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—I am puzzled why Spudis believes that by making statutory provisions allowing patients to refuse unwanted medical treatment, the North Carolina General Assembly lawmakers are guilty of "blending" whole brain and higher brain concepts of death. Decisions to refuse life-sustaining medical treatments by patients with persistent vegetative states, terminal illnesses, or advanced dementias have nothing to do with the determination of brain death.Brain-dead patients are dead and should be so declared. Patients with persistent vegetative states, terminal illnesses, or advanced dementias are not dead, but they may be permitted to die as the result of their valid refusals of life-sustaining treatments. Valid refusals of treatment by incompetent patients such as those in persistent vegetative states can be accomplished by advance directives such as those provided in the North Carolina statute noted by Spudis.
Bernat JL. Brain Death-Reply. Arch Neurol. 1993;50(2):132. doi:10.1001/archneur.1993.00540020012008
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