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brain death, culturally congruent care, ethics, law, religion



  1. Johnson, Donald O. MS, RN
  2. Westphal, Christine G. MSN, NP, ACNS, ACHPN, FPCN


In 1968, the neurologic or "brain death" standard for declaration was introduced as an accepted standard for declaration of death in hospitals where heartbeat and breathing are being sustained by technology, but functions of the brain, including the brain stem, have ceased. For many people, this accepted ethical, legal, and medical definition of death by neurologic standards can seem to blur the line between life and death as the heart is still beating, the lungs are still moving air albeit by mechanical ventilation, and the body is still warm. As experts in end-of-life care, hospice and palliative care nurses must be knowledgeable about declaration of death by neurologic criteria, understand beliefs that do not support the concept, and collaborate with the health care team in providing compassionate end-of-life care. This article will use a case study to describe the legal and ethical challenges that ensue when religious and/or cultural beliefs result in rejection of the concept of brain death and propose ethically sound strategies to navigate these challenges within a framework of culturally congruent care that includes a 4-step process to progressively appreciate, accommodate, negotiate, and/or explicate the differences.