Nurses Question Brain Death: Survey Reveals Deep Uncertainty About When Life Ends

When does a human being actually die? It sounds like a question medicine answered long ago, but a new survey of Polish nurses and midwives suggests that the people who spend their lives at patients’ bedsides remain deeply divided about one of modern medicine’s most consequential definitions: brain death. The study, published in BMC Medical Education, surveyed 269 master’s students of nursing and midwifery at the Poznan University of Medical Sciences, all of whom were already qualified professionals and most of whom were actively working in their field. The results reveal a striking gap between broad acceptance of the medical definition of brain death and persistent, sometimes contradictory doubts about what that definition really means for a living, breathing patient.

The research team, led by Justyna Czekajewska of the Department of Social Sciences and Humanities at Poznan University of Medical Sciences, together with Dariusz Walkowiak, Anna Jelińska and Jan Domaradzki, used a self-administered, anonymous pen-and-paper questionnaire. Their goal was to map how these clinicians think about death in general, how they understand the concept of brain death, and how confident they feel about the diagnostic criteria used to establish it. The topic matters far beyond Poland. Brain death determination underpins organ donation programs worldwide, and nurses and midwives are often the professionals who spend the most time with patients and families confronting the reality of catastrophic brain injury.

On the fundamental nature of death, the respondents were largely aligned. A commanding majority, 90.4 percent, viewed death as a final phenomenon characterised by the irreversible and final loss of life. Even more tellingly, 78.8 percent agreed that the understanding of death is shaped by factors beyond medical criteria, an acknowledgment that culture, religion, philosophy and personal experience all colour how clinicians interpret the moment life ends. Death, in other words, is not seen purely as a biological event with a clean technical definition; it is also a human and social one, and the nurses and midwives surveyed were acutely aware of that duality.

When the questions turned specifically to brain death, the picture became more complicated. On the surface, support for the medical consensus looked strong: 82.5 percent of participants said they accepted the medical definition of brain death. But the agreement fractured as soon as the survey probed deeper. Nearly one in four respondents, 23.8 percent, agreed that brain death is not the same as human death, a position that runs directly counter to the legal and medical framework in most countries, including Poland, where irreversible cessation of brain function is what legally constitutes death. And in the analysed subgroups, roughly two-thirds to three-quarters of respondents indicated that a brain-dead patient should not be treated as dead.

That inconsistency is the study’s most provocative finding. How can most clinicians accept the definition of brain death while simultaneously believing that a brain-dead patient should not be treated as dead? The authors suggest the answer lies in the layered nature of the concept. Clinicians may intellectually endorse the neurological standard, which declares death when the brain has irreversibly lost all function, while emotionally and intuitively continuing to perceive a warm, breathing, beating-heart patient as alive. This dissonance is not unique to Poland; international literature has long documented similar ambivalence among health professionals, but the new survey quantifies it precisely in a group of practising nurses and midwives pursuing advanced degrees.

Doubts extended to the diagnostic machinery itself. Brain death is not diagnosed casually; it requires a rigorous clinical examination, testing of brainstem reflexes, an apnoea test to confirm the absence of spontaneous breathing, and in some settings confirmatory tools such as electroencephalography, or EEG, which measures electrical activity in the brain. Yet 45.0 percent of the surveyed nurses and midwives were uncertain whether the existing diagnostic criteria are insufficient, and a clear majority, 60.9 percent, agreed that more accurate diagnostic tests are needed. In other words, even among trained clinicians, confidence in the current diagnostic toolkit is far from universal, and a substantial share believes the technology and protocols should be improved.

The survey also revealed that attitudes were not distributed randomly. Religiosity, political orientation, professional activity and place of residence were all associated with differences in response patterns for selected attitudes towards death and brain death, although the authors note that these associations varied across individual statements rather than forming a single uniform pattern. This heterogeneity matters for educators and policymakers: it suggests that no single intervention will reach all clinicians equally, and that personal worldview, professional context and geographic background all shape how the concept of brain death is received and internalised.

The study was conducted with appropriate ethical safeguards. It followed the Declaration of Helsinki and was approved by the Poznan University of Medical Sciences Bioethics Committee, with approval KB-07/24 granted on 3 January 2024. All participating students signed an informed written consent form before completing the survey. The researchers received no external funding for the work, and the authors declared no competing interests. The article was published open access on 5 October 2026, having been received in December 2024 and accepted at the end of September 2026, and it is citable under the DOI 10.1186/s12909-026-10530-1.

Why do these findings resonate so widely? Because brain death sits at the intersection of medicine, law, ethics and religion, and because the stakes are extraordinarily high. A declaration of brain death allows withdrawal of ventilatory support and, in many cases, opens the door to organ donation, where a beating-heart donor with a dead brain is the ideal source of transplantable organs. If the clinicians caring for such patients harbour private doubts about whether the patient is truly dead, those doubts can ripple outward, affecting communication with grieving families, trust in the donation system, and even the willingness of the public to register as donors. The survey’s respondents, as practising professionals, are precisely the people whose convictions families encounter first.

The authors’ conclusion is measured but pointed. Although most participating nurses and midwives accepted the medical definition of brain death, some expressed reservations or uncertainty about its equivalence with human death, its implications, and selected diagnostic issues. The findings, they write, identify areas of agreement, uncertainty and variation that can inform nursing and midwifery education. Their recommendation is clear: curricula should include explicit, rigorous teaching on brain death and its diagnostic criteria, alongside opportunities to discuss the ethical and thanatological, that is, death-related, dimensions of the topic. Preparing students for the clinical and emotional challenges of brain death, they argue, is not optional but essential. The broader lesson for medicine is uncomfortable but valuable: a definition can be legally settled and scientifically robust, and yet still contested in the minds of the professionals who must apply it. Closing that gap will require more than protocols; it will require education that treats death not only as a diagnostic event, but as the profound human question it has always been.

Subject of Research: Attitudes of Polish nurses and midwives towards death, brain death and its diagnostic criteria

Article Title: Polish nurses’ and midwives’ attitudes towards death, the definition of brain death and its diagnostic criteria: a questionnaire survey among master’s students

Article References: Czekajewska, J., Walkowiak, D., Jelińska, A., & Domaradzki, J. (2026). Polish nurses’ and midwives’ attitudes towards death, the definition of brain death and its diagnostic criteria: a questionnaire survey among master’s students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10530-1

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10530-1

Keywords: brain death, nurses, midwives, diagnostic criteria, medical education, death attitudes, Poland, organ donation, EEG, religiosity, thanatology, clinical practice