S. K. Sergienko’s research while affiliated with Institute of Philosophy, Russian Academy of Sciences and other places

The concept of brain death was introduced in the late 1960s and continues to develop. The article presents a brief history of the evolution of the idea of death by neurologic criteria. The concept is accepted worldwide, but there is still considerable variability in brain death determination protocols. New treatments for critical patients change the preconditions for brain death testing. The refinement of diagnostic techniques improves the capabilities of confirmatory tests. Controversial cases of determination of brain death cause public resonance and justified criticism of opponents of the concept. All these factors lead to review of some concept statements, terminology and update diagnostic protocols. In 2020, an international expert working group presented the minimum clinical standards for determination of brain death/death by neurologic criteria with guidance for various clinical circumstances. Some countries have already started to implement international recommendations and revise national diagnostic protocols. The extensive debate accompanying this process is an important contribution to the improvement of the concept of brain death.

Intensive care allows maintaining the vital functions of patients with irreversible brain damage for a long time. Under appropriate criteria, human death is determined by brain death, but most patients die after an undetermined period from the inevitable complications. Our legislation does not allow stopping futile treatment and letting a hopeless patient die naturally. In Russia, patient’s right to autonomy and self-determination is fulfilled through the informed consent or refusal to medical intervention. An adult comatose patient with a brain damage isn’t able to make this decision and sign the consent or refusal form, doesn’t have a Health Care Agent, and the medical council makes decision. In this situation, proper treatment is performed regardless of the prognosis. Even if the patient would prefer to die with dignity and comfort, his right to decide cannot be realized. In many countries of the world, there has long been a practice of the advance care planning in case the patient is unable to decide. A person signs advance directives, appoints a Health Care Agent for the medical decision-making. Based on the documented preferences of the patient and communication with his surrogate, doctors can limit the life-sustaining treatment for a hopeless patient and allow him to die. The presented analysis of international data provides basic information for the discussion of the possibility of advance care planning in our country.