To the Editor.—
Dr Liptak1 is to be congratulated for articulating with sensitivity some of the insights gained by those who confront the death of children. This reader, however, was stunned by his statement about the "disconcerting" aspects of disconnecting children from ventilators: "They shudder and gasp and twitch and inevitably lead you to believe that you have made a mistake and should not have disconnected them." Disconcerting indeed!Contemporary medical practice affords few indications for disconnecting seriously ill patients from ventilators. In the context presented, ventilatory support is withdrawn when brain death has been established. Readers of The Journal should understand clearly that patients who have been competently diagnosed to be brain dead neither shudder, nor gasp, nor twitch when ventilatory support is disconnected. The absence of such responses is, in fact, part of the process of certification of brain death.2It would be reassuring were Dr
Poulton TJ. Spontaneous Movements in Brain-Dead Patients. JAMA. 1986;255(15):2028. doi:10.1001/jama.1986.03370150070027
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