How Future Nurses Confront Brain Death
The silent struggle behind the ICU doors.
In the high-stakes environment of an intensive care unit, healthcare professionals routinely navigate the thin line between life and death. For nurses and midwives, this challenge reaches its peak when caring for a patient who has been declared brain dead—a concept that is legally recognized as death but can often feel unsettlingly different from traditional cardiac death. A recent study conducted at the Poznan University of Medical Sciences reveals how the next generation of Polish nurses and midwives grapples with the profound ethical and legal dilemmas surrounding brain death, where medical knowledge, personal beliefs, and clinical responsibilities intersect 1 .
Brain death is defined as the irreversible cessation of all brain functions, including those of the brainstem 2 . Unlike a coma or a vegetative state, it is a definitive legal and medical determination of death. In Poland, as in many countries, the diagnosis follows strict protocols updated in 2019 to align with international standards 2 .
Confirm absence of responsiveness to external stimuli
Check for absence of pupillary, corneal, gag and cough reflexes
Confirm inability to breathe independently
Use EEG, cerebral angiography when clinical uncertainty exists
The confirmation process requires two specialist physicians—one in anesthesiology, intensive care, or neonatology, and the other in neurology, pediatric neurology, or neurosurgery 1 . They must verify the absence of responsiveness, brainstem reflexes, and the capacity to breathe independently (a positive apnea test). When clinical uncertainty exists, instrumental tests such as electroencephalography or cerebral angiography provide confirmation 2 .
Despite this medical and legal clarity, brain death remains one of the most ethically challenging concepts in healthcare, particularly for the nurses and midwives who provide continuous care for these patients and support their families.
To understand how future healthcare professionals perceive these challenges, researchers conducted an anonymous, self-administered survey among 269 master's students in nursing and midwifery at Poznan University of Medical Sciences 1 3 . These students were uniquely positioned to provide insights—having already completed bachelor's degrees, they were qualified healthcare professionals actively working in various facilities while pursuing advanced studies 1 .
Master's students surveyed
Cited medical knowledge as influence
Accepted medical definition of brain death
Sustaining vital functions in pregnant brain-dead patients raises questions about futile therapy and whether continuing support solely for fetal benefit is justified 1 .
Family objections to organ donation create a conflict between respecting family wishes and honoring a patient's potential desire to donate 1 .
Lack of legal consequences for patients' declarations of will refers to uncertainties around the legal weight of a patient's prior wishes 1 .
When asked what influenced their attitudes toward brain death, the students identified 1 :
Statistical analysis further showed that personal values influenced stances on specific issues. Religiosity and older age were associated with greater support for sustaining life functions, while liberal political views and a nursing background correlated with greater support for overriding family objections to donation and discontinuing futile therapy 1 8 .
A significant divergence emerged between theoretical acceptance and practical application. While 82.5% of students accepted the medical definition of brain death, only 53.6% prioritized the quality of life over the preservation of life at all costs 1 . This gap illustrates the profound difficulty of translating abstract knowledge into complex clinical decisions.
A related study delved into a specific legal and ethical tool: the conscience clause. This provision allows healthcare professionals to refuse participation in procedures that conflict with their ethical or religious beliefs 2 .
The data revealed that religious participants were more likely to support conscientious objection in organ retrieval procedures 2 . This highlights the very real personal conflicts that healthcare workers may face, balancing their professional obligations with their deepest convictions.
The studies conclude that current educational programs may be insufficiently preparing students for these realities. Despite the critical nature of brain death, most nursing and midwifery curricula in Poland lack a dedicated module on caring for brain-dead patients 1 . Practical training in areas like donor care, family communication, and discussions about organ donation is often missing 1 .
Average knowledge score (7.53/13)
knew diagnostic tests and procedures 4
in donor care & family communication 1
This educational gap is not isolated. A 2023 study with Polish medical students found that knowledge about brain death increased with clinical training but overall scores remained unsatisfactory. Fewer than 30% of clinical-year students could correctly answer questions about diagnostic tests and procedural criteria 4 .
Emerging technologies are poised to add new layers to this already complex field. Researchers are discovering that a growing number of brain-injured patients, though outwardly unresponsive, may have cognitive-motor dissociation (CMD), where cognitive processing remains intact despite an inability to physically respond 1 .
The future may see the use of fMRI, EEG, brain-computer interfaces, and AI-based systems to better assess consciousness and even communicate with these patients 1 . Such advancements could eventually influence legal regulations by allowing clinicians to better understand a patient's wishes regarding life support, treatment cessation, or organ donation.
Brain death is far more than a medical diagnosis; it is a profound human experience that tests the limits of knowledge, ethics, and compassion. The voices of Polish nursing and midwifery students reveal a generation poised to provide skilled clinical care while deeply wrestling with the moral dimensions of their work.
As the studies suggest, empowering these future caregivers requires an educational evolution—one that moves beyond technical knowledge to foster robust dialogue about professional ethics, legal frameworks, and the real-life bioethical dilemmas they will inevitably face. Only then will they be fully equipped to navigate the delicate balance between life and death with both competence and humanity.