brain death as the end of human life

In North America, discussion about brain death has been limited for the most part to a small group of doctors and an even smaller group of lawyers and intellectuals. The contribution of culture to this debate is virtually never raised, except perhaps to account for a perceived “lack of cooperation” among certain minority groups with the donation of organs. Periodically the debate has leaked into the media, usually when something newsworthy happens in connection with organ transplants. These reports are almost always positive and laudatory of medical he­roics. Rarely has the assessment of brain death or the actual procure­ment of organs been given more than fleeting coverage.

Discussion of the institutionalization and legitimization of brain death as the end of human life, followed by its routinization across North America and much of Europe, has been dominated by two lines of thought. The first attempts to assign death to a scientifically deducible and verifiable moment, and thus to make it at once indisputable in med­icine and recognizable in law. However, professional consensus has been lacking as to whether death is a moment or a process and how best to determine when it occurs. No consensus exists even as to whether a definition of death should be applicable to all living forms or whether there can be a death unique to humans.

Until the late 1960s this long-standing professional controversy had little effect on determining the death of individual patients, the precise timing of which is usually not important unless foul play is suspected. With the development of critical-care medicine, it became imperative to decide if and when it would be appropriate to discontinue life support for patients who were expected never to recover—who were in an ir­reversible condition that could end only in biological death. During the same period, organ transplants were becoming increasingly common. Particularly after the world’s first heart transplant in 1967, many rec­ognized that doomed patients on life support represented potential or­gan sources. However, these patients could not be diagnosed as dead in the usual way because their hearts were still beating, sustained by the ventilator. Doctors urgently needed to be able to formally declare death so that organs could be removed from brain-dead patients without legal repercussions. A new definition for death had to be established, one that located death in the brain; and its criteria needed to be uniform and objective.

 

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