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Understanding Brain Death and Incapacity Planning

The recent news stories involving Jahi McMath and Marlise Munoz have drawn renewed attention to the concept of brain death and how it plays a role in incapacity planning. When you make an incapacity plan, it’s important to understand medical terminology like brain death and other ideas so you can make knowledgeable choices. To that end, let’s take a look at some important ideas surrounding the concept of brain death.

The Brain

Our brains are the most complicated organs in our bodies. It is comprised of trillions of connections between different nerve cells, and are divided into different areas. To get a better understanding of the brain, it can be helpful to divide it into two distinct areas: the higher brain and the lower brain.

The lower brain is responsible for controlling physiological processes, such as heartbeats and breathing. The higher brain, on the other hand, allows us to think, feel, communicate, and do everything else we associate with our higher cognitive functions.

Brain Death

If someone is brain dead, that person has lost brain activity in both the higher and lower brain areas. A brain-dead person cannot communicate or reason, and is also not able to control his or her bodily functions. In some cases, brain-dead person can have his or her physiological processes maintained by the use of machines, such as respirators.

Persistent Vegetative State

A person who maintains activity in the lower brain area but who lacks activity in the higher brain is in what is known as a persistent vegetative state, or PVS. Unlike brain death, someone in a persistent vegetative state typically does not need the assistance of medical machines to maintain physiological process. However, a person in a persistent vegetative state does not show any signs of higher cognitive function. Most people with PVS do not recover, but there are rare cases in which they do.


Someone in a coma shows brain activity in both the higher and lower brain areas, but does not show any outward sign of consciousness or recognition. A coma is a prolonged unconscious state, somewhat similar to a deep sleep. People in comas tend to recover quickly, but some cases can lead to prolonged unconsciousness for years or longer. Some people in comas can develop more serious medical conditions, such as PVS, while others do not.


Knowing the difference between brain death, PVS, and other medical terms is essential if you intend on creating an incapacity plan. Making individual choices about what your desires are in various situations is all part of the incapacity planning process. Once you understand the issues involved and make choices, you can then include those choices in the relevant advance medical directive

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