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Addressing Religious or Cultural Opposition to Brain Death Diagnosis

Johnson, Donald O. MS, RN; Westphal, Christine G. MSN, NP, ACNS, ACHPN, FPCN

Journal of Hospice & Palliative Nursing: June 2018 - Volume 20 - Issue 3 - p 252–259
doi: 10.1097/NJH.0000000000000435
Ethics Series

In 1968, the neurologic or “brain death” standard for declaration was introduced as an accepted standard for declaration of death in hospitals where heartbeat and breathing are being sustained by technology, but functions of the brain, including the brain stem, have ceased. For many people, this accepted ethical, legal, and medical definition of death by neurologic standards can seem to blur the line between life and death as the heart is still beating, the lungs are still moving air albeit by mechanical ventilation, and the body is still warm. As experts in end-of-life care, hospice and palliative care nurses must be knowledgeable about declaration of death by neurologic criteria, understand beliefs that do not support the concept, and collaborate with the health care team in providing compassionate end-of-life care. This article will use a case study to describe the legal and ethical challenges that ensue when religious and/or cultural beliefs result in rejection of the concept of brain death and propose ethically sound strategies to navigate these challenges within a framework of culturally congruent care that includes a 4-step process to progressively appreciate, accommodate, negotiate, and/or explicate the differences.

Donald O. Johnson, MS, RN, is Family Matters Support Service nurse, Beaumont Hospital Dearborn, Michigan.

Christine G. Westphal, MSN, NP, ACNS, ACHPN, FPCN, is director/nurse practitioner, Palliative Care Beaumont Hospital Dearborn, Michigan.

The authors have served on ethics committees and worked with culturally diverse patient/family populations for over 30 years. This article reflects the views of the authors and are not intended to reflect the views and positions of Beaumont Health.

This article is dedicated to Stephanie Meyers Schim, PhD, RN, FAAN (1952–2016). Her research in cultural competency and end-of-life decision making provided the impetus and inspiration for this article, which was initially coauthored with Dr Schim, but unfortunately did not come to fruition during her lifetime.

The authors have no conflicts of interest to disclose.

Address correspondence to Christine G. Westphal, MSN, NP, ACNS, ACHPN, FPCN, 2390 Woodgreen Ct, Canton, MI 48188 (

© 2018 by The Hospice and Palliative Nurses Association.