At what
point do we say death has come? Death is a process and all of the
body’s organs do not fail simultaneously. Today’s technology can
restore and sustain the function of many organs. Machines can operate
for hearts that do not beat and lungs that do not breathe on their own.
The question of when death is final is complex. In 1968 the Harvard
Medical School Committee developed a definition of death. According to
this definition, a person is brain dead when he or she has suffered
irreversible cessation of the functions of the entire brain, including
the brain stem. This is determined by a number of tests that determine
unawareness of all stimuli, no spontaneous muscular movement or
respiration, no reflexes of any kind and a flat electroencephalogram,
indicating the cessation of electrical activity in the brain. If after
24 hours there is no change, the person can be declared dead.
The new
understanding of death is largely a consequence of technological
advances in life support systems. Some severely-injured people who have
suffered permanent cessation of functioning of the entire brain can be
given circulator y and respiratory support such that their appearance
resembles that of the dead. They no longer respond to their environment
by sensual or intellectual activity. Their appearance differs, however,
because mechanical support generates breathing, heartbeat and the
associated characteristics of life. According to authors Bernat,
Culver and Gert, a neurological standard for declaring death is in place
from the past and still exists in the present. Physicians traditionally
have determined death by examining people for total unresponsiveness –
lack of any spontaneous movements, including breathing, absence of
papillary light reflexes and absence of heartbeat. Of these signs, only
the last one is not directly a sign of cessation of brain functioning.
The value of the commonly known tests of death, which detect the
permanent absence of spontaneous heartbeat and breathing, depends upon
the irreversible cessation of functioning of the whole brain. This is
where things become complicated and are subject to controversy.
The
essential significant features of human life are the consciousness with
which humans have and maintain personality, memories and other
attributes of personhood. These in turn are dependent on brain
function – if the body cannot maintain itself from impulse from the
brain and can only be maintained by mechanical means, then the
essentially significant features of human life are gone. To keep a body
going when there is no life – no capacity for consciousness- is done so
for purposes relevant to the survivors of the deceased and/or those
caring for them. It is certainly not for the benefit of the person in
this unconscious state.
Two
physiological components control conscious behavior – arousal and
content of consciousness. The arousal represents behavioral changes
that occur when a person awakens from sleep or transits to a state of
alertness. The content of consciousness, also known as awareness,
represents the sum of cognitive and affective mental functions, denotes
the knowledge of one’s existence and the recognition of internal and
external worlds. Consciousness can be further categorized into
wakefulness and awareness. Awareness is the same as the content of
consciousness and wakefulness is provided by arousal (subcortical
arousal). According to physician, P. Plum, author of Coma and
Related Global Disturbances of the Human Conscious State, a human
being’s state of consciousness reflects both his level of arousal and
the sum of the cognitive, affective and other higher brain functions.
These cognitive functions can be further divided. The state of
consciousness regulates the sustained behavioral state and function of
affect, mood, attention, cognitive, integration and psychic energy (cathexis)
depending on the integrity of the limbic structures. The cerebral level
is related to the processes of higher levels of perception,
self-awareness, language, motor-skill and planning.
A law
in place for determining the issue of death must set a legal standard
for determining death and a medical criteria for doing so. This
determination should be updated and stay in line with current diagnostic
and biomedical tests and knowledge. Any law governing these important
issues should recognize the standards of medical practice which in turn
require a time period in which the situation is evaluated and diagnostic
tests can be read by more than more physician. In this way, there would
be less debate in “disconnecting” the person from organ supporting
equipment. The current medical criteria establishes death declaring that
the “whole brain” most no longer be capable of functioning for death to
be declared..
The
President’s Commission for the Study of Ethical Problems in Medicine and
Biomedical and Behavior Research published its first report in 1981 on
defining death considering the medical, legal and ethical issues
involved. The Commission discusses the role of cessation of ventilation
and circulation in the cessation of functioning of the organism as a
whole. The definition or conception of death is on the other side of
the subject. Dr. Robert M. Veatch presents the ethical, philosophical
and policy confusion of the definition of death, addressing those
referring to the “loss of specifically human properties” and those
arguing the “loss of integrative unity of the body”. Veatch has proposed
to search for the essential property that characterizes life in humans.
“What is it about human life, and that its loss is so essential, that
the individual who loses it ought to be called dead?”