The Definition of Death: Contemporary Controversies Review

Average Reviews:

(More customer reviews)Are you looking to buy The Definition of Death: Contemporary Controversies? Here is the right place to find the great deals. we can offer discounts of up to 90% on The Definition of Death: Contemporary Controversies. Check out the link below:

>> Click Here to See Compare Prices and Get the Best Offers

The Definition of Death: Contemporary Controversies ReviewStuart Younger, Robert M. Arnold, & Renie Schapiro, editors
The Definition of Death:
Contemporary Controversies
(Baltimore, MD: Johns Hopkins University Press, 1999)
(ISBN: 0-8018-5985-9; hardcover)
(Library of Congress call number: RA1063.D44 1999)
(Medical call number: W820D285 1999)
This book was created from a conference in 1995.
Brain-death was well established by that time.
But some details were still being questioned.
And some people advocated higher-brain definitions of death,
which would allow even earlier declarations of death,
which is always better for harvesting donor-organs.
This review will deal selectively with the chapters indicated below.
Chapter 3: "How Much of the Brain Must Be Dead?"
by Baruch A. Brody, PhD.
Many common definitions of brain-death
say that the integrative functions of the brain have ceased.
And they cannot be restarted.
But one common integrative function
that remains in brain-dead cadavers is hormonal regulation.
Even when machines are needed to keep the heart and lungs functioning,
the brain-stem is sometimes still putting out hormones
that regulate various bodily functions.
On a literal level, hormone regulation
is one remaining integrative function of the brain.
But hair and nails keep growing too.
These are cell-activities that need no brain at all.
If all that my brain-stem can do on its own
is to produce hormonal regulators,
then I should be declared dead.
In fact, I prefer permanent unconsciousness as the definition of death
that should be used at the end of my life.
I have no philosophical problems being declared brain-dead.
If others agree with Dr. Brody's objection,
we might need to modify the definition of brain-death
to say that most of the integrative functions of the brain have been lost.
I do not think we should add any new tests
to see if the brain-stem is still producing hormones.
Brody argues that biological death is a process rather than a moment.
Various brain and body functions shut down at different times.
If we wait for each and every part of the process of dying to be completed,
it could be 3 days later when death is finally declared,
which would usually mean that the organs would be useless for transplant.
But we do need a consistent and comprehensive definition of death.
And we need good ways to convince the relatives of the dying patient
that death has really happened,
even tho some tests show continuing functions,
such as the production of the hormones that regulate some bodily functions.
This question about laypersons with concerns and objections
is more serious than the technical questions of testing and certification.
Some relatives will be quite conservative about the definition of death.
They will look only at the traditional concept of death
--when all bodily functions have come to a permanent and irreversible end.
They want to be completely certain that death has occurred
before burial or cremation--or anything else happens to the body.
This reviewer thinks that the following will probably emerge:
The scientific definitions and tests will apply to most declarations of death.
And organ-transplants will follow some declarations of brain-death.
But there will be a minority of families who will never accept brain-death.
They will insist on using their traditional definition of death.
At the end of his chapter Brody raises the issue of anenchephalic infants.
These are infants born with most of their brains simply missing.
They will never have even a single moment of conscious thought or feeling.
But their brain-stems can sometimes keep their bodies alive for a few days.
The American Medical Association now approves
of using babies born without brains
as organ-donors to save the lives of other babies.
According to the traditional definitions of death,
they would still be 'alive' when their organs are harvested.
But this situation could be clarified by certifying
that these babies were born permanently unconscious.
And they should be officially declared to be dead by an independent physician
before any organs are harvested for transplant into other infants.
Should such infants be officially declared brain-dead
before organ-donation is even considered?
This would avoid the very odd situation of declaring the time of death
to be when the first vital organ was removed.
Thus, this reviewer's answer to Dr. Brody's question:
"How much of the brain must be dead?" is:
Let the parents of infants decide for their babies.
And let adult decide for themselves.
My personal answer is that permanent unconsciousness
is a good definition of death.
And I should certainly be declared dead if I am brain-dead.
~~~~~~~~~~~
Chapter 4: "Refinements in the Definition and Criterion of Death"
by James L. Bernat, MD
Dr. Bernat agrees with Dr. Brody that death is more like a process than an event.
But common-sense usage requires that we say of an organism
that is it either still alive or that it has died.
We need a defined moment of death for a variety of reasons:
organ-donation, life insurance, burial, etc.
And a declaration of death also leads to the removal of life-support systems
without asking for informed consent from anyone.
The family need no longer be asked to approve any medical procedures
since a dead body does not warrant any medical treatment.
Sometimes we can only be certain of the moment of death in retrospect.
One such situation would be the failure to restart vital functions.
When someone dies in a hospital, the 'crash team' is often called
whose job it is to restore any and all failing vital functions.
And they keep trying for a significant number of minutes.
If their efforts are successful, the patient was not really dead--only dying.
If resuscitation does not work,
then we can say that the patient was doomed from the start of the CPR.
And death will be declared after the failure of resuscitation.
In retrospect, we can say that for all practical purposes,
the patient died some minutes earlier.
But the official time of death will be declared
as the moment when the resuscitation efforts were terminated.
The basic change Dr. Bernat proposes
is adding the word "critical" to the following expression:
"Death occurs when the critical functions of the whole brain have ceased."
Thus we do not need to concern ourselves
with the random firing of groups of neurons in the brain
--if such activity makes no difference
to the critical function of the brain as integrator of bodily functions.
Likewise, the secretion of hormones and continuing auditory-pathway signals
do not count in the determination of death.
Such subtle distinctions will be lost on most laypersons.
We simply want to know: Is the patient alive or dead?
And we will normally not object to the declaration of death by a physician
--using acceptable criteria and tests for separating life from death.
~~~~~~~~~~~~~
Chapter 8: "The Conscience Clause:
How Much Individual Choice in Defining Death Can Our Society Tolerate?"
by Robert M. Veatch, PhD.
Most laypersons have given no thought to the definition of death.
So they just follow what seems most comfortable and familiar to them.
This will often be colored by their religious background or cultural group.
And the more religious they are,
the more traditional their definition of death will probably be.
Some religious groups refuse to acknowledge that someone is dead
if the heart is still beating and the lungs are still breathing.
But the medical profession and the law has moved ahead.
Some states now permit physicians to declare death
based solely on brain functions.
Veatch proposes that the default definition of death
be the whole-brain criterion:
If all the functions of the whole brain have ceased,
the patient may be declared dead.
If the patient or the family have not expressed any views,
then this definition of death can be used without any further question.
But patients and/or families ought to be permitted to deviate
from this default definition of death in either direction:
Conservatives could insist that heart and lungs must have stopped.
Liberals could deviate toward higher-brain definitions of death.
For example, when all consciousness is over forever,
such permanent unconsciousness could be defined as death.
There must be limits, however:
We will not tolerate relatives declaring the merely-disabled to be dead.
At the other end, we will not tolerate our hospitals keeping corpses
because the relatives refused to allow death to be declared
until the very last cell in that body is obviously dead.
In most human deaths, the differences in definitions
will have no practical effect.
Opting for the more conservative definitions
will mean that the doctor will wait a few more minutes
before declaring death based on signs obvious to all...Read more›The Definition of Death: Contemporary Controversies Overview

Want to learn more information about The Definition of Death: Contemporary Controversies?

>> Click Here to See All Customer Reviews & Ratings Now