The Advance of Technoscience and the Problem of Death Determination

2020 ◽  
Vol 24 (3) ◽  
pp. 306-331
Author(s):  
Bas de Boer ◽  
Jonne Hoek ◽  
Keyword(s):  
Brain Death ◽  
Medical Literature ◽  
Life Support ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Life And Death ◽  
Brain Death Determination ◽  
Existential Choice ◽  
Medical Involvement ◽  
Death Determination

Death determination has long been a topic of intensive technoscientific and medical involvement. Due to advances in twentieth-century medical technology, the distinction between life and death has become less evident. Ambiguities appear when we start to use life-support technologies in order to save lives, bringing about “tragic artifacts” such as brain death and persistent vegetative state. In this paper we ask how this technoscientific and medical involvement shapes our understanding of death. We provide an overview of medical literature that has appeared on (brain) death determination, highlighting thereby the role that technologies played in its establishment. Subsequently, we develop three philosophical interpretations of technological death determination: With Agamben and Marcuse as the installation of political power; with Don Ihde as an existential choice for the inevitable; and with Jacques Derrida as an encounter with the ineradicable mystery of death. To conclude, we argue that technological death determination reveals an intrinsic, paradoxical connection between human’s technicity and its ignorance of death.

scholarly journals Dualism Revisited: Body vs. Mind vs. Soul

2008 ◽  
Vol 8 (1-2) ◽  
pp. 99-115 ◽  
Author(s):  
Rebekah Richert ◽  
Paul Harris
Keyword(s):  
Stem Cell ◽  
Life Support ◽  
Ethical Issues ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Life And Death ◽  
Simple Body ◽  
And Function ◽  
The Mind ◽  
Afterlife Beliefs

AbstractA large, diverse sample of adults was interviewed about their conception of the ontological and functional properties of the mind as compared to the soul. The existence of the mind was generally tied to the human lifecycle of conception, birth, growth and death, and was primarily associated with cognitive as opposed to spiritual functions. In contrast, the existence of the soul was less systematically tied to the lifecycle and frequently associated with spiritual as opposed to cognitive functions. Participants were also asked about three ethical issues: stem cell research, life support for patients in a persistent vegetative state and cloning. As expected, participants' beliefs about the ontology and function of the soul were linked to their judgments about these ethical issues whereas their beliefs about the mind were unrelated. Overall, the findings show that many adults do not espouse a simple body-mind dualism, and any tendency toward such dualism is unlikely to explain their beliefs in an afterlife. Instead, afterlife beliefs appear to be associated with the idea of an immaterial essence, potentially dissociable from the biology of life and death.

Moral Justice and Legal Justice in Managed Care: The Ascent of Contributive Justice

1995 ◽  
Vol 23 (3) ◽  
pp. 247-265 ◽  
Author(s):  
E. Haavi Morreim
Keyword(s):  
Access To Health Care ◽  
Life Support ◽  
Vegetative State ◽  
Health Maintenance Organization ◽  
Persistent Vegetative State ◽  
Autologous Bone Marrow ◽  
Marrow Transplant ◽  
Health Maintenance ◽  
Access To Health ◽  
Aggressive Care

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state (PVS), cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization (HMO). Similarly, Baby K was an anencephalic infant whose mother, believing that all life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer.

Brain Death and Organ Donation

2018 ◽  
Author(s):  
Thomas I. Cochrane
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death ◽  
Brain Death Determination ◽  
Brain Dead ◽  
American Academy Of Neurology ◽  
Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

scholarly journals Analyzing EEG of Quasi-Brain-Death Based on Dynamic Sample Entropy Measures

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Li Ni ◽  
Jianting Cao ◽  
Rubin Wang
Keyword(s):  
Brain Death ◽  
Real Time ◽  
Time Window ◽  
Approximate Entropy ◽  
Sample Entropy ◽  
Well Performance ◽  
Entropy Measures ◽  
Brain Death Determination ◽  
Death Determination ◽  
The Brain

To give a more definite criterion using electroencephalograph (EEG) approach on brain death determination is vital for both reducing the risks and preventing medical misdiagnosis. This paper presents several novel adaptive computable entropy methods based on approximate entropy (ApEn) and sample entropy (SampEn) to monitor the varying symptoms of patients and to determine the brain death. The proposed method is a dynamic extension of the standard ApEn and SampEn by introducing a shifted time window. The main advantages of the developed dynamic approximate entropy (DApEn) and dynamic sample entropy (DSampEn) are for real-time computation and practical use. Results from the analysis of 35 patients (63 recordings) show that the proposed methods can illustrate effectiveness and well performance in evaluating the brain consciousness states.

scholarly journals The effect of incorporating an arterial pH target during apnea test for brain death determination

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ibrahim Migdady ◽  
Moein Amin ◽  
Aaron Shoskes ◽  
Catherine Hassett ◽  
Sung-Min Cho ◽  
...  
Keyword(s):  
Brain Death ◽  
Cleveland Clinic ◽  
Apnea Test ◽  
Arterial Ph ◽  
Common Etiology ◽  
Brain Death Determination ◽  
Blood Gas Analyses ◽  
The Impact ◽  
Death Determination ◽  
Current Guidelines

Abstract Background Persistent apnea despite an adequate rise in arterial pressure of CO2 is an essential component of the criteria for brain death (BD) determination. Current guidelines vary regarding the utility of arterial pH changes during the apnea test (AT). We aimed to study the effect of incorporating an arterial pH target < 7.30 during the AT (in addition to the existing PaCO2 threshold) on brain death declarations. Methods We performed retrospective analysis of consecutive adult patients who were diagnosed with BD and underwent AT at the Cleveland Clinic over the last 10 years. Data regarding baseline and post-AT blood gas analyses were collected and analyzed. Results Ninety-eight patients underwent AT in the study period, which was positive in 89 (91%) and inconclusive in 9 (9%) patients. The mean age was 50 years old (standard deviation [SD] 16) and 54 (55%) were female. The most common etiology BD was hypoxic ischemic brain injury (HIBI) due to cardiac arrest (42%). Compared to those with positive AT, patients with inconclusive AT had a higher post-AT pH (7.24 vs 7.17, p = 0.01), lower PaO2 (47 vs 145, p < 0.01), and a lower PaCO2 (55 vs 73, p = 0.01). Among patients with a positive AT using PaCO2 threshold alone, the frequency of patients with post-AT pH < 7.30 was 95% (83/87). Conclusion Implementing a BD criteria requiring both arterial pH and PaCO2 thresholds reduced the total number of positive ATs; these inconclusive cases would have required longer duration of AT to reach both targets, repeated ATs, or ancillary studies to confirm BD. The impact of this on the overall number BD declarations requires further research.

The implementation of a protocol promoting the safe practice of brain death determination

2015 ◽  
Vol 30 (1) ◽  
pp. 107-110 ◽  
Author(s):  
Jonathan Cohen ◽  
Avraham Steinberg ◽  
Pierre Singer ◽  
Tamar Ashkenazi
Keyword(s):  
Brain Death ◽  
Safe Practice ◽  
Brain Death Determination ◽  
Death Determination
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