Declaring a child brain dead can prompt showdowns. New rules seek to resolve those doubts.

The parents of 14-year-old Bobby Reyes were furious in 2019 when officials at a Michigan hospital withdrew life support from their son, who had suffered a severe asthma attack that left him unresponsive.

The mother of 2-year-old Isaac Lopez sued a Kentucky hospital in 2014, urging a judge to prohibit staff from removing the ventilator and feeding tube that had kept the boy's organs functioning three weeks after doctors declared him brain dead.

The family of 13-year-old Jahi McMath prompted a nationwide bioethical debate that same year when they opposed to their daughter's brain death diagnosis in California and transferred her to a New Jersey hospital, where doctors kept her on life support for years.

In each of these cases, doctors declared children brain dead, but they did so with minimal professional guidance, leaving their diagnoses subject to criticism from all sides.

New guidelines released on Wednesday aim to iron out those conflicts. The recommendations, published in the peer-reviewed journal Neurology, provide a comprehensive list for clinicians to follow for determining brain death in children and adults.

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The guidelines not only standardize the process, experts say, but they also address ethical sticking points that have caused consternation over the decades. They aim to provide clarity on where doctors have the authority to move ahead and outline areas where they must take addition steps in the case of children.

“It’s doing a huge service not just in the medical community but to the public in cementing trust,” said Arthur Caplan, a medical ethicist at the New York University Grossman School of Medicine. “When people are declared dead as a result of neurological examinations, that diagnosis can be trusted.”

One of the biggest points of contention between families and clinicians has been over the idea of consent. Some parents believe a doctor should obtain consent from family to perform tests that lead to a diagnosis of brain death, experts say, especially in cases involving minors.

Only a few states, such as Nevada and New York, have laws that explicity give doctors the right to test for brain death without the express consent of parents.

“It’s been sort of murky,” said Dr. Michael Bell, chief of critical care medicine at Children’s National Hospital in Washington. “There are families who want to stop you from proceeding because they don’t want the answer."

Though the new guidelines recommend clinicians notify family before evaluating the patient for brain death, they explicitly that say parental or familial consent is not required for a doctor to perform the assessment.

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“Making a determination of death is one of the most important actions that a doctor and a team of health care people have to do,” Caplan said. People who want doctors to ask permission typically don't want to accept brain death.

The guidelines also recommend that clinicians take their time and additional precautions in determining brain death in children. Whereas adult patients typically undergo one evaluation before physicians can establish brain death, clinicians are instructed, under the guidelines, to perform two separate evaluations at least 12 hours a part.

Children have developing brains that are more able to bounce back. The guidelines say clinicians must take additional time to confirm their brains can't recover from the trauma. But they also say infants under 37 weeks cannot be classified as brain dead partly because experts say it's difficult to make a diagnosis in brains and bodies that small.

Brain death is a medical diagnosis and a legal declaration of death, said study author Dr. David Greer, professor and chair of neurology at Boston University School of Medicine. Experts say it’s important to make that clear when informing family that there is no wiggle room in that diagnosis. They hope the new guidance leaves little room for mistrust or doubt.

“This is obviously a high tension, high stakes, high stress situation for families,” Bell said. “But this (guidance) gives the clinicians the opportunity to say … ‘We tested this according to the guideline and we can therefore call this a brain death.’”

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This article originally appeared on USA TODAY: Brain dead diagnoses can be controversial. New guidance looks to help.