stories about premature burials rich people had bells on inside of coffin in case they were not in fact dead
embalming way to make sure they were dead when you buried them
Advent of iron lungs negative air tanks sealed off below the neck
positive pressure ventilator invented in 1960s
Þ pump the lungs from the inside
thus technology has allowed us to substitute for just about every vital function
When pronounced dead, not every single cell in the body is in fact dead
Þ can still harvest organs for transplants
persistent vegetative state
Þ brainstem remains intact so can breath on own but has no ability for consciousness (cortex destroyed)
can live up to 30 or 40 years with support of feeding tube; if feeding tube removed
Þ death
The Clinical and Legal Acceptance of So-called "Brain Death"
clinical acceptance due to four factors:
(1) Easy and reliable diagnosis
(2) Prognosis absolutely certain
(3) Patient never wakes up again
(4) Patient soon dies traditional death (asystole) even if the most aggressive care is given
legal recognition in every state
including Ohio, which has a brain-death statute
Why do we care when a person is dead? What matter does it make?
social/cultural behaviors associated with death
: burial/cremation; mourning/grief; treatment stops; health insurance stops; life insurance pays; inheritance; battery vs. murder
medical behaviors associated with death
: dissection; autopsy; remove organs for transplantation; practicing techniques such as endotracheal intubation; transport to morgue
Uniform determination of death act
"an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards."
allows one to turn off ventilators without being charged with death
facilitated organ donation since most organs must be taken from brain dead individuals
Þ can take organs without being accused of murder
Tests to determine brain death
no ocular, verbal, or motor response to any painful stimuli (Glasgow coma score = 3)
Absence of pupillary responses
Absence of corneal reflexes
Absence of gag reflexes
Absence of eye movements with calorics
Absence of cough reflexes
Apnea in the presence of hypercapnia
Þ take off ventilator, can they breathe on their own?
EEG must be flatline
Definition of death is a functional definition
Þ not based on destruction, based on loss of function
Definition is conceptual; must answer question "which function is so significant that its loss means death has occurred?"
The loss must be irreversible; "death of what?" becomes important
Reversible conditions which mimic death
therefore can flunk all the tests above and still not be dead; brings back the issue of irreversible; these conditions must be ruled out:
Presence of intoxicating drugs or sedation sedative overdose: bilateral reactive pupils to light, preserved conjugate slow phase eye movements to caloric stimulation with no saccades and symmetric motor findings
Hypothermia
Neuromuscular blockade (Guillian Barre)
Gross electrolyte abnormalities
Gross endocrine disturbances
Reasons for acceptance of whole brain criterion
diagnosis clinically reliable
prognosis certain
patients quickly "die" traditional cardiovascular death