Circulatory arrest in a brain-dead organ donor: is the use of cardiac compression permissible?

Care of the brain-dead patient is common in intensive care practice. Aggressive donor management is advocated to increase supply of viable organs. Significant controversy exists over cardiac resuscitation in patients determined dead by cardiac criteria. The issue, till now, has not been addressed in brain dead patients. We discuss a case of cardiac resuscitation of a brain-dead donor to ensure organ donation. This case allows us to examine the use of brain death criteria to declare death, the controversy regarding cardiac resuscitation in organ donor patients, and the standards for use of cardiac resuscitation in the organ donor declared dead by brain death criteria. The consent process for organ donation in brain dead patients should address the possibility of subsequent cardiac arrest.

Parental refusal of medical treatment for a newborn.

When there is a conflict between parents and the physician over appropriate care due to an infant whose decision prevails? What standard, if any, should guide such decisions?This article traces the varying standards articulated over the past three decades from the proposal in Duff and Campbell's 1973 essay that these decisions are best left to the parents to the Baby Doe Regs of the 1980s which required every life that could be salvaged be continued. We conclude with support for the policy articulated in the 2007 guidelines of the American Academy of Pediatrics on non-intervention or withdrawal of intensive care for high-risk newborns.

Tort reform by regulation: FDA prescription drug labeling rules and preemption of state tort claims.

In 2006, the Food and Drug Administration (FDA) asserted in the preamble to a revised physician labeling rule for prescription drugs that FDA labeling requirements preempt state common law failure to warn claims. The FDA's action reflects a wider effort of administrative agencies to preempt conflicting state law requirements. The debate over preemption raises a set of difficult issues, including the sufficiency of agency safety review, the scope of administrative deference, and federalism. This article surveys the background to the 2006 FDA labeling rule and the Supreme Court's recent preemption jurisprudence in leading cases such as Cippollone v. Liggett Group, Inc., and Geier v. American Honda Motor Corp.