marek vácha 2011. once a central ritual of social and religious life, death has been privatized,...

Marek Vácha2011

Once a central ritual of social and religious life, death has been privatized, desacralized, hidden behind institutional walls, and implicitly made taboo.

(Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press, p.67)

Nedherlands, around 1460

The Criterion of Death

serious controversies over formally defining death began with the invention of the positive pressure mechanical ventilator in the 1950s. prior to the development of mechanical ventilators,

brain injuries severe enough to induce apnea quickly progressed to cardiac arrest from hypoxemia.

before the 1950s, the loss of spontaneous breathing ond heartbeat ("vital function") were perfect predictors of death because the functioning of the brain and of all other organs ceased rapidly and nearly simultaneously thereafter, producing a unitary death phenomenon.

with the advent of mechanical support of ventilation, the previous unitary determination of death became ambiguous

now patients were encountered in whom some vital organ functions (brain) had ceased totally and irreversibly, while other vital organ functions (such as ventilation and circulation) could be maintained, albeit mechanically.

they resembled dead patients in that they could not move or breathe, were utterly unresponsive to any stimuli, ad had lost brain stem reflex activity.

but they also resembled living patients in that they had maintained heartbeat, circulation and intact visceral organ functioning.

Were these unfortunate patients in fact alive or dead?

Bernat, J.L., The Whole-Brain Concept of Death Remains Optimum Public Policy. Journal of Law, Medicine and Ethics 34, no. I (2006):35-43.

Death

a higher vertebrate organism can reside in only one of two states, slive or dead: no organism can be in both states or in neither simply because we currently lack the technical

ability to always accurately identigy an organism´s state oes not necessitate postulating an in-between state.

death must be an event and not a process. if there are only two exclusive underlying states of

an organism, the transition from one state to the other, at least in theory, must be sudden and instantaneous, because of the absence of an intervening state.

Death

death is irreversible by its nature, if the event of death were

reversible it would not be death but rather part of the process of dying that was interrupted and reversed

The Definition of Death

by "death" it is not required the cesation of functioning of every cell in the body, because some integument cells that require

little oxygen or blood flow continue to function temporarily after death is customarily declared

"death" is not the cessation of heartbeat and respiration

The Definition of Death

Rober Veatch: "the irreversible loss of that which is considered to

be essentially significant to the nature of man" his project attempted not to reject brain death, but

to refine the intuitive thinking underlying the brain death concept by emphasizing that it was the cerebral cortex that acounted in a brain death concept and not the more primitive integrating brain structures

BUT that a higher-brain formulation of death would count PVS patients as dead...

...despite their progound and tragic disability. All societies, cultures, and laws consider PVS patients as alive

The Criterion of Death

the whole-brain formulation USA and most parts of the world

cessation of all brain clinical functions including those of the cerebral hemispheres, diencephalon (thalamus and hypothalamus) and brain stem

it does not require the loss og all neuronal actibities. Some neurons may strvive and contribute to recordable brain activities by an electroencephalogram, f.e. but not to clinical functions

the higher-brain formulation, popular in the academy but accepted in no jursdictions anywhere

the brain stem formulation accepted in the United Kingdom

the cardiac option some religious communities

The Test of Death

Brain death tests must be used to determine death ony in the unusual case in which a patient´s ventilation is being supported

traditional examinations for death, in addition to testing for heartbeat and breathing, always included tests for responsiveness and pupillary reflexes that directly measure brain function


how can we measure that the brain has been irreversibly destroyed (that it has "died")?

ought we as a society or as individuals to treat an individual with a dead brain as a dead person? this question is clearly not something about which

the neurological community can claim expertise this is a religious, philosophical, ethical or public

policy question, not one of neurological science

"In the current practice of organ donation after cardiac death (formerly known as non -heart-beating organ donation), I and others raised the question of whether the organ donor patients were truly dead after only five minutes of asystole. The five-minute rule was accepted by the Instutue of Medicine as the point at which death could be declared and the organs procured. Ours was a biologically valid criticism because, at least in theory, some such patients could be resusucitated after five minutes of asystole and still retain measurable brain function. If that was true, they were not yet dead at that point so their death declaraltion was premature.

But thereafter I changed my position to support programs of organ donation after cardiac death. I decided that it was justified to accept a compromise on this biological point when I realized that donor patients, if not already dead at five minutes of asysstole, were incipiently and irreversibly dying because they could not auto-resuscitate and no one would attempt their resuscitation. Because their loss of circulatory and respiratory functions was permanent if not yet irreversible, there would be no difference whatsoever in their outcomes if their death were declared after five minutes of asystole or after 60 minutes of asystole."


A Jewish Approach

where there is breath, there is life

Japaneses, influenced by Buddhist and Shinto belief system, see the presence of life in the whole body, not just in the brain

Definition of Death

Historically, death was considered to occur when the soul left the body, which might be determined by the cessation of breath and heartbeat.

Regardless of religious persuasion the traditional definition of death was cardiopulmonