Question:
I want to ask regarding brain dead patients that exhibit reflex movements such as finger jerks and others. In this situation, can the patient be certified as dead for he is in a brain dead condition?
Answer:
Alhamdulillah, praise and thanks to Allah for the countless blessings He has blessed us all with. Blessings and salutations to the Prophet Muhammad PBUH, his wives, his family, companions and all those that follow his teachings to the day of judgement.
Regarding the issues of rulings related to brain death, we have answered it in Irsyad al-Fatwa Series 100. Basically, for those who are certified as dead by trained and licensed doctors, the patient will no longer exhibit reflex movements except some remaining movements such as a pulse and muscle movements which is not considered as signs of a life.
In the medical ethics of Malaysia, before the death of a person is confirmed due to brain death, the patient must first undergo a series of diagnoses and tests for the patient to be diagnosed as brain dead which will then make it permissible to switch off the patient’s life support. Among the diagnoses and tests [1] are:
- The patient must be in a coma and does not give any responses and scored 3/15 on the Glasgow Coma Scale.
- Has undergone the apnea test (breathing suspension test)
- Test to determine the loss of reflex in the brain stem through the following tests:
- Pupillary light reflex
- Ocula-cephalic reflex
- Motor response in cranial nerve distribution
- Corneal reflex
- Vestibulo-ocular reflex (Caloric Test)
- Oro-pharyngeal reflex
- Tracheo-bronchial reflex
If all of the diagnoses have been performed and it has been confirmed by a specialist, then and only then will the death be confirmed. This shows that the confirmation of death for a patient is only done after a thorough and stringent procedure. Thus, if the patient is still exhibiting reflex movements, then the case must be referred to a specialist doctors before any following steps are taken. Wallahua’lam.
End notes:
[1] Taken from Guideline of The Malaysian Medical Council regarding Brain Death. pg. 15-18.