Danesha Goble – Phi 380 – 29 September
The Use of Both Standards Before taking this class I was oblivious to the apparently well-known fact that there are two standards of death. One standard is the cardiopulmonary standard, which is when the heart and lungs cease to function on their own. The second standard is the total brain death standard which is when there is complete and irreversible loss of brain function. There are people who stand in both corners of this argument but most, if not all, stand for only one standard. While the definitions of each standard seems to be clear cut, it is not, as there are some cases in which one standard will not suffice, which we will be discussing in a later paragraph. I will argue that both the
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This standard only seemed important once the use of ventilators became popular in hospitals around the world. An argument made in favor of the total brain death is that people who have been determined ‘brain dead’ are great prospects for organ donation (Council, p. 8). As a way to support this argument it is said that because there is artificial respiration and circulation, the blood will continue to circulate throughout the body, which will in turn maintain the durability of the organs needed for surgical removal and therefore enhancing their use for their awaiting recipients (Council p. 8). There are also arguments that do not particularly agree with the total brain death standard and would assumingly prefer the cardiopulmonary standard of death. A downside pointed out by Robert D. Truog in the article “Is it Time to Abandon Brain Death?” is that as a hypothermic patient you are not able to be tested for brain death. According to Truog “the circularity of this reasoning can be clinically problematic, since hypothermic patients cannot be diagnosed as brain-dead but the absence of hypothermia is itself evidence of brain function” (Truog). While continuing to support his argument Truog mentions that “clinicians have observed that patients who fulfill the tests for brain
Initially, cooling was recommended to 32° C-34° C[6, 7], but the enhanced effect of cooling at 33° C compared to 36° C in terms of mortality and neurological outcome could not be proven[2]. Since the most optimal cooling level is yet unknown, current (2015) Resuscitation Guidelines recommend mild hypothermia treatment regimen at the temperature range between 32° C and 36° C[3, 4].
viii. Brain Death must be established- person must cease having neurons firing in the neuro system
In "What is Death? The Crisis of Criteria" Louis Pojman introduced four definitions of death and describes their benefits and limitations. The four definitions include loss of the soul, cardiopulmonary failure, whole brain death and neocortical brain death, of which the cardiopulmonary is typically most common. I intend to show, using the work of Jonathan Glover and reasoning, that the neocortical brain death definition holds significant merit and is truly more practical and ethical.
Louis Pojman and Roland Puccetti took the position that neocortical brain death was the best definition of death. Many implications resulted from this, including views on assisted death and organ transplant. Would this lead to a slippery slope regarding what death was? Would this lead to an increase in organs available for donation? These are only some of the implications that arose from Pojman and Puccetti’s position. Looking at the neocortical brain death position versus the biologically integrative whole brain position allowed for judgement on which definition had better merit. I will argue that the biological whole brain position is more inconsistent in regards to application. As such, I will take the position of advocating for the
Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized as an acceptable way to determine death. (Iltis)
It is a beneficial treatment that should be implemented as early in patient care as possible, such as, within the EMS system. Through the last century this therapy has been accepted and rejected by many medical professionals. Since medicine is an ever-changing field, future research and practice of hypothermia will dictate if this therapy is more beneficial than harmful, and maybe one day could be a permanent major role, or it may never be used again. Hypothermia has been proved to decrease neurological impairment after cardiac arrest, but also has many limitations that can occur. A major limitation of this therapy is, if continued care cannot be guaranteed by receiving hospitals, therapeutic hypothermia is irrelevant for EMS to initiate. Likewise, if hypothermia is not begun in the field by EMS, then the receiving facilities now will have a delayed time in starting the therapy and anoxic brain injury could have already occurred. EMS agencies can drive the implementation of therapeutic hypothermia in the medical field. This therapy allows EMS providers to have a major role in the outcome of a cardiac arrest patient’s recovery and neurological outcome. With the progression of research and practice, medicine is evolving day after day, and patient mortality and morbidity have decreased over the years. Although, cardiac arrest patients have a poor
The topic I have chosen is whether or not a dead, decomposed body can be resuscitated or not long after death. The movie I am relating to is the original Frankenstein. In the movie, Dr. Frankenstein went to various graveyards and execution sites to recover the dead bodies and dissect them to create his “new life.” One scene in the movie showed Frankenstein’s assistant breaking into a medical school and stealing a brain that was sitting in a formaldehyde solution. That brain then went on to finish the “monster” that Dr. Frankenstein was creating. However, that brain had been sitting in that solution for a very long time; also being disconnected from any oxygen and blood flow. The brain, along with all of the other various body parts that Dr.
