Dead or not dead?

Delegates to the 2015 Canadian Bioethics Society conference in Winnipeg in May heard of a difficult case that has now ignited debate in the media. Read a National Post article about it here.

To summarize: a patient in British Columbia was declared brain dead by the health care team. The patient came from a culture that does not acknowledge brain death, and since the patient’s heart was still beating, his family considered him to be alive, and requested he be maintained on life support until he could be repatriated to his country of origin. Although logistically difficult, this was facilitated. Further challenges arose with respect to the death certificate. A BC physician signed the death certificate, as per protocol when someone is declared (brain) dead, but since he left the country on life support, the province refused to register the death. This caused problems for the patient’s family in his home country as they were trying to settle his estate.

A few interesting questions arise in this case:

1. Do you think the hospital did the right thing in maintaining the patient on life support or in facilitating his transfer home? Why or why not?
2. Who should pay for care like this?
3. What are the ethical considerations in this situation from a clinical perspective? In other words, what is the best way to care for patients and their families in these situations? What are the critical elements necessary to resolving them in the best possible way?
4. What are the ethical considerations in this case from an organizational perspective? What implications do cases like these have for resource allocation? By what process should we determine whose interests take priority – the patient in the bed (and his family), or the patient waiting for the bed?