Long term survival of four children diagnosed as brain dead by clinical features: a reconsideration of children’s terminal cures

Abstract

We experienced four pediatric cases who lived long term after being diagnosed as brain-dead by clinical features. In all of the cases, we did not declare brain death and continued life-prolonging treatment. In November 2014, the guideline about terminal care for emergency and intensive care medicine was published. This guideline defined brain death as the end of life. Because of the social background in those days and a lack of consensus on cures for terminal illnesses, we continued treatment to sustain patients' lives in two of the four cases. Cases of child abuse, wherein no one has parental authority or the ability to decide upon the treatment method on behalf of the patient, or problems of family acceptance could make it difficult to withdraw life-sustaining treatment. However, in order to protect the affected children's dignity, brain death should be judged appropriately and the option of terminating cures should be presented to their families.