Mr V* is a 23-year-old orthodox Jewish man. Mr V was admitted to the intensive care unit following a bicycle accident. Three days after the accident, the consulting neurologist declared Mr V to be brain dead based on current medical standards, thus meeting the state's legal definition of death. When the consulting neurologist shared the brain death diagnosis with Mr V's family and their rabbi, the rabbi responded, "Our sect of Judaism does not believe in the diagnosis of brain death. We believe that there is only one way to determine death: when your heart and breathing stop." The family also responded, "We believe that our son is alive. We want to take him home."

Dr R, the patient's attending physician, is also an orthodox Jew. Dr R is in full support of Mr V's family taking him home; however, before discharge, Mr V will require a feeding tube and tracheostomy to continue mechanical ventilation. Several days have passed while Dr R seeks a surgeon to perform these procedures. Numerous surgeons refused to participate because of the brain death diagnosis and the associated belief that it is unlawful to perform surgery on a dead person.

Throughout this time, the nursing staff attempt to provide culturally sensitive care while concurrently attempting to educate the family about brain death and Judaism using information found via the Internet. A surgeon finally agrees to perform the surgeries, but Mr V experiences cardiopulmonary death before the surgeries can be performed.

Following this incident, the nursing staff raises many questions:

1. What is the rationale for the rejection of brain death by Jews?

2. Can a family and/or healthcare provider refuse the diagnosis of brain death in a state where brain death is a recognized definition of death?

3. What are the nurse's responsibilities (both ethical and legal) when caring for a person with a brain death diagnosis with no plan to cease interventions?

4. How do insurance companies view care provided after a diagnosis of brain death is made? Who is responsible for the financial costs following the diagnosis of brain death?

5. What actions should a nurse take if he or she cannot morally participate in providing care to a patient with a brain death diagnosis but no plan exists to cease interventions?

*This case is based on an actual patient care situation, but facts have been changed to protect confidentiality. [Context Link]