Transcript Consciousness, Dreaming, and Hypnosis

Brain Death
Courtney Bartel,
Vishruth Reddy
What is Brain Death?
 Brain Death is defined as irreversible
unconsciousness with complete loss of brain
function, although the heartbeat may
continue; the cessation of detectable electric
activity in the cerebral cortex.
 Not to be confused with a persistent,
vegetative state.
Demonstrating Brain Death
 Demonstration of brain death is the accepted criterion for
establishing the fact and time of death. Factors in diagnosing
brain death include:
 Irreversible cessation of brain function as demonstrated by
fixed and dilated pupils, lack of eye movement, absence of
respiratory reflexes (apnea), and unresponsiveness to painful
stimuli.
 In addition, there should be evidence that the patient has
experienced a disease or injury that could cause brain death.
 A final determination of brain death must involve
demonstration of the total lack of electrical activity in the brain
by two electroencephalographs (EEGs) taken twelve to
twenty-four hours apart.
 Finally, the physician must rule out the possibilities of
hypothermia or drug toxicities, the symptoms of which may
mimic brain death. (Some central nervous system functions
such as spinal reflexes that can result in movement of the
limbs or trunk may persist in brain death.)
Defining Death
 For many centuries death has been thought to occur when the vital
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functions cease—breathing and circulation (as evidenced by the
beating of the heart). This view has been challenged, however, as
medical advances have made it possible to sustain respiration and
cardiac functioning through mechanical means.
Thus, more recently, the concept of brain death has gained
acceptance. In this view, the irreversible loss of brain activity is the
sign that death has occurred.
French neurologists were the first to describe brain death in 1958.
Patients with coma depasse were unresponsive to external stimuli
and unable to maintain homeostasis.
In 1968 the "Harvard criteria" for determining brain death were
published in the Journal of the American Medical Association,
under the title of "A Definition of Irreversible Coma.“
A majority of the states in the United States had accepted brain
death as an essential sign of death by the late 1980s.
Defining Brain Death
 Brain death is not medically or legally equivalent to severe
vegetative state. In a severe vegetative state, the cerebral
cortex, the center of cognitive functions including consciousness
and intelligence, may be dead while the brain stem, which
controls basic life support functions such as respiration, is still
functioning.
 Death is equivalent to brain stem death. The brain stem, which is
less sensitive to anoxia (loss of adequate oxygen) than the
cerebrum, dies from cessation of circulation for periods
exceeding three to four minutes or from intracranial catastrophe,
such as a violent accident.
 Even the concept of brain death has been challenged in recent
years, because a person can lose all capacity for higher mental
functioning while lower-brain functions, such as spontaneous
respiration, continue.
 For this reason, some authorities now argue that death should be
considered the loss of the capacity for consciousness or social
interaction. The sign of death, according to this view, is the
absence of activity in the higher centers of the brain, principally
the neocortex.
Defining Brain Death
 Difficulties with ethics and decision making may arise if it is
not made clear to the family that brain stem death is
equivalent to death.
 According to research conducted by Jacqueline Sullivan and
colleagues in 1999 at Thomas Jefferson University Hospital,
roughly one-third to one-half of physicians and nurses
surveyed do not adequately explain to relatives that brain
dead patients are, in fact, dead.
 Unless medical personnel provide family members with
information that all cognitive and life support functions have
irreversibly stopped, the family may harbor false hopes for the
loved one's recovery.
 The heartbeat may continue or the patient may be on a
respirator (often inaccurately called "life support") to maintain
vital organs because brain dead individuals who were
otherwise healthy
Ethical Questions
 Who shall decide the criteria for death—physicians, legislatures,
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or each person for him- or herself?
Is advancement of the moment of death by cutting off artificial
support morally and legally permissible?
Do people have the right to demand that extraordinary measures
be stopped so that they may die in peace?
Can the next of kin or a legal guardian act for the comatose dying
person under such circumstances?
All these questions have acquired new urgency with the advent
of human tissue transplantation. The need for organs must be
weighed against the rights of the dying donor.
End Of Life Issues
 Money Spent of End-of-life Care
 Organ Donation
 Right to Die
 Living Wills
Terri Schiavo Case
 NOT BRAIN DEATH
 Terri was in a Persistent Vegetative State
(PVS) for 15 yrs
 PVS is wakefulness without awareness
 Collapsed in 1990-respiratory and cardiac
arrest caused brain damage
 Her husband, Michael, fought for 7 years
to have her feeding tube removed. Her
parents were opposed to the removal.
 Terri had no living will.
 Years of court battle created a high profile case.
 Congress actually passed a bill to get federal
jurisdiction over the case.
 President Bush flew into DC to sign the bill at 1am.
 Ultimately proved to be ineffective
 Terri’s feeding tube was ultimately removed in
March 2005 and she died 2 days later.
 Autopsy reports showed she would have never
recovered (Left, Normal Brain Right, Terri’s Brain)
Ethical Questions
 Who shall decide the criteria for death—physicians,
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legislatures, or each person for him- or herself?
Is advancement of the moment of death by cutting
off artificial support morally and legally permissible?
Do people have the right to demand that
extraordinary measures be stopped so that they
may die in peace?
Can the next of kin or a legal guardian act for the
comatose dying person under such circumstances?
All these questions have acquired new urgency with
the advent of human tissue transplantation. The
need for organs must be weighed against the rights
of the dying donor.
End Of Life Issues
 Money Spent of End-of-life Care
 Organ Donation
 Right to Die
 Living Wills
Works Consulted
 Microsoft® Encarta® Encyclopedia 2002.
 http://www.deathreference.com/BlCe/Brain-Death.html