THE NEED FOR BETTER UNDERSTANDING
n late August of 1984, an unconscious, five-year-old child was I brought to the emergency room of a northern California community hospital. She was immediately placed on a respirator, which forced oxygen into her lungs, permitting the still-beating heart to deliver oxygenated blood to her organ systems. Within a few days, it became apparent that the child's brain function was entirely destroyed. A consulting neurologist, in accordance with accepted medical standards, noted in the chart that the child was neurologically dead-i.e., dead by brain death criteria.
The attending physician, however, did not declare the child dead, nor did he discontinue treatment. Instead, he asked the child's distraught mother for permission to withdraw the respirator. The mother refused. The body continued to receive "treatment," including blood, fluids and antibiotics and the dead child remained in the intensive care unit on full code status. The neurologist continued to make daily visits, regularly noting on the chart, "Patient neurologically dead again today." The stalemate continued a week, then two weeks. The newspapers heard about it and there were press conferences, abortive court hearings, and numerous meetings. There were also repeated refusals to discontinue the respirator-but now they came not only from the mother but also from her lawyer, the attending physicians and their lawyer. The crisis was resolved when the hospital administration decided, on its own authority, to cease providing mechanical ventilation for the dead patient.
In 1974, California was among the first states to recognize "irreversible cessation of all functions of the entire brain" as a definition of death. In 1983, the state legislature revised the 1974 statute to conform to the recommendation of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. In California, "[ a]n individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions, or 2) irreversible cessation of all functions of the entire brain, including the brain stem, is 0 1985 by The Regents of the University of California