Choosing the Best Criteria for Determining When Death Has Occurred

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Traditional Criteria of Death (Whole Body): Physicians used signs of life such as a feeling for a pulse, listening for breathing, holding a mirror before the nose to test for condensation, and looking to see if the pupils are fixed.

In the 18th and 19th centuries , there were macabre tales of "corpses" reviving during funerals and exhumed skeletons found to have clawed at coffin lids. In 1882 an undertaker names Kirchbaum attached periscopes to coffins so that a person who woke up after being buried might signal for help.

The brain has 3 general anatomic/functional divisions:

the cerebrum ("higher brain"), with its outer shell called the cortex.

The cerebrum has primary control of consciousness, thought, memory and feeling.

the cerebellum, which coordinates voluntary movements and maintains bodily equilibrium.

the brainstem ("lower brain").

The brainstem has control of spontaneous vegetative functions such as swallowing, yawning, and sleep-wake cycles. It controls respiration, which maintains the correct levels of carbon dioxide and oxygen.

The Development of Medical Technology: Life-support machines, such as those supporting heart-lung operation, were developed in 1950s and 1960s.

An artificial respirator can be used to compensate for the inability of the thoracic muscles to fill the lungs with air.

The heart can pump blood without external control from the brain. An intact heart can continue to beat despite loss of brain function. This can continue for only a limited time (2-10 days for adults, longer for babies) when the brain has entirely ceased functioning. At present, no machine can take place of the heart except for a limited time and in limited circumstances.

When brainstem functions remain, but the major components of the cortex are irreversibly destroyed, the patient is usually in what is called a persistent vegetative state. Such persons can exhibit spontaneous involuntary movements such as yawns or facial grimaces, their eyes may be open and they may be capable of breathing without assistance. But they have no awareness of their environment. They can survive months or years without a respirator.

In 1959, the concept of Brain Death was first described in the medical literature.

In 1968, an ad hoc committee at Harvard Medical School developed the Harvard criteria of brain death, requiring loss of virtually all brain activity. Complete certainty of irreversibility.

In 1981, the President's Commission for the Study of Ethical Problems wrote a report on criteria for death. The Commission regards only whole brain non-functioning as meeting the criteria of death.

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