There’s an old saying by Ben Franklin that goes: “in this world nothing can be said to be certain, except death and taxes.” This speaks to the inevitableness of death as a fact of life. Surprisingly, with something as inevitable as death, there is still a lot of talk about when exactly someone is “dead”. These problems concerning the definition of death come up often in cases concerning brain function and brain death.
Questions concerning the definitions of death are raised in the Forbes article titled “What Does ‘Dead’ Mean? The Debate Continues Some 50 Years After Harvard Defined Death.” The article highlights the main questions still surrounding brain death, such as “‘Is death defined in terms of the biological failure of the organism to maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment?’ ”. These questions raise a multitude of concerns, not limited to, but including organ transplantation. The concept of when someone is dead is crucial in organ transplantation, as a living person is clearly not capable of donating their vital organs. So, even if someone looks as if they have passed on, if they are technically still alive, their organs are not able to be donated.
The problem extends outside of the scientific community, pervading public thought as well. The Forbes article references how “the inaccurate use of ‘brain death’ has contributed to public misunderstanding of the neurological state.” Many people do not know the differences between distinctions such as a coma, persistent vegetative state, or brain death. This leads to many people misunderstanding crucial facts of what is and is not medically possible for their loved ones. For example, a coma is a state in which a patient is not awake and is also not aware of painful or verbal stimuli. Comas may also be reversible, meaning that the patient can recover. Comas are one of 3 criteria for declaring someone brain dead. An important distinction that leads to the diagnosis of brain death rather than coma is the fact that brain death is irreversible. Permanent vegetative states differ from brain death in that people in PVS do not need respirators to breathe for them. In some cases, PVS patients can show some sense of awareness or recovery of some function.
The problem concerning the definitions surrounding brain death, comas, etc. is in the communication between care providers and families. Care providers use language that is misleading and confusing. On the other end, families of patients are sometimes unsure of the exact reality of the situation they and their loved one is in. This leads to the question of how do we bridge this gap between the scientific community and the confused public. I believe this is best done through bioethicists. Bioethicists fill the crucial gap and allow the information to be relayed in the best way possible. Bioethicists would be able to step in and advise the family on their options and inform them even more clearly on the reality of the predicament they are facing. Bioethicists can also provide a buffer between the family and care providers when it comes to disagreements in care for the individual in question.
Whatever path is taken to accomplish it, it is clear that the area of medicine surrounding neurological states must work to be more compassionate to families, while also maintaining the importance of truth and clarity.
Sources and Links:
Forbes Article “What Does ‘Death’ Mean? The Debate Continues Some 50 Years After Harvard Defined Death.”:
Jefferson, Robin Seaton. “What Does ‘Dead’ Mean? The Debate Continues Some 50 Years After Harvard Defined Death.” Forbes, Forbes Magazine, 17 Jan. 2019, www.forbes.com/sites/robinseatonjefferson/2019/01/16/what-does-dead-mean-the-debate-continues-some-50-years-after-harvard-defined-death/#5d5390694a22.
Powell, T. “Brain Death: What Health Professionals Should Know.” American Journal of Critical Care, vol. 23, no. 3, 2014, pp. 263–266., doi:10.4037/ajcc2014721.
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