Defining Death

My first encounter with brain death was back in the early 1970s. I was a new RN in a shock-trauma unit. We admitted a 17-year-old young woman who had attempted suicide by jumping out of a fifth-floor window. If it wasn’t awful enough, I remember it was Thanksgiving weekend and she had been home from college.

Angiograms of normal blood flow in an active brain (at left) and lack of blood flow indicating
brain death. Photos © Fusionspark Media Inc.

As one might imagine, she sustained massive injuries, including severe head trauma. She had been intubated at the scene and was on a mechanical ventilator. Her pupils were fixed and dilated, and she had no spontaneous respirations and virtually no brain activity, according to electroencephalography (EEG) studies.

A gradual refinement of criteria.

I recall that there had to be three consecutive EEGs done before we could remove the ventilator. There was no ethics committee or formal meetings with hospital attorneys or administrators—just the physician, the family, and the pastor. And then the patient’s siblings and grandparents came to say goodbye. It was heart-wrenching.

Things have gotten more […]

2020-03-05T08:21:37-05:00March 5th, 2020|Nursing|0 Comments
Read More

‘We Request Your Quiescent Contribution’: Predatory Publishers Are Absurd, But Not Funny

Multiple daily solicitations.

The screenshot below shows an excerpt from an email our editor-in-chief recently received. Editors at AJN receive multiple emails daily from mysterious publishers soliciting them for article submissions, important roles on editorial boards, or as conference speakers. If it weren’t alarming, it would be flattering. We’re not scholars and experts in sub-specialties of botany or engineering, in fossil fuel geology, neurosurgery, or, for that matter, microbiology. Our advice on such topics might well be dangerous, or at least irrelevant and wrong.

Some open access journals are highly respected in their fields; the journal that sent this letter also bills itself as open access, but if it contains legitimate articles on microbiology, and I’m not saying it doesn’t, they may find themselves with strange bedfellows.

Despite obvious warning signs, some authors are not deterred.

It’s impossible to keep ahead of the flood of such emails, most of which are characterized by typographical oddities and peculiar juxtapositions of tone. There are many other tell-tale signs of predatory publishers, most of which have little or no oversight from real content experts and no editing or filtering of content (one must simply pay a fee to be published or attend a conference).

But what’s most worrisome about this trend is that their strategy of casting […]

2019-02-28T11:46:34-05:00February 28th, 2019|Nursing, nursing research, writing|0 Comments
Read More

Nurses, Dying, and Who Gets to Decide

by Ramon Peco/via Flickr

On Wednesday, a California court declared the state’s right-to-die law unconstitutional. The End of Life Act (AB-15) was passed in 2016 in a special session called by Governor Gerry Brown, and permitted physicians to prescribe medications to a patient “for the sole purpose of ending his or her life.” California was one of just a handful of states that had such legislation. Reports note that an appeal is likely.

And also last week, Australian scientist and right-to-die advocate David Goodall, who was 104 years old, flew to Basel, Switzerland, to take advantage of its right-to-die law and end his life. According to the New York Times, Goodall, whose health had been deteriorating since a fall, said, “One wants to be free to choose his death when death is at the appropriate time.” Mr. Goodall lamented that his home country didn’t allow him to die there.

An ongoing debate.

These events last week underscore the struggle over whether people have a right to choose to end their lives and who should decide that. It’s also why we are very pleased to highlight this important topic in the current issue of AJN.

In “Assisted Suicide/Aid in Dying: What Is the Nurse’s Role?”, ethicist Ann Hamric and colleagues report on […]

2018-05-18T14:04:40-04:00May 18th, 2018|Nursing|1 Comment
Read More

Aid-in-Dying: A Daughter’s Challenging New Nursing Role

A father’s request.

The March Reflections essay in AJN is by a nurse whose terminally ill 92-year-old father asked her to help him legally end his own life under the requirements of Oregon’s Death with Dignity Act. The short essay is intimate, informative, and honest. Here’s a brief excerpt from near the end:

Although I miss my father terribly, I have no regrets. Mostly, I am thankful for his strength and courage, his clear-mindedness, and his willingness to work with me to repair our relationship. I am also thankful that nursing prepared me for the role of nurse advocate and taught me how to ‘be with’ a person at the end of life, even when that person was my father.

By Barbara Hranilovich for AJN.

Death With Dignity laws.

It can’t be easy for a nurse, whose job usually focuses on restoring patients’ health and preserving their lives, to help a family member die in this way. Nor is the process without challenges: the requirements of Death with Dignity laws are rigorous, layered with checks and double-checks to guard against potential abuses. […]

2018-02-26T10:41:13-05:00February 26th, 2018|Nursing, nursing stories|1 Comment
Read More

Brain Injury. Undocumented Patient. Who Decides About Treatment?

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.

© Photolibrary Wales/ Albany Stock Photo.

Imagine that someone you love—a young person—suddenly collapses and is rushed to the hospital. Her heart is restarted, but it soon becomes apparent that there has been extensive anoxic brain injury. In a vegetative state, on a ventilator, no ability to follow commands, spastic extremities, an EEG showing continuous seizure activity. . . . and this person is an undocumented immigrant. And uninsured.

In this month’s AJN, Kimberly Radtke and Marianne Matzo present a fictional case (based on their real-life experience in palliative care) to illustrate the ways in which this kind of scenario might play out. The parents are overwhelmed, trying to make decisions while they are still in shock. Physicians soon express their concerns about prolonging “medically inappropriate care.” And who will pay for it?

In addition, hospitalization due to critical illness increases an unauthorized immigrant’s risk of repatriation without their consent. What must the family be feeling as they struggle to understand their daughter’s future?

The role of the ethics committee.

Radtke and Matzo discuss […]

2017-11-17T15:19:22-05:00November 13th, 2017|Ethics, Nursing|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top