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Brain death was defined in 1968 as a condition characterized by three major features. A brain-dead individual is not capable of responding and receiving stimuli from his surrounding environment. In addition, a brain-dead person does not have the capacity to perform spontaneous actions, including breathing and beating of the heart (Boissy et al., 2008). Lastly, a brain-dead person does not show any reflex actions. The cessation of the pumping of the heart can be technically determined through the employment of an electroencephalogram (EEG) which detects any electrical activity that originates from the brain of an individual. Thirty years after the establishment of the definition of brain death, additional descriptors were incorporated into the concept. The concepts of brain death and cerebral definitions of death influence the decision-making process in medical and social-ethical areas because the main concept that still remains unclear now is not only the definition of death but also the definition of life. If death is defined as the loss of breathing and the loss of the heartbeat, which are both based on the proper functioning of the brain, then it can then be subjectively derived that life is the presence of breathing and the existence of a heartbeat.
The controversy over brain death was triggered by the inception of innovative medical equipment such as the life support system that is commonly attached to a patient that is in a comatose condition. The life support system provides a means for a comatose patient to continue breathing through the use of a respirator. In addition, the development of defibrillators serves as a tool in introducing electrical impulses to the chest of an individual who is experiencing either a loss of heartbeat or an improper rhythm of the heart. The controversy over brain death started when the classical definition of brain death involves the loss of capacity in breathing and maintaining a heartbeat. However, with the development of new medical equipment that could revive and maintain the essential processes of the human body, the definition of brain death became vague. The concept of brain death is also further complicated by the questions raised by healthcare providers wherein these companies would like to define the limits of their coverage, especially when the person that is covered by healthcare is already considered brain-dead.
Blank (2001) has explained that the current concepts and definitions of death can be integrated using technological innovations in brain research and imaging technologies. The author explained in his paper the difference in the definition of death several decades ago, which actually only involves the stoppage of breathing through the lungs and beating of an individual’s heart. However, due to the advances in medical equipment and technologies, it is now possible to keep individual breathing through the use of a ventilator. Hence the classical definition of death has now evolved to the cessation of the functioning of the brain amidst the prolongation of heart and lung function due to the employment of medical equipment that has the capability of replacing the functions of the heart and lungs. The related issues of human life, as well as the benefits and risks of disconnecting an individual from a life support system, should also be discussed in terms of its impact on the values and conscience of society. The implications of brain death are also discussed in connection to the continuation of coverage of health insurance amidst indications that a patient in a vegetative state is actually brain dead. The employment of methods for euthanasia in terms of cremation and the administration of lethal injections for the preparation of a patient for death may generate conflicts and moral issues with respect to the psychological load that the immediate family members are carrying. The development of new medical equipment has strongly influenced the evolution of the definition of death because the employment of this medical equipment has provided ways in substituting specific mechanisms of the body that are essential in establishing the life of an individual.
Monaghan (2002) has comprehensively explained how to handle a patient with a non-functioning brain. Brain death is perceived in different ways in different countries. For example, in Japan, the United States, and Germany, the definition of brain death is swayed to another dimension because the concept of organ donation and transplant is added to the complex issue. Hence it is much more difficult to deal with death in this modern age because not only is brain death implicated in the scenario, but also whether it is already possible to collect specific organs of a brain-dead patient in order to use this in organ transplant procedures. The employment of life support systems has thus initiated more issues to be debated and discussed, instead of just achieving one goal, and that is to sustain the life of the patient. It is also interesting to know that different countries accepted the concept of brain death during different decades of the 20th century, with Japan debating over the issue for almost 30 years and Sweden contemplating on the topic for almost 20 years. Thus culture plays a major role in the concept of brain death; hence the values of Asian societies may not always be the same as that of Western societies. The principles and mechanisms of organ transplantation are also different from one country to another; hence it is important for all of us to be aware of these differences.
The proposed cerebral definition of death is radically different because the concept of brain death is now defined based on two important functions of the brain. Each critical brain function has been described to be situated in separate areas of the brain; hence the proposed cerebral definition of death requires that both critical regions of the brain should be confirmed to be nonfunctional before an individual can be validly claimed as brain-dead. The two critical and essential regions of the brain are the cerebral cortex and the brain stem. The cerebral cortex is responsible for maintaining the consciousness of an individual. This brain region is also accountable for the capacity of an individual to perform any mental functions such as thinking and reading. The brain stem, on the other hand, is responsible for providing an individual the dexterity and adroitness in performing motor activities and movement. Research has claimed that the brain stem remains functional even when the cerebral cortex has been determined to be nonfunctional. This observation can also be observed a few minutes after the death of an individual, wherein some individuals tend to slightly jerk by themselves even when they have also lost their heartbeat and have already stopped breathing. It should be remembered that breathing and heart activities are maintained by the cerebral cortex, which is only one of the two critical regions of the brain. The classical definition of brain death states that the nonfunctioning of at least one of the two regions of the brain is enough to ascertain the death of an individual. However, controversy has now arisen because of the emergence of new medical equipment that can replace the lungs and the heart of an individual, thus substituting for the cerebral cortex. There has been a debate with regards to this new medical setting because even if the individual continues to breathe and keep a pulse, the individual remains unconscious and unresponsive, and these features of normal mental functioning can not be substituted by any medical equipment and at the same time, can not be reversed to the original normal condition.
References
Blank RH (2001). Technology and death policy: Redefining death. Mortality, 6(2):191-202.
Boissy AR, Ford PJ, Edgell RC, Furlan AJ (2008). Ethics consultations in stroke and neurological disease: A 7-year retrospective review. Neurocritical Care, 9(3):394-9.
McMahan J (1998). Brain death, cortical death and persistent vegetative state. In: Kuhse H and Singer P (eds.), A companion to bioethics (pp. 250–260). Oxford: Blackwell.
Monaghan P (2002). The unsettled question of brain death. Chronicles of Higher Education, 48(24):A14-A18.
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