Tuesday, 2 April 2013

Liverpool Care Pathway - Redefining Death

Medical ethics is beginning to scrape the bottom of the barrel. There has been previous mention in these pages of the descent into that darkness into which medical ethics is sinking.
"How long will it take before modern medical practice recognizes permanent unconsciousness as death?"
There are those who may doubt the extent of that descent and even the slippery slope upon which we all stand.
"If a specific patient and his or her proxies are all in agreement that permanent unconsciousness can be certified as death, then the doctor who is called upon to declare death will merely have to determine scientifically that there is no chance that consciousness will ever return to this body."
This is James Leonard Park from the reputable University of Minnesota -



    Organ transplants are only permitted when the donor is dead.
Living donors are only permitted to donate paired organs,
such as a kidney or a lung, where the donor can survive with just one.
Also living donors can donate fluids and tissues that will regenerate,
such as blood , bone marrow, & parts of livers.
All other donations are from cadavers
donors who are dead.

    However, the definition of death is open and flexible, at least to some degree.
Death might be closer to a process than an instant.
And when we are considering organ-transplantation,
it is especially important to have the organs as alive as possible,
so that the organs can resume their functions in the body of the recipient.

    Death must be declared before any cutting and harvesting begins.
Otherwise, the transplant surgeons might be accused of causing death
by removing vital organs.

    And the concepts of death must be acceptable to people who might donate organs.
If there is too-subtle a difference between being alive and being dead,
then those who must approve donations will have qualms and doubts. 


The dead-donor rule should continue to be observed in transplant medical practice.
But the definition of death can advance over the centuries,
as science develops more precise tests of brain function.

Progressively, we will accept organs from the brain-dead,
from former persons who are permanently unconscious,
from former persons who are in persistent vegetative state,
and from patients who have lost their personhood to Alzheimer's disease.

Medical ethics is redefining death as a condition of 'permanent unconsciousness'.
"This article also addresses legal aspects of the debate over whether to expand the definition of brain death to include permanent unconsciousness."
This is PubMed -

 1999 May;17(2):295.

Brain death.


Cornell Law School, Ithaca, New York 14853-4901, USA. bersford@law.mail.cornell.edu


Current law in the United States authorizes physicians to diagnose brain death by applying generally accepted neurologic criteria for determining loss of function of the entire brain. This article offers a medical-legal perspective on problems that may arise with respect to the determination of brain death. These include the possibility of diagnostic error, conceptual disagreements that may constrain the use of neurologic criteria to diagnose death, and the conflation of brain death and loss of consciousness. This article also addresses legal aspects of the debate over whether to expand the definition of brain death to include permanent unconsciousness. Although existing laws draw a clear distinction between brain death and the persistent vegetative state, many courts have authorized removal of life support from individuals whose unconsciousness is believed to be permanent on proof that removal accords with preferences expressed before sentience was lost.
[PubMed - indexed for MEDLINE]

Ellen Kappy Suckiel writes in the Journal of Medicine and Philosophy on -

'Death and Benefit in the Permanently Unconscious Patient: A Justification of Euthanasia'
(J Med Philos (1978) 3(1): 38-52)
Suckiel discusses the ‘value of life and the viability of its continuation’; the characterisation of the criteria for death and how this has been ‘insufficiently distinguished from the valuational question about the warrant for preserving an individual’s life’; and ‘whether, in the case of certain sorts of patients, it is morally permissible to cease to preserve, or to terminate, their lives’.

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