Ludka Nicholas, Hurse Deidre, Brummett Abram
Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Clinical Ethics, William Beaumont University Hospital, Royal Oak, MI, USA.
Neurocrit Care. 2025 Jan 14. doi: 10.1007/s12028-024-02196-8.
There have been growing sentiments that the Uniform Determination of Death Act needs to be revised. One suggestion is to include a conscience clause, that is, allowing patients to "opt-out" of brain death determination. Understanding public attitudes toward a conscience clause may help inform policymakers and future proposed revisions. Therefore, we sought to investigate informed public attitudes toward continued medical support after the determination of brain death.
A nationwide online survey was distributed by a third-party provider. The survey had three components: (1) a 2-min educational video that explains five basic facts of brain death, (2) a validated five-item questionnaire to measure understanding of brain death, and (3) a six-item questionnaire to measure informed public attitudes toward a family's request to continue medical support for a patient with brain death. Attitudes were measured on a seven-point Likert scale. A multiple linear regression model was developed to identify predictors of attitudes toward opting out of brain death. Analysis of variance with a post hoc Tukey test was used to compare attitudes across categorical demographic variables.
We collected 1386 responses from participants across 49 states. The average five-item knowledge score was 88%. A total of 41.9% of all participants agreed that the hospital should be required to continue treatment for an individual with brain death if their family rejects brain death. A total of 24.4% and 27.3% of participants would request further treatment for themselves and a family member after a determination of brain death, respectively. Multiple linear regression identified attitudes for oneself and for a family member, age greater than 65 years, understanding that brain death is legal death, and male sex as predictors of attitudes toward requiring continued treatment (F(6, 1380) = 142.74, adjust R = 0.38, p < 0.001).
Nearly half of the participants would require hospitals to continue treatment for families who reject brain death as death. Future discussions on revising the Uniform Determination of Death Act to adopt a conscience clause should consider informed public attitudes.
越来越多的人认为《统一死亡判定法案》需要修订。一种建议是加入良知条款，即允许患者“选择退出”脑死亡判定。了解公众对良知条款的态度可能有助于为政策制定者和未来提议的修订提供参考。因此，我们试图调查公众对脑死亡判定后继续提供医疗支持的知情态度。
由第三方供应商在全国范围内开展在线调查。该调查包含三个部分：（1）一段2分钟的教育视频，解释脑死亡的五个基本事实；（2）一份经过验证的五项问卷以衡量对脑死亡的理解；（3）一份六项问卷以衡量公众对家属要求继续为脑死亡患者提供医疗支持的知情态度。态度通过七点李克特量表进行衡量。建立多元线性回归模型以确定对选择退出脑死亡态度的预测因素。使用方差分析及事后的图基检验来比较不同类别人口统计学变量的态度。
我们收集了来自49个州参与者的1386份回复。五项知识平均得分率为88%。所有参与者中共有41.9%同意，如果家属拒绝脑死亡判定，医院应被要求继续为脑死亡个体提供治疗。共有24.4%和27.3%的参与者在被判定脑死亡后会分别为自己和家庭成员要求进一步治疗。多元线性回归确定了为自己和家庭成员的态度、年龄大于65岁、理解脑死亡即法定死亡以及男性性别是要求继续治疗态度的预测因素（F(6, 1380) = 142.74，调整R = 0.38，p < 0.001）。
近一半的参与者会要求医院为拒绝将脑死亡视为死亡的家属继续提供治疗。未来关于修订《统一死亡判定法案》以采用良知条款的讨论应考虑公众的知情态度。
