Finally, section V concludes that any attempt to amend existing national laws or to adopt a national standard should be aimed with the utmost care to reconcile the need for medical accuracy with sound ethical principles compatible with respect for the inviolable and inherent dignity of the human person. Clarity of laws and policies based on medical ethics that reject the utilitarian use of human beings is necessary to bridge the gap between the medical community and an increasingly suspicious public, and to restore confidence in ethical criteria for determining death and standards for organ procurement. There are big differences in brain death guidelines between major neurological hospitals in the United States. Compliance with the guidelines of the American Academy of Neurology varies. While the guidelines reflect actual practice in each facility, there are significant differences in practice that may have implications for the determination of death and initiation of transplantation procedures. The legal definition of death must respond to technological progress and distinguish between life and death. But where to draw the line is difficult to determine. The current legal definition of death requires an irreversible cessation of cardiorespiratory function or an irreversible cessation of all brain function. But technology can often restore certain brain functions without restoring consciousness, so brain death is often diagnosed without meeting the requirement of irreversibility.
This article argues that the law should be updated to require permanent interruption rather than irreversible interruption, and that medicine should be transparent about what permanent means. The legal definition of death must continue to respond to advances in medical technology. To be practical and ethical, it must describe when a person no longer has meaningful functions or qualities of life and cannot regain them, when loved ones can begin to shape their lives without the individual, and when clinicians are released from their duty of care. However, it is difficult to agree on the lack of meaningful quality of life. The definition of death has changed to reflect medicine`s increasing ability to restore qualities of life that we all agree are significant, such as the ability to consciously and intentionally interact with the world.1 People who would have been considered dead in another era are sometimes “returnable.” 2 However, breathing and circulation—”realistic” qualities—which were good indicators of the presence of more meaningful quality of life, became less reliable. Breathing and circulation can now be done artificially. Therefore, the definition of death remains difficult. Can a definition capture when significant qualities of life have completely disappeared and are irrecoverable? Should he try to define what qualities of life have meaning? A minority of critics have argued that brain death is a legal fiction formulated simply to solve the moral problem of organ harvesting from a potentially living body (Miller & Truog, 2008; Shah and Miller, 2010, p.
540; Sade, 2011). Since its inception, proponents of neurological criteria used to determine death have been accused of having a hidden agenda: to meet the growing need for vital organ donation. Heartbeatless organ donation, or NHBD, is the procurement of organs after cardiac death. Cardiac death is determined after a patient has suffered cardiac arrest for two to five minutes. [23] [24] In Lovato v. District Court In and For Tenth Judicial Dist., Colorado adopted the brain death standard in 1979, describing it as “a more comprehensive definition of death.” 14 He concluded that “to do otherwise would mean turning a blind eye to the scientific and medical advances that have been made around the world over the past two or three decades.” 15 Since their inception, judicial authorities have struggled to resolve the medical and ethical dilemmas associated with brain death. Current laws and medical implementation have subtle differences in the United States, and the resulting controversies continue to spark national interest and debate. Any attempt to eliminate inconsistencies in various state laws and/or to meet the growing demand for human organs should receive the utmost attention to reconcile the rigor of medical accuracy with sound ethical principles compatible with a philosophical anthropology that recognizes the dignity of the human person. Inheritance law: Without a formal declaration of death, benefactors cannot inherit a person`s estate. There are three main ways to define death: legal, cultural, or clinical. Find out what criteria are used to determine the time of death.
1 President`s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Defining Death: Medical, Legal and Ethical Issues in the Determination of Death, [`the Commission`] 13-16 (1981). Oregon is the only state that specifically addresses “fetal death” in its provision of the death law: most people don`t think about the uniform law on declaration of death until the unspeakable happens. If you are facing a difficult situation and need legal expertise regarding UDDA or other end-of-life legal issues, you should speak to an experienced health advocate in your area. Proponents of a national standard believe that its implementation would promote equal treatment of potentially brain-dead patients, minimize the risk of inconsistent legal outcomes, and provide physicians with a unified set of procedures for determining death (Eun-Kyoung et al., 2008). Some suggest that subjecting the standard to legal codification would ensure that it is tested through extensive debate and review by various medical, ethical and legal experts. This alone can justify the national standard approach, as some hospitals keep their criteria secret (Fry-Revere, Reher, & Ray, 2010, 68). Of course, the difficulty of implementing a national standard would be inherent in the political process it would have to endure. 23 The development of critical care medicine in the late 1950s led to the surprising phenomenon of patients with severe brain injuries remaining in a coma with the help of mechanical ventilators and other medical interventions. Could these patients legitimately be declared dead due to a completely defective brain? At that time, death was defined by the cessation of circulatory and respiratory functions. In the early 1980s, a consensus emerged in the United States to determine death based on neurological criteria – that patients diagnosed as “brain dead” are biologically and legally dead. The Uniform Determination of Death Act (UDDA) of 1981 became the legal standard in the United States.
The UDDA states that “a person who has suffered either 1) irreversible cessation of circulatory or respiratory functions or 2) irreversible cessation of all functions of the entire brain, including the brain stem, has died. The determination of death must be made in accordance with accepted medical standards. Significantly, however, about half of patients diagnosed as brain dead maintain the function of the hypothalamus – a part of the brain – which manifests itself in controlling the urinary concentration formed by the kidneys. This is a serious problem because the UDDA explicitly calls on the medical profession to set diagnostic standards, but in many cases the application of these long-established standards is incompatible with the “irreversible cessation of all functions of the entire brain.” A patchwork of states has adopted a variety of different regulations (see Fig. 2). The Kentucky version of the UDDA defines its criteria only as the “minimum requirements” for a death determination. In the foreground are “the usual and customary norms of medical practice” (KY Rev. Stat. § 446.400, [2009]). If respiratory and circulatory functions are artificially maintained as such, so that it is impossible to establish that these functions are no longer extinguished, death may be established for legal and medical reasons if the function of the whole brain, including the brainstem, is irreversibly interrupted, determined in accordance with this Article (Fla.