Wednesday, September 12, 2012

What is Death?

The catch-line for a recent Discover Magazine article reads:

They urinate. They have heart attacks 
and bedsores. They have babies. They may even feel pain. 
Meet the organ donors who are “pretty dead.”

This article, a part of a larger book by Dick Teresi, talks about the fate of the so-called beating-heart donor. These are people who are declared brain dead and they donate their organs. The question is: is our definition of brain dead just? By defining death, is medicine treading on the property of philosophy? Publishing this book passage elicited letters from both sides of the debate. These letters were published in the following issue. Those who have benefited from such donations were quick to argue that this definition of brain dead has been well thought out and is just for both the donator and the person who receives the organ. Others wanted to share their own stories of the "pretty dead."

Due to the incredible advances in medical knowledge and technology in recent years, the line between life and death has been irrevocably blurred. We can keep people alive longer. We can detect even the smallest sign of life in a body. These advances have helped to manage and cure diseases that our ancestors would never had dreamed possible. They also have allowed us to put the body, the person, through hell to keep them alive.

The Uniform Determination of Death Act of 1980 states that:

An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.  A determination of death must be made in accordance with accepted medical standards.

This Act which has been accepted in most states was the first time that the brain death was accepted as a definition of death on a widespread basis. Brain death is generally accepted when the patient shows no signs of brain function. They show no response to pain, no reflexes, and no spontaneous breathing.

This is determined by two physical examinations by two separate doctors. An EEG is run to confirm when a patient has already failed the examination. All of the tests are ran again 24 hours later. If there has been no change the patient is declared brain dead.

There are many issues with this definition of brain death. First of all, patients who are dead according to the above criteria still exhibit a number of signs of life, as listed in the Discovery article:

• Cellular wastes continue to be eliminated, detoxified, and recycled.
• Body temperature is maintained, though at a lower-than-normal temperature and with the help of blankets.
• Wounds heal.
• Infections are fought by the body.
• Infections produce fever.
• Organs and tissues continue to function.
• Brain-dead pregnant women can gestate a fetus.
• Brain-dead children mature sexually and grow proportionately.
So, why is brain death defined as it is? The cynical writer of the Discovery article points to profit. This definition frees many more bodies for organ donation and the organ donation business is a lucrative one. While the donors family doesn't get paid (because that would be morally problematic), the hospitals and the doctors who do the transplants rake in the dough. The writer doesn't want to kill the industry, though, he just wants people to think more about the donors.

In my next post I will discuss the Catholic opinion on "brain death," stay tuned.

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