BRAIN DEATH

Brain Death

[Name of the Institute]

Brain Death

Introduction

Brain death is a concept that has been used extensively in medicine, particularly by intensive care specialists, to define a group of patients with no cortical activity, who no longer require intensive care. There is a philosophical debate in bioethics as to whether the term 'brain death' is an accurate and useful one. Death was traditionally defined in strict biological terms, but one philosophical suggestion has been that it should be redefined in person centered terms. The present commentary examines whether the term brain death is a useful one and whether redefining death in person-centered terms would be helpful.

Death or Dying

Two hundred years ago, Sydney Smith (1771-1845) said 'death must be distinguished from dying, with which it is often confused'. I will argue that to talk of brain death, either in biological or person-centered terms, is to use the word 'death' inaccurately, to describe someone who is dying or whose life morally does not need to be sustained, but who is not actually dead (Shewmon, 2001).

The traditional concept of death is of the lack of circulation of vital fluids, the blood of a human or the sap of a plant, signifying the end of the organism's life. Dying is a process; death is finite and irreversible. It was in 1959, in France that the concept of coma dépassé or brain death was first introduced. The possibility of redefining death arose because medical technology had developed respirators capable of maintaining the cardio respiratory function of patients with no detectable brain activity. Medical technology kept patients alive who would previously have died. The other motivation was the advent of organ transplantation, and the increasing need for viable donor organs (Veatch , 1978).

In 1981, brain death was defined by the Harvard Brain Death Committee to include 'comatose individuals who have no discernible central nervous system activity'. The Harvard criteria have been widely accepted, and essentially have been the basis for life-and-death decisions about continuing intensive care for the past 20 years.

A Person-Centred Approach

Green and Wikler advanced what they called an ontological argument that brain death occurs when a person ceases to be a person. Brain death, they suggested, should be defined in person-centered, not biological terms. What we understand as a person is a conscious, self-aware human being, who can relate to other persons. Once someone ceases irreversibly to be a person, their moral existence is over. Ceasing to be a person certainly has moral significance. What are the practical implications of using a person-centered approach to death? When someone ceases to be a person, it might be considered that we are not obliged to sustain their life, although we might want to do so. There are two contrasting examples that show the strengths and weaknesses of a person-centered approach: persistent vegetative states and anencephaly (Green, Wikler.1980).

Persistent Vegetative States

Adults with no cortical activity can exist for years in a persistent vegetative state without regaining consciousness. Persistent vegetative state has been defined as 'a clinical condition of unawareness of ...