#10043 - Definition Of Death - Medical Law and Ethics

DEFINITION OF DEATH

OPENING QUOTE

1. Lamb – ‘It is as wrong to treat the living as dead as it is to treat the dead as alive’

INTRODUCTION

1. Chau & Herring – highlight a vast number of definitions, I’ll explore some

LEGAL DEFINITION

1. Airedale NHS Trust v Bland (HL)

• brain stem death = definition of legal and medical death

• LORD KEITH: ‘in the eyes of the medical world and of the law a person is not clinically dead so long as the brain stem retains its function’

2. Brain Stem Death Definition: Department of Health, A Code of Practice for the Diagnosis of Brain Stem Death outlines the three requirements, it must be concluded by 2 experts that: RSB (reversible, several, breath)

1. The coma is not due to reversible causes, such as drug overdose

2. Several elements of brain stem have already been permanently destroyed; AND

3. Patient is unable to breath spontaneously

WHY IT’S IMPORTANT

1. Organ donation – at what point can we remove organs

2. Resources – should treatment and life-support machines be kept on for people in comas and/or permanent vegetative states?

3. Delaying grievance process for the family

4. Inquests can rely on circumstances surrounding the moment of death to ascertain causes

5. John Burgess (2010) – he suggests there should be a consistency between the point when life begins (so legal status of the foetus) and the point of death

6. Lamb – ‘It is as wrong to treat the living as dead as it is to treat the dead as alive’ highlighting importance of fixing the right point

PROPOSED ALTERNATIVE DEFINITIONS

2. BRAIN STEM DEATH

1. this is the current definition

2. Glannon (2009) – criticizes for elevating brain to essential organ

3. Joffe (2010)

1. even where brain is dead other functions can continue (eg. growth, excretion)

2. just because cerebral function controls factors which contribute to personhood and consciousness, that doesn’t justify brain stem death as the vital point

3. this definition could lead to the view that PVS patients are dead

4. Veatch (1999) – brain transplant in the future; similarly other technological concepts such as crypto-freezing raises other problems with our understanding of death

5. Miller & Truog – people opposing a return to definitions based on circulatory and respiratory criteria raise the ‘decapitation gambit’ (ie. decapitated human could still be alive, as it maintains circulatory and respiratory function) – but Miller and Truog argue in favour of these former definitions, by looking at chickens that can still walk around without their heads and pregnant women can gestate a viable foetus for a period of time after brain activity has stopped – showing how a decapitated person has an ambiguous state

3. END OF BREATHING

1. traditional view

2. Danish Council of Ethics – they favour this approach as it’s the comman man’s understanding

3. Pallis – stopping breathing is the most common cause for the brain stem to stop functioning – hence why Mason & Laurie things its wrong to regard brain stem death as distinct from stopping breathing

4. stopping the heart doesn’t mean end of brain activity

5. odd result that patients could technically be resurrected in this version (ie. they die in the operating room, and then resuscitated)

4. END OF ORGANISM

1. Lamb (1985) – if the body is seen as a ‘working organism’ with various functions then it might be possible to define death as when that organism ceases to achieve those functions

2. But it treats body as a piece of machinery

5. DEATH OF EVERY CELL

1. extreme view

2. only when body begins to putrefy

3. would adversely affect organ donation – but it would be in line with taking conception as the point for legal status of the foetus

4. Kennedy – so we’re not dead until we’re ‘some kind of smelly porridge?’

6. CONSCIOUSNESS

1. Fletcher (1979) – personhood essential features are viability, consciousness and self-determination

2. Point at which person lacks these they are dead

3. This would mean PVS patients would be dead – even though some can recover

4. Technically this means someone in a 24 hour coma was dead for 24 hours – another odd result

7. DESOULMENT

1. Tonti-Filipinni (2011) Religious perspective – so when ‘soul’ leaves the body

2. Hughes – the soul is the ultimate internal principle of our personhood

3. Unascertainable though

THERE SHOULDN’T BE A SINGLE POINT

1. Chau & Herring - In medicine death is seen as a process, not a moment, can only identify milestones within that process

2. Especially when death is ‘natural,’ where it can be a long drawn out affair

3. Aries – critical of breaking death down into a series of ‘little silent deaths’, it removes the moment when death has its meaning

4. Stanley (1987) – law, relatives and professionals all require a single point

CHOICE

1. Bagheri (2007) – so many it should be when individual decides

2. Zeiler (2009) – range of options which people select from?

3. Problem with this is the same as advance directives, most people wouldn’t have selected one because they don’t like to consider death (Stern)

TWO OCCASIONS OF DEATH

1. McMahan – take two occasions, ie. when we lose consciousness and then when our biological organism stops

1. Gervais – two camps to when death occurs

1. those that...