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. 2023 Aug 1;24(8):628-635.
doi: 10.1097/PCC.0000000000003246. Epub 2023 May 1.

Refusals of the Determination of Death by Neurologic Criteria: A Mixed Methods Study of Physician Perspectives on Refusals Cases

Erin D Paquette  1   2   3   4   5   6 , Lainie F Ross  4   5 , Jairo Chavez  2 , Joel E Frader  2   6
Affiliations

Refusals of the Determination of Death by Neurologic Criteria: A Mixed Methods Study of Physician Perspectives on Refusals Cases

Erin D Paquette et al. Pediatr Crit Care Med. .

Abstract

Objectives: Refusals to allow examination for determination of death by neurologic criteria (DNC) challenge pediatric physicians and create distress for medical teams and families of patients suspected to meet criteria for DNC. The objective of this study was to inquire about and assess experiences with such refusals from the perspective of physicians.

Design: We conducted a mixed-methods survey and interview-based study to understand physicians' experiences with refusals.

Setting: An online survey was sent to pediatric intensivists and neurologists; phone interviews were conducted in a subset.

Patients/participants: The study included 80 physician survey respondents and 12 interview physician respondents.

Interventions: None.

Measurements and main results: Refusals occur for many reasons regarding patients with both acute and progressive brain injury. The most common reasons were consistent in surveys and interviews and include "waiting on a miracle," not wanting to give up, religious objections and disbelief in brain death. Time was an important mediator in many cases. Physicians described several approaches to managing refusals, highlighting the impact on medical teams, distraction from other patients, and need for resources to support physicians.

Conclusions: Refusals may have important sociodemographic associations that should be considered in managing complex cases. Physicians seek more guidance in law and policies to manage refusals.

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Conflict of interest statement

Dr. Paquette’s institution received funding from the National Institute of Child Health and Human Development; she received support for article research from the National Institutes of Health. Dr. Ross disclosed that her spouse owns stock in Bristol Meyers Squibb and General Electric. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

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