1. Technology and Death Policy Redefining Death through technological and social changes Marra DeJesus, Nino Rivera and Juan Andujar

2.  Before 1970s:  Instant permanent end of  Respiration System  Circulation systems  Late 1970s:  Brain is dead  Shit down of Cardiorespiratory system  End of all the vital functions of organism Advances in Medical Technology allows a machine to control the Cardiorespiratory system Defining Death

3.  Death-related policy issues  Treatment reduction  Physician- assisted suicide Personally, how do you define death of a human? Public and Professional Debate

4. 1. Theoretical interpretation of what death means through medical technology  Traditional death: permanent end of cardiopulmonary functions (heart and lungs)  Technology can extend these functions  Life-sustaining technologies 2.Clinical Tests that determine if a patient is dead  Diagnostic technology: measures the existence and absence of specific types of brain activity in specific areas Two Critical Dimensions

5.  Brain  Controls functions of the whole body  Cannot restore neural cells once the whole brain has been seriously injured  Indirect:  Shut down of lungs and heart  Breathing continued with respirators and ventilators  Machine cannot restore consciousness or other higher brain functions Why is the Brain a direct link to death?

6.  Brain starts to die early in life  Unneeded neurons eliminated  Aging process  Gradual loss of sensory capacities  Visual activity declines between ages 20 and 50 Brain Death

7.  Decline in Neuron density in many regions on brain  Hippocampus  Subcortial  Cerebellum  Brain shrinks 5-10% per dance in normal alge  5% by 70  10% by 80  20% by 90 Ageing process

8.  Neurodegenerative  Diseases caused by aging  Alzheimer’s  Parkinson’s)  Neurotoxin  Slow down functions of neurons  Collection of these:  High blood pressure  Shrink size of brain had been found to shrink the size of the brain in elderly persons  Decline in hormonal activity  Emphasis placed on estrogen  Alcohol and drug abuse=brain cell death at all ages Ageing: Neurodegenerative and neurotoxin

9.  Concept:  Not gradual loss process of cell death  Ending of brain activity and function measure by specific tests  EEG Diagnostics  Measures impulses  Mental (cognitive) death can occur even though human organism is still alive  Observers oppose and/or in acknowledging the idea of brain death Brain Death

10.  1968:  Concern rose about how to treat respirators that supported patients  Led to creation of “Harvard Criteria for brain death  Focuses on  Unreceptively and unresponsiveness  Lack of spontaneous movements or breathing  Lack of reflexes Brain Death (cont.)

12.  Showing no visible electrical activity in cerebral corex  Recommended as test  Before life support systems can be stopped, tests repeated for at least 24 hours  Must show no change in death brain activity EEG Tests

13.  Growing needs  Organ(s) must be whole and unbroken  Desirable donors  Healthy  Person considered dead until removal of organs Emergency Organ Transplants

14.  Uniform Definition of Death Act  An individual who has sustained either  irreversible cessation of circulatory and respiratory or  irreversible cessation of all functions of the entire brain, including the brain stem, is dead  A determination of death must be made in accordance wit accepted medical standards Medical and Law

15. Redefining Brain Death  McMahan (1998) writes that brain death can be understood as: (1) The irreversible cessation of the integrated functioning in the organism as a whole; and (2) the irreversible capacity for consciousness and mental activity.  Singer (1995) also writes that brain death was not accepted because of it’s functions, but because of it’s association with consciousness and personality.

16. Redefining Brain Death  Veatch (1993) argues that whole-brain definition of death has become so complicated that it could hardly be referring to the death of the whole brain.  Whole-brain death also assumes that the brain is the most important organ whose functions cannot be replaced.

17. Redefining Brain Death  One problem with a whole-brain death definition is that the two essential capacities of the brain are in different parts of the brain: the cerebral cortex and the brain stem.  Loss of either capacities is sufficient for life – only the loss of both is sufficient for death.

18. Brain Imaging Techniques  Until recently research on the brain structure was based largely on post-mortem examinations of the brains of normal persons and those individuals who suffered from mental disorders.  X-rays, radioactive tracers, and radio waves combined with rapid advances in computerization have allowed for safe investigation of the brain.

19. Brain Imaging Techniques  Some of these imaging techniques are:  Computerized Axial Tomography (CAT)  Dynamic Computed Tomography (DCT)  Echo Planar MRI (EPI)  Magneto encephalograph (MEG)

20. Brain Imaging Techniques  For Singer (1995) these advances in the knowledge of the brain has “Pushed aside” a powerful reason for continuing to treat patients in persisted vegetative state as alive.

21.  Coming Back to the Brain: 2 parts  Cerebral Cortex –responsible for Consciousness, aka (life as we know it)  *Once damaged, irreversible. (Alzheimer's)  Brain Stem-Responsible for body functions(lungs, heart)  (artificially replaced by technology)  Definition of Brain Dead – Death of both the cerebral cortex and brain stem. (Just Before) Issues Redefining Death

22. Controversy between Advanced Alzheimer's Patients.  Economic Pressures(insurance costs – don’t know whether to pay)  Family Pressures(cannot let go)  Same applies for dementia patients  These cases also involve full death of cerebral cortex How to we find a solution? Issues Redefining Death If Brain-death is the definition, should these patients be considered ‘dead’?

23.  (Cerebral Cortex) death focuses on the end of personhood and rather than the death of the organism(brain stem). To focus on cerebral cortex death as the meaning of death would be saying that; the loss of ones consciousness is the end of their life. Obviously Not accepted in families, questioned by insurance providers for patients. Issues Redefining Death  Remember

24.  Some suggest returning to cardiorespiratory death “would eliminate the objections some groups with brain death, and would serve as a common denominator”(pg 23-24)  We must Emphasize.. Whether whole, or cerebral death, it offers no benefit for the dead person, but rather for the family, society, and potential recipients of organs. Both harm and benefit only applies to the living. It must be a decision of public policy, not medical/technological one. Plausible solution – why have only 1 definition of death Plausible Solutions to defining Death

25.  Should there be a definition(s) based on ones culture, religion, or philosophical beliefs?  By family? What ever it is: the definition(s) will always be an issue of public policy. The difficulty of letting go, the false hope for a miracle, and confusion of values resulting from new technology cause many to refuse to authorize unplugging the artificial life – support machines. Plausible Solutions to defining Death

26.  What we do know for sure is that… “Our very conception of what it means to be human is challenged by these rapid advances in medical technology.”(pg 24) And… “Solving problems by redefinition rarely works, and this case [brain death] was no exception.”(pg 24) What we do know about Humans

27. Citation  From Mortality, volume 6, number 2, July 2001, pp. 191-202. Copyright © 2001by Robert Blank.