The Universal Determination of Death Act provides a comprehensive base for determining death in all situations. In 1979, the American Medical Association created the Model Determination of Death statute due to modern advances in lifesaving technology. A person may be artificially supported for respiration and circulation after all brain functions come to an end. The medical profession, has developed techniques for determining loss of brain functions while cardiorespiratory support is administered. The definition of death can’t assure recognition of these techniques, and can be demonstrated by the absence of spontaneous respiratory and cardiac functions.
Much media attention has been directed at the very practical use of euthanasia or assisted suicide on patients who are in a vegetative state or irreversible coma. The truth is that a significant number of such cases actually recover. This essay is devoted to those types, some very young, who would have been killed if euthanasia/assisted suicide had been legalized.
Until brain death was introduced the diagnosis of death was the lack of cardiac function. Without a heart beat blood did not
The next test is the corneal reflex which is done by touching the patients eyes with a cotton swab or putting a drop of water in the patients eye to see if they blink, if they do not they are considered brain dead. The oculocephalic reflexes is the next test done which means they move the patients head from side to side to see if the patients eyes remain fixated if the patients eyes do not fixate they are considered brain dead. The gag reflex is tested to make a patient gag if they do not gage they are brain dead. And the last test is the cold calorie test which ice water is placed in a patient’s ear if the patients eyes do not move then they are brain dead. C. The third and final test that is done is the apnea test; this test is done by taking the patient off of the ventilator and monitored to see if they give any attempt at breathing.
There are three things that need to be checked in order to declare death on a patient. First the patient must have no spontaneous heartbeat. Second, the patient must have no spontaneous breaths. Finally, the patient must have no response to painful stimuli.
The American Heart Association (AHA) updated the 2005 cardiopulmonary resuscitation clinical practice guidelines after the New England Journal of Medicine published two landmark studies in 2002. The HACA and the Bernard, et al. study found significant improvement in neurological outcomes with therapeutic hypothermia. Additionally, the Bernard, et al. study also revealed reduced mortality after cardiac-arrest survivors received therapeutic hypothermia (2002). In 2010, the AHA strengthened its position based on the growing body of research. Therapeutic hypothermia was the only intervention shown to improve neurological outcomes (Peberdy, et al., 2010). The most updated guidelines, set by the AHA in 2015, recommended that all comatose,
How is brain death defined? Well brain death is defined as an irreversible brain damage that causes loss of all brain function, which also includes the brainstem. There are three essential findings that conclude brain death: (1) coma; (2) absence of brainstem reflexes; (3) apnea. This is not considered a coma or vegetative state. In 1959, brain death was also known as an irreversible coma. This has become a new criteria for death since new technology has come about such as: ventilators, that could maintain a patient to the point that the heart is still beating, but the brain is not responding.
To others, socializing is very important to life. And for others, communication is the key. The definition of death is "the act or fact of dying, permanent ending of all life in a person, animal, or plant" according to Webster's Dictionary. Mason defines death in terms of "irreversible failure of the cardiopulmonary system or consequently as a permanent state of tissue anoxia." (43). Another definition that should be addressed is the definition of brain death. According to Stedman's Medical Dictionary, brain death is "in the presence of cardiac activity, the permanent loss of cerebral function, manifested clinically by absence of purposive responses to external stimuli, absence of cephalic reflexes, apnea, and an isoelectric electroencephalogram for at least 30 minutes in the absence of hypothermia and poisoning by central nervous system depressants." (142). If the heart is functioning, but the cerebrum is not functioning, the patient can be declared to be brain dead. To determine if the cerebrum is functioning, doctors would analyze the responses of the patient to external stimuli, run an electroencephalogram, check for cephalic reflexes, and check respiration of the patient. Lamb states that the absence of spontaneous respiration and circulation is not a sign of death, which is determined only when the physician is satisfied that the brain has ceased to function (31). Testing for respiration and circulation are simply