Definition of Death

8/2/2019 Definition of Death

1/14

When is dead?

The definition of death and its

implication for organ

transplantation

Cristina Gavrilovici, MD, MA, PhD


2/14

Empirical and conceptual issues

Statutory definition of death: Uniform

determination of death act: an individual

who has sustained either

(1) irreversible cessation of circulation and

respiratory function or

(2) irreversible cessation of all functions ofthe entire brain, including the brain stem

is dead


3/14

Empirical and conceptual issues

Death = natural event or process

the two notions approach:

the patient as person the person as body

there are dead bodies but no dead persons

how do we decide whether a body has ceased to

function ?


4/14

Irreversibility

UPMC protocol: legally dead after 2 minutes of

pulseless apnea, unresponsivenes to verbal

stimulus, EKG

the moral questions:

whether the withdrawal of life support and subsequent

removal of organs are morally permissible

killing vs letting die


5/14

Irreversibility

UPMC protocol: irreversible cesation of

cardiopulmonary function (legally dead after 2minutes of pulseless apnea, unresponsivenes to verbal

stimulus, EKG ()

the moral questions:

whether the withdrawal of life support and subsequent

removal of organs are morally permissible

killing vs letting die

the empirical question:

how much time after cardiopulmonary function is lost one

must wait to ensure that spontaneous recovery will not occur?


6/14

Irreversibility

David Cole: central to UPMC protocol is

irreversible concept, that is dangerously

ambiguous:

irreversible by whom? When? Under what circumstances?

The UPMC protocol involves a totally implausible and weak

construct of what is for a loss of function to be irreversible

central to UPMC protocol is the absence of auto-resuscitation


7/14

Irreversibility

Tom Tomlison: a critique of Cole:

irreversibility is a requirement that arises only at the

level of the criteria for the determination of death rather

than at the level of the concept of death. Why would anyone think that the determination of death

should be a determination of the irreversible?

A significant important translation of irreversible in

the criteria for determining death is the possibility of

reversal is not ethically significant.


8/14

Irreversibility

Lynn and Cranford: four possible times of

death: T1: when critical function is lost

T2: when the critical function is observed to be lost

T3: when the function is irreversible lost

T4: when the function is demonstrated to be irrversible lost


9/14

Public ambivalence and confusion

Acceptance in great part of the brain death

criteria because it was seen by the public

as a defense against the invasiveindignities of technological medicine.

The number of minutes needed to declaredeath might be ignored


10/14

Public ambivalence and confusion

Trust in physicians and health care system

is often a problem in minorities

communities

fear of exploitation of innocent victims by

medical scientists


11/14

Recommendations

1. When stipulating how long one must wait after

the cessation of circulatory function to declare

death, protocols should explicitly explain theempirical and philosophical grounds for their

position

2. If one holds the weakest position of

irreversibility, data will be helpful to reassure

skeptics that autoresuscitation will not occur.


12/14

Recommendations

3. Transplant community should take seriously the

need for data based justifications for pushing the

time of death closer and closer to whencirculatory function is lost.

4. There should be organ procurementorganisations functioning as a regional engine

for opinion and practice change


13/14

Recommendations

5. NHBD policies should be uniform with the

regards to the declaration of death

6. Institutional protocols should be developed with

community involvement and input.


14/14

Recommendations and conclusion

Death is both a biologically based and socially

constructed notion about which there is little

prospect for social consensus

Documents

Definition of Death