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Chapter 17

PHI2396 Chapter 17: Bioethic Note 13 Chapter 17

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Dean Lauer

Chapter 17-Definition & Criteria of Death: It seems to be black and white –easy to define, but it is grey –hard to define DCD-Donation after cardiac death: it is very precious donations for numerous patients out there -but the problem arises that it is hard to define the point of the death and hard to know when it is right to take DCD -ideally, organ harvesting would take place before death for the highest quality organs (fresh & oxygenated) But in practice, it takes place within around 5min - 30mins after cardiac death (distinguishing death is very cloudy) **The best organs are the freshest organs (which are living tissues that degrades fairly quickly without fresh supplies and oxygen)  sooner the access, the better use for transplant like through DCD which usually use of organs that are fresh & oxygenated  Organ viability is time-sensitive & some organ-transplant doctors have been viewed as greedy killers who can’t wait to retrieve organs, or even encouraging death by suggesting opiates (killing analgesic drug)/blood thinners to still live patients **The ethical concern arises from the permission of letting die vs intentional encouragement of death to save another person’s life Permits the intentional killing of innocent life if: 1. Innocent will die anyway & 2. Another innocent life will be saved **In Canada, pronouncing cardiac death for organ donation need doctors to wait at least 5mins after the heart stops beating Traditional heart-lung definition Aka cardiopulmonary, cardiorespiratory, clinical death -For long periods of time, it was thought that the moment of death was based on just heart/lung death until the 1960s Simple layman’s diagnosis (inverse discussion questions on abortion): when life starts, it signals life (quickening) -which was hard to detect long time ago. Now the diagnosis of abortion is easier and it goes same for death which involved the end of movement  It is easy to detect when lung/heart stops, but breathing feeling of the circulation can be mistaken by shallowness  it is just simplest definition of death before medical society boomed which was unreliable & shabby technique Currently we look at much closer at the physiology and psychology. After ww2, there were development of medical science such as heart machine & transplant machine to keep the patients alive even with brain is dysfunctional -this turned the moment of death into a period of ear of death at the same time, life support with the new medical intervention, provided critical means for preserving retrieval of organs **Physicians argued to form a new definition of death, fearing they may be liable (with duty) for a patient’s well-being or fate for removing life-support for organ retrieval under the dead donor rule (organs cannot be obtained after the donor has died)–due to the chance of lawsuits on the physicians Whole-brain death: Harvard Med School ad hoc committee under Dr. H. Beecher proposed that death can be defined as when the entire brain irreversibly ceases functioning. This include: 1. unreceptive & unresponsive to external stimuli/inner need 2. lack of/no movements (breathing, etc.) under continuous medical observation up to 1h 3. lack of reflex action eg. blinking/eye movement –pupil dilation Whole Brain Formation: Breathing vs heart/respiration or brain -the pulse can be shallow or the breathing can be weak without any detail information about the person -if there is still brain functioning and still retrieving the functioning organs  is this criminal?? Or is it audacious?? -required to find new definition of death -There has to be finding electrical functioning -knowing details on brain stem -even with malfunctioning of the brain stem -there can be functioning of the cerebellum  the higher brain death seemed to be the real deal as permanent death Use of EEG for confirmation of whole-brain death - there was whole re-defining of the death of a person through the end of electrical signals within brain  it made doctors even harder to define death, when it dealt with the brain death which has fully functional organs other than dead brain **In Canada one of the whole-brain criteria for death has been practiced since 1968 “A person is dead when an irreversible cessation of all that person's brain functions has occurred” –this was recommended but wasn’t passed down Challenges to the Whole-Brain Formulation Return to the heart-lung formulation: whole-brain death is inessential, secondary since neural activity depends on a healthy circulation of [blood & oxygen] through heart-lung function but the time it takes for the signals to stop is too long for organ retrieval to happen -so there
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