How do you Define Death?

Define Death
The definition of death has undergone a revolutionary change over the past few years. This is basically due to the technological advances in the practice of medicine at the hospitals. Today we have machines like the ventilators for respiratory support, dialysis machines for kidneys, the heart lung machine for cardiovascular support etc which have enabled doctors to keep the vital organs like the heart, lung and kidneys alive and functioning at the molecular level. In such a situation when do we say that 'life' has gone or that the person is dead? Well, the answer is not easy now! It has brought several legal, ethical and moral issues to the fore with which doctors, lawyers, administrators and policy makers are still grappling with. However a sort of consensus has recently emerged over the exact medical definition of death by doctors and others concerned, though several other related issues remain to be tackled.

Doctors have traditionally determined death by examining the persons for the presence of breathing, heartbeat and the light reflex of the pupil in the eye. However we now know that the essential feature of life is 'consciousness' which in turn is dependent on brain function. If the body cannot maintain itself and can function only through mechanical means, the essential feature of human life is gone. The process of death occurs at different levels from the organism to the organ and at the cellular and sub cellular levels. Death does not occur at a single moment of time. It occurs gradually, though there may be a moment when the 'spark of life' departs from the body!

Life and death are two separate states. A person is either alive or dead at any given point of time and not both. The determination of death rests on the premise of 'reversibility'. If a person who had suffered an episode of a 'Heart attack' with brief cessation of breathing and heartbeat recovers, then by convention that person was never dead. The doctors have not resurrected him but only resuscitated him. The person can be said to have had a near death experience and not an after death experience. The Harvard Medical School Committee has developed a definition of 'death' in 1968 which is widely followed. According to this definition of death, a person is declared as 'brain dead' when there is irreversible cessation of the functioning of the 'whole brain' as evidenced by a flat electroencephalogram(EEG), non reacting pupils, loss of consciousness(coma), lack of spontaneous movements etc. The most important criterion is the total lack of electrical activity in the whole brain as demonstrated by a flat EEG.

The legal declaration of 'death' has several legal aspects. There has to be a legal standard for determining 'death' which should take into account the current medical knowledge and practice. It should be updated periodically in line with the expanding medical knowledge. The law should prescribe a time period for evaluation to determine that 'death' had indeed taken place, as per the current definition. The opinion of more than one physician has to be taken into consideration. The declaration of death has major implications. The immediate consequence would be 'disconnecting' the person from 'Organ' supporting equipment and terminating the 'vegetative state' much to the relief of all concerned. The other vital issue concerns the 'Harvesting' of organs from the body for donation. If the dead person had authorized in writing while alive that he or she wishes to donate certain specified organs after death, a medical transplant team can immediately move in and initiate the harvesting process. The consent forms may be signed by someone with the power of attorney for the patient. If the wishes of the dead person are unclear, the hospital staff should discuss the options with the family members. The wishes of the surviving family members should always be respected. The organs should never be removed without the consent of the nearest surviving family members.

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Author: Dr. Pilli Samuel Rajkumar, MD (Hyderabad, India)

Useful external resources

Definition of Death in UK

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Edited by: Rajesh Bihani ( Find me on Google+ )

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