PubMed Health⌕ Search

Biomedical subjects

David Crippen

Publications and source records attributed to David Crippen.

16 recordsLinked to original sources
PubMed2006

Brain death and withdrawal of support.

The definition of death has evolved to include the concept of brain death. The brainstem is an indispensable central integrative unit for all vital functions. The clinical criteria for brain death consist of the demonstration of the absence of function of the brainstem. Confirmatory testing, which mostly evaluates higher clinical function, is usually not required for the diagnosis of brain death.

Brain Death↗
PubMed2006

Ethics roundtable debate: patients and surrogates want 'everything done'--what does 'everything' mean?

Highly complex and specialized care plans sometimes overwhelm the comprehension of patients and families. Many optimistic surrogates of critically ill patients err on the side of desiring that everything be done but with a nebulous idea of what 'everything' entails. Physicians must work closely to educate surrogates as to the benefits versus the risks of treatment. Our roundtable experts ponder the question of whether providers possess the authority to interpret unilaterally the nature of requests for everything.

Critical Illness↗
PubMed2005

Pro/con ethics debate: when is dead really dead?

Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment. Not only is the distinction between sapient life and prolongation of vital signs blurred but the concept of death itself has been made more complex. The demand for organs to facilitate transplantation promotes a strong incentive to define clinical death in a manner that most effectively supplies that demand. We consider the problem of defining death in the ICU as a function of viable organ availability for transplantation.

Attitude to Death↗
PubMed2004

Pro/con clinical debate: life support should have a special status among therapies, and patients or their families should have a right to insist on this treatment even if it will not improve outcome.

Most hospitals are facing the dilemma caused by demand for critical care beds outstripping supply. This imbalance is likely to get worse over the coming years as a result of many factors, including aging of the population, improved technology, and improved therapies, among other factors. As a result we are likely to have to make further tough decisions about rationing of this service. In this issue of Critical Care, two authors debate the appropriateness of providing life support in accordance with a family's wishes to an individual who is unlikely to survive admission to the intensive care unit. Understanding both sides of this debate is an important aspect of an intensivist's job.

Critical Care↗
PubMed2004

Ethics roundtable debate: withdrawal of tube feeding in a patient with persistent vegetative state where the patients wishes are unclear and there is family dissension.

The decision to withdraw or withhold life supporting treatment in moribund patients is difficult under any circumstances. When the patient becomes incompetent to clarify their wishes regarding continued maintenance in long-term facilities, surrogates sometimes cannot agree, further clouding the issue. We examine a case where the State's interests come into play, forcing a controversial resolution.

Adult↗