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Most persons know that an individual dies when the heart stops beating. Ancient records on medicine have also revealed the same idea. However, modern medicine and technology has blurred the line between life and death (Veatch 182). The case of the Jessica Santillan, the 17 year-old Mexican girl highlights this research. This girl had undergone two heart and lung transplants. Two weeks after the second transplant, this girl passed on. This came after the doctors announced that she was dead because her brain had “died.” They made the decision to remove her from the life support system. The case of Miss Santillan brings to the limelight on the issues of brain death and life support system. The enraged family plotted a legal case to investigate the medical ethics and conduct of the doctors. This essay focuses on brain death and the controversies that surround it especially the timing of removal from the life support system.
Brain death can refers to the irreversible termination of all activities of the brain (Ad Hoc Committee of the Harvard Medical School 3). This includes all the involuntary activities for example breathing that are very vital in life sustenance. Brain death can be cause by complete necrosis of the cerebral neurons due to lack of oxygen in the brain. In most jurisdictions, the death of the brain or the brain stem is used as a legal marker of death. After the brain dies, a person slips into unconsciousness.
History of Brain Death
In the 20th century, researchers began studying brain death, its causes, determination, and effects on the family, the medical fraternity, and society in general. In 1959, Mollaret and Goulon conducted a study on 23 patients who were hospitalized at Claude Benard Hospital in France. All these patients had a neurologic state and all of them died afterwards. Mollaret and Goulon termed this state as an “irreversible coma.”In 1968, an ad hoc committee was set up in Harvard School of Medicine to look into the irreversible coma. This committee opted to refer to death as the absence or total lack of brain functions and then they looked for ways of determining death. This committee was purely interested in futile medical care (Ad Hoc Committee of the Harvard Medical School 3). They also tried to determine when physicians could withdraw a patient from the life support systems. This committee recommended that the surgeons involved in organ transplants should not make the decision to withdraw a patient from the life support system.
In 1971, Chou and Mohandas researched on the vital part of the brain that if damaged results to the entire damage of the brain. They discovered that if the brain stem is injured, then the whole brain ceases to function. In 1976, neurologists in the United Kingdom said that if the brain stem of a person is dead then automatically the brain is dead and so is the person. By the beginning of 1980, many countries had accepted the fact that legal death occurs when the brain of an individual dies. The confirmation of brain death varies from country to country. Several factors help doctors to confirm the occurrence of brain death. Some of them include:
Brain Stem Reflexes
The shape of pupils can help a physician to detect brain death. Pupils that are oval, round or irregularly shaped are common in a person who has brain death.
This is when the eyes do not turn in a coordinated manner. In cases of brain death, the eyes do not turn in a coordinated and conjugate manner. This implies that there are no eye movements when the head moves (Sullivan, Debbie and Frank 37). This confirms that brain stem reflexes that coordinate ocular movements are very absent.
Motor and Sensory response of the face
The jaw and cornea reflexes do not occur when the brain dies. Corneal reflexes can be checked by using a swab that has a cotton tip. If a patient grimaces in pain when pressure is applied to the nail beds then that patient does not have a dead brain.
Tracheal and pharyngeal reflexes
A brain dead patient does not cough or respond to gags.
This is also known as loss of breathing. When the brain stem stops to function, a person’s breathing is also inhibited. This necessitates the use of ventilators to help the patient to sustain his or her breathing system (Sullivan et al 37).
According to the American Electroencephalographic Society, an eighteen or sixteen channel can be used to confirm brain death. This machine uses brain waves to determine brain death. A complete cessation of electrical activity for durations of 30 minutes as indicated by a flat line on the machine implies that the brain of the patient is dead (Ad Hoc Committee of the Harvard Medical School 3).
It is important for the physician to rule out certain symptoms for instance alcohol overdose, hypothermia and other intoxications resulting from drugs. Additionally, the subject must have had suffered from a disease that can result to brain death. It is common for spinal reflexes to persist even after brain death has occurred.
Origin and use of Artificial Life Support Systems
Until 1958, people were not aware of brain death. People just knew that a person died when the brain heart and lungs stopped to function. This is because their functions are easily observable by any person. Technology was then developed to sustain those activities irrespective of the death of the brain. This led to the designing of life support systems that help to maintain the functions of the lungs and heart.
The term “life support” means the equipment and drugs that are used to keep a patient alive in a health condition (Veatch 185). Patients that are put on life support usually have one or more body organ that is failing and thereby they need assistance to live. In most situations, the organs that fail and require support are the respiratory system, the renal or kidney system, the gastrointestinal system and finally the cardiovascular system. When brain death occurs, the patient is put on life support. This is aimed at reviving the other systems while giving the brain and the nervous system time to rejuvenate so that it can start to support various body functions (Sullivan et al 39).
Life support can be used in an appropriate or inappropriate manner. The appropriate method is to maintain the person for a period that is long enough so that they can return to the normal functions of life. In patients with diseases like kidney failure, the person can be put on a respiratory support system while the physician performs dialysis.
Life support can also be used in a very inappropriate manner. This is when physicians use it to maintain the body functions of a person past the point recovery. At this point, there are usually no signals of improvement and it is often referred to as “futile treatment.” In such cases, a patient‘s brain is dead. In addition to that, he or she has other failed systems and there are no signs of improvement. It is important to note that futile medical treatments can interfere with medicine, faith, and ethics of physicians, and family of a patient. As illustrated by the case of Miss Santillan, families play a great role in many cases of futile treatments since they fail to give the physicians the right decision. They leave the whole issue to the physicians and when they take action, they face legal cases. The indecisiveness of family makes the physicians to continue administering futile treatment because they fear liability. Most of the families who had subjected their family members to futile treatments stated that they were expecting recovery.
Medically, a patient who is put on life support systems should be alive. Nevertheless, life support systems can be used to sustain the body of a patient who has already been announced dead by the fact that his or her brain is dead. This system can maintain organs like the heart, liver, pancreas, and kidneys until the family arrives to decide on what to do with such vital organs. At this point, these systems are known as support rather than life support because they are not supporting any life.
Popular Misunderstandings about Brain Death
Family members and friends of a person who has suffered from brain death need clear and correct information on the situation. It is common for many people to think that because a patient has a heartbeat or is warm, they are being supported by the life support system. Some family members may think that the patient will recover after undergoing intensive treatment using the life support systems. The fact is that brain death is a permanent condition that cannot be reversed. People who have dead brains are not aware of their environment and therefore they do not think. These people cannot be able to communicate with others. Professionals in the field of medicine are also confused on issues concerning brain death and what should be done when it occurs. This is why most of them put the patient on life support system as they await for decisions from family members and friends.
Death is clearly defined by a brain dead person. This implies that the life support system can do very little in making the brain dead patient alive. Therefore, the family should accept the body of the patient or donate the organs that are functional to other patients.
Discontinuation of life support system to a patient whose brain is dead is very reasonable and justifiable. This person can be an organ donor and when the life support system is switched off, many resources are saved. Every day, many people get sick and medical resources are at times minimal. Discontinuing a person from the system means another bed for another patient. This can save the life of a patient who is critically ill and the support system can be of great help.
Continuation of life support for a brain dead patient prolongs the emotional suffering of friends and family members. If a patient has been clinically diagnosed as dead, then the family should be informed. The tests to confirm that the brain is dead should be conducted after duration of seven hours to remove the possibility of doubt and error. The clinical diagnosis of brain death should be carried out by physicians who are competent and they should use the most appropriate method should be used.
“Brain Dead” Organ Donor
In many countries where legal death is confirmed using brain death, the brain dead patient can become the organ donor. When a patient is on the life support system, organs as the kidney, heart, lungs and liver could be functioning well (Beecher 85). This gives organ transplantation a chance. In countries like Poland, if a patient is announced brain dead, this automatically marks the beginning of organ donation (Youngner, Seth, Claudia, Barbara, and Mark 2205). However, this depends on one condition, the consent of the family. Before the family makes a decision, the brain dead patient is kept on life support system to ensure that the other organs do not “die.”
Ethics surrounding the use of Life Support System
Many bioethicists say that discontinuing people like Miss Santillan from the life support system is tantamount to death. Discontinuation of the support system implies that the life that a person had has been lost or has been taken away. Some say that such an action is the same as committing murder. Other people argued that it would have had been in vain hooking a dead body to machines. This case raised contentious issues as to when, for how long the medical technology can be used to lengthen the life of brain dead people.
Medical ethicists argue that the use of technology to lengthen the life of brain-dead people when there is no certain recovery makes the patient to succumb into unnatural deaths that are more painful than the natural death. According to Callahan, the use of life support technologies has made the human race to think of death as a curable disease or as a postponable act (14). Latest life support technology has made every person on earth to think that all manner of deaths can be prevented by such developments. Some people argue that medical technologies should not burden patients by offering them futile treatment. Some should just be left to die naturally like the case of terminally ill patients.
Every person knows that the withdrawal of life support system causes death. This is what makes it not to be allowed because it is morally wrong. In legal situations, surrogate decision-makers should be able to choose the right time when life support should be stopped. The decision should be made on grounds that stopping has nothing to do with treatment but rather treatment was futile. People should always understand that there is a right to give up artificial life support systems and this is based on the patient’s responsibility and out of informed consent.
This itself is a right that that is protected by the U.S constitution and it is a under self-determination and personal liberties (Bernat 21). This right is also held by the common doctrine that that treating a patient without informed consent makes the tort of battery. This implies that when patients are not able to exercise their right to accept or refuse treatment, the surrogate decision-makers should take that responsibility on behalf of the patient. This should be in accordance to the patients’ prior expressions on the treatment. This means that a patient had made his or her own independent judgment in the best of his interest according to his or her own preferences that are at times unknown. Legal and ethical considerations that aid the fact that and end of life decision has to be made do not undermine the fact that removing artificial life support cause eventual death (Bernat 26). It is important to understand that death is a social act, natural and at times, it cannot be postponed especially when life support systems have to be withdrawn. People should agree that death is the end of life and that is it. Universally, we can only prolong life but we cannot do away with death.
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