pupils. He was intubated and ventilated at the scene but has not been sedated or paralysed. On examination he has no brain stem reflexes. A CT shows a massive ICH. With this information, he can be clinically certified brain dead (Neurological Determination of Death).

BECAUSE

Reason: His clinical exam is consistent with brain death

Assertion: During neurological determination of death, abnormal extension to a central painful stimuli is an acceptable spinal reflex and ongoing brain death testing can occur

BECAUSE

Reason: Spinal reflexes may be present in patients with permanent loss of brain function