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To the Editor:—
A communication by Dr. Hannibal Hamlin in the Oct 12, 1964, issue of The Journal (190:112) succinctly describes the value of the EEG as an index of the "point of no return" in the moribund patient. He suggests that in most patients an isoelectric record justifies giving up further efforts at artificial maintenance of respiratory and heart action.Of the accessory criteria which he offers, one seems unreasonable, at least in its stated form; he urges that, in addition to the recording of the EEG, the physician should demonstrate that the patient has "no spontaneous respiration for a minimum of 60 minutes." Since spontaneous breathing may sometimes alter in rhythm to occur in synchrony with a respirator and thereby be masked by it, conclusive proof that the patient cannot breathe at all on his own presumably requires withholding mechanical aids for the prolonged period mentioned. This
Kunkle EC. Life or Death by EEG. JAMA. 1965;191(6):506. doi:10.1001/jama.1965.03080060080040