A very sad ethical dilemma emerged in Fall of 2018 in Texas (Read the article written by Romero and watch the attached video of the newscast). A nine-year old girl suffered a cardiac arrest, was resuscitated, but was later declared brain dead. The brain death diagnosis was supported by two separate exams, 12 hours apart per Texas law. The family filed a temporary restraining order against the hospital in order to keep the girl alive for two weeks while the family worked to identify another hospital to care for their daughter. Eventually the girl's heart stopped, and she died.

In the United States, each state has a definition of what constitutes brain death (criteria/definitions are very similar) which is a legal death. Once an individual is declared brain dead, a death certificate is issued and insurance coverage ceases. This sad case brings up some ethical and legal questions and concernsto ponder.

1. Should insurance companies continue to pay for care after brain death noting the heart is still beating with support of oxygenation through a ventilator? Why or why not?
2. Should hospitals be required to continue to provide life support to those declared brain dead when the family (e.g. parents) requests continued life support? Support your response with ethical principles.
3. If there is no funding via insurance for the care, should the hospital be required to provide charity care (assume the cost associated with care)? Provide your ethical reasoning why or why not.
4. Is brain death considered death even when the heart continues to beat with life support?