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The Paradocs Podcast

The Paradocs is a fun and lively discussion with a couple of docs on the practice of medicine. Occasionally serious, usually lighthearted, and accidentally informative. A show for physicians to learn more about what is going on and a great place for them to direct their friends and family to better understand the challenges they face.

Jan 12, 2019

One of the tasks assigned to physicians, and certainly not a task one thinks of when entering medical school, is to verify death. The first time you declare someone dead - for me, it was as a first year resident in the ICU - is a weird feeling because of the finality of it. As with anything you do as a physician for the first time there is some uncertainty that you aren't "messing up." But you don't need to be a doctor to declare someone dead because anyone can tell when someone or something is dead, right?
However, what happens when they are breathing on a machine, being fed by a tube, and receiving medicines by IV? Are they dead? Unconscious? Can the rest of the body be alive while just the brain isn't? Is brain death declared at the bedside really a way of being dead despite the rest of the body continuing on?
My guest, Dr. Alan Shewmon, is a professor emeritus in pediatric neurology who spent his career evaluating brain and neurological disorders. You can find a lot of his work online and much of it now has to do with whether brain death (as we traditionally think of it as declaring someone dead because of a loss of brain function) can be a separate definition of death. He presents a number of extraordinary clinical cases which challenge the reasons most physicians feel comfortable declaring death without the cellular death of the patient's other organs.
Aside from being an interesting philosophical or bioethical discussion, there are practical considerations for not being able to declare patients brain dead. Primarily, the solid organ transplantation specialty would be dramatically scaled back and the number of patients needing transplants would increase. Also, the ability of hospitals to stop life saving interventions, i.e. life support, for "hopeless cases" would be made more difficult legally. 
  Dr. Alan Shewmon is Professor Emeritus in Pediatrics & Neurology at UCLA. He has publicly questioned whether we can die twice - whether there is truly a brain death that should count as the death of the patient while the rest of their body may be viable.


show notes

The Curious Case of Jahi McMath- Dr. Shewmon's discussion and evidence from his review of the case of the young girl. His discussion begins at the 41:35 mark.

What Does it Mean to Die? An article from the New Yorker regarding the case of Jahi.

Episode 017:  The practice of forced organ harvesting in China where they don't bother to determine whether someone has an irreversible loss of brain function - they execute the donors.

Memorial for Andy Larson: This is the donation link to honor Andy's death with the Grand Rapids Choir of Men and Boys where he blossomed and served as a head chorister.

YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page.

Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.

Listen to The Paradocs on RadioPublic