Diagnosing brain death without a neurologist

Simple criteria and training are needed for the non-neurologist in many countries

“death hath ten thousand several doors

For men to take their exits.”

John Webster, The Duchess of Malfi, 16121

When nature takes its course the heart stops beating or the lungs stop breathing as a sequence of events unfolds, ending with death eventually overcoming the last cells of our bodies. The vast majority of the world's people leave life through doors marked “death from natural causes.” During the last decades some new doors for death have been opened by medical progress and by the law. Palliative medicine strives to ease the final step over the threshold, extending the physician's traditional role by using modern medicine.2 In some places, two other doors have recently been unlocked: medically assisted suicide has been legalised in the Netherlands, the American state of Oregon, and Belgium, and euthanasia has been legalised in the Netherlands and Belgium. Knocking at the doors of (medically) assisted suicide has not met with success in the US Supreme Court3 nor in the European Court of Human Rights.4

Modern medicine has also given us tools as never before to oppose death. If this battle is lost, defeat reveals yet another aspect of death. Let us consider that brain functions fail to the point …