Death occurs at an individual at the moment that his or her heart and lung stops functioning in such a way that they could never be restored. At the same instance, the brain function also stops. Death had been referred to as cardio respiratory death until technology altered the context death through the introduction of what was known as brain death which refers to the cessation of brain function and activity determined or measured by different test such as EEG diagnostics. Most of the time, the term brain death refers to a patient that lost brain capacity to do important function.
They may sometimes be sustained by medical apparatus but is not literally dead in the physical context. However in some countries, these persons are considered dead and organs can be transplanted to some other patients who need body organs and patients who are brain alive. Thus, benefiting the society as a whole and as well as the receivers of the organ. Although the acknowledgment of brain death benefits the community, several controversies and contradictions arise. Such conflict includes the different views regarding when the patient is to be considered brain dead, which also includes the controversies regarding PVS patients.
Although new development on the fields of technology arises to be able to determine if one person is really brain dead, such as Digital Subtraction Angiography, Computerized Axial Tomography (CAT), Dynamic Computed Tomography (DCT), Magnetic Resonance Imaginary (MRI), Echo Planar MRI (EPI) and many other types of equipment, a consensus regarding the acceptance of brain death was never reached because of some ethical and cultural concerns. Such factor includes the different views and stand of the pubic regarding organ transplant.
Still, the main factor against the consensus of accepting brain death is the public’s opinion and view, specially the families of the patient who were considered to be brain dead, regarding the matter. They are unlikely to accept the burial of a breathing human or to intentionally terminate the cardio respiratory function of an individual through lethal injections or some other means. Due to several controversies regarding brain death, several policies had been made. However controversies and contradictions are still present, regarding brain death.
Returning to Cardio Respiratory death will eliminate objections regarding brain death which was the original definition of death. Modern advances in medical technology are really challenging our conception of what it means to be human, to be alive. For some, the concept of Brain Death is also a form of legalizing killing.
DEFINITION OF BRAIN DEATH: ROBERT BLANK
Studies showed that the brain begins to die due to some several causes. One of the major causes was ageing in which there exist a gradual lost of sensory capacities in one’s brain.
The higher the age of an individual means higher risk of having a decline in memory and other functions of the brain. Aging is the natural process in which brain functions declines. There are also causes which are not natural such as injuries, cancer, stoke as well as alcohol and drug abuse. However, the concept of brain death does not necessarily refers to this process of brain cell death but rather to the cessation of functions and activity of the brain as indicated by several test such as EEG diagnostics.
This concept is different from what we normally regard as death. In a general sense, brain death refers to situation to which the patient was diagnosed to be unable to regain consciousness or unable to recover from his or her current state of having brain damage. When a person is considered brain dead he or she is regarded as already dead and thus, organs can be taken for transplants. Because of this definition, several controversies and contradiction occurs.
In the beginning of the issue regarding brain death, several criteria were used conclude that a person was really brain dead: “(1) unreceptivity and unresponsiveness; (2) lack of spontaneous movements or breathing and, (3) lack of reflexes” (Blank, page 3). Due to the seriousness of the issue, there had also been acts in order to determine if the person is brain dead. The concept of brain death is still being debated up to the contemporary time even in the presence of modern technological devices such as Digital Subtraction Angiography, CAT, DCT, MRI and others.
WHAT TRIGGERED THE CONTROVERSEY OVER BRAIN DEATH?
The very reason for the creation of the concept of brain death was the advancement of medical technology. Although there are some machines in the field that were able to support the lungs and heart of a person, the fact that once the brain stem was seriously damaged. Spontaneous respiration could never be returned, providing a patient with no hope of recovery. Thus, the death of a person was linked to the death of certain brain function rather than to the cessation of the heart and lungs.
CEREBRAL DEFINITON OF DEATH
The idea of total brain death has always been surrounded by controversies even it was accepted as the standard practice in most of the Western Nations because some argues that it cannot be referring to the death of the whole brain or the cessation of all the functions of the brain. Since the concept of the whole brain death ignores spinal cords reflexes as well as the emission of small electrical potentials measurable by the EEG continuous in some isolated brain cells. On the other hand, the cerebral death was associated to the cessation of the function of the cerebral cortex that is associated with consciousness and mental activity.
Thus whenever specific higher brain functions of an individual ceases, he or she is considered cerebral dead rather than the cessation of all brain activity. The concept of equating death to cerebral death was based on the assumption that human life has no longer exist in the absence of the person’s consciousness. Thus, cerebral death focuses on the death of personhood rather than the death of the organism itself. Because of these assumptions, death gains a lot of criticism and objectivity.
WHY IT IS DIFFICULT TO INSTITUTE A POLICY DEFINING PVS PATIENTS AS BRAIN DEAD?
Patients with PVS have a relatively intact brain stem with the complete lost of cerebral cortical function that may be due to lack of oxygen or blood flow to the brain for about 4-6 minutes. Thus, the patient is left with a transient coma for days and weeks that sometimes also resulted in eyes-open consciousness for years. Although they have cough reactions as well as times of wakefulness and sleep because of the brain stem, they are completely unaware of themselves as well as their environments. PVS patients also experience no pain during the period.
These characteristics that makes PVS patients different from permanent coma patients, patients with locked-in syndrome and irreversibly comatose are also the reason why it is difficult to institute a policy that defines PVS patients as brain dead.
Summary: PETER MONAGHAN ARTICLE
The idea of referring to brain dead people as dead resulted in different views and stands taken by different groups and cultures. In the United Sates and Canada, the concept of brain was accepted and organs of people who are considered brain dead can be taken for transplant.
Several countries on the other hand have different views regarding the matter specially those that that are outside the United States. Other countries have acknowledge the concept of brain death but were unwilling to view brain dead persons as dead and chose to stick to the cessation of heart and lungs as the indication of death of an individual. The differences in the views of the public regarding brain death creates several issues, controversies and as well as objections of the concept.
For some, legalizing brain death is just a way of legalizing killing; others believed otherwise, mostly are professionals in the field of medicine who believed that this concept will be able to save the lives of those persons whose brains are well functioning but are desperately in need of organ transplant. The acceptance of the whole concept of brain death is likely to produce a great development in the field of organ transplant, cloning and other medical fields. However, this would also mean changing the public’s definition of dead; disregarding mostly religious and biological beliefs of the definition of death.
Medical technology developments also complicate the issues regarding brain death. Even the question of when should a person should be considered brain dead was still debatable up to the contemporary time. Still, the significance of death in the societal context still overrides medical authority when it comes to a patient known to be brain dead. One of the strongest issues that were against the concept of brain death was the difficulty of family members of a brain dead person to acknowledge the burial or even cremation of their love.
Another issue that also arises was whether anesthesia should be used for patients that were brain dead. The concept of brain death really does create a lot of controversies and questions that remained debatable up to the present time.
COUNTRIES OUTSIDE THE USA
In the United States as well as in Canada, once a person was considered to be brain dead, his or her organs can be removed for transplant. However not all the countries, because of cultural differences, does not view and accept the concept of brain death in the same way.
In several European Countries, surgeons could perform the transplant unless the patient forbade it. Still, there are those countries that accepted the idea of brain death and take it into consideration, but still preferred biological death and brain dead persons are not considered dead. There are also some countries that were totally against the idea of brain death. The concept of brain death was merely a convention outside the United States and Canada. For example, in Japan, it took more than 3 decades of debate before the concept of brain death was legally accepted.
Still, the issue of brain death remain restricted that allowed for organ transplants. Brain Dead individuals are not considered dead unless they wish to donate their organs. Germany on the other hand first recognized the concept of brain death but reversed its recognition in 1999. Although brain death had been legally accepted in Sweden in 1980’s, the issue is still being debated. On the other hand in the early 1900’s Denmark accepted the concept of brain death but decided not to use this concept in determining if an individual is dead rather they retain the heart and lung cessation of determining death.
Thus, because of different views, beliefs and norms, different countries have different approaches regarding the issue of brain death.
DECISION MAKING IN OTHER SENSITVE MEDICAL AND SOCIAL ETHICAL AREAS
The issue on brain death had made certain impacts when it comes to decision making of some related medical, ethical and social issues. When it comes to ethical concerns, the main question that arises is the issue of life and death. Brain Death had moved some conception of death; it is a new definition of death as some may say.
Brain death is a treat to some ethical, cultural and religious beliefs as it offenses certain beliefs of society. On the other hand, brain death offers great advancement in some field such as medicines and other medical aspects. Brain death made it easier for medical personnel to decide on whether to sustain or cut off different medical apparatus that sustains the breathing of the patients. It also helps in deciding to make an organ transplant from patients that are considered brain dead. Thus, it created medical advancement especially in the filed of organ transplant, cloning and other fields.
On one point, brain death can be said to help the society by providing organs from those patients who are brain alive and are capable of making a change in society. However, the issue also brings disagreement among the members of the society.
TERRY SCHIAVO CASE
The Terry Schiavo Case illustrates both societal and ethical issues concerning brain death, the decision that concern individuals and groups have to make. The different views of Terry’s husband and parents brought conflicts and legal issues.
The concept of brain death made it legal to cut off the apparatus or the feeding tube used by Terry. Although Terry’s parents appeals to the court to put back the feeding tube, the court had rejected this appeal. It can be said that the court accepts the fact of brain death and agrees with Terry’s husband that she would rather be dead. However it was really hard for Terry’s parents to accept that their daughter was already dead. Different doctors who had seen Terry have different views and beliefs whether Terry would be able to recover or not.
Thus, it was really hard even with several developments in medical fields to have a consensus of whether a brain dead person can be classified dead or not.
It can really say that medical development altered our notion of death. This brings new challenges to every culture and society. Because different cultures are different, they may have different stands regarding brain death. For some, it was proper to view brain dead person as dead because of the lost of the main function or the brain was already dead.
However, some argues that legalizing brain death as death is also a form unjustified killing. The issue or concept of brain death will remain controversial and objections will always arise because of the differences of every culture and individual. Thus, the consensus regarding the matter can never be accomplished.
Blank, R. (2001). Technology and death policy: redefining death. Mortality: Vol. 6.
Monaghan, P. (2002, February 22). Unsettled Question on Brain Death. The Chronicle of Higher Education. Washington: Vol. 48, Iss. 24; pg. A. 14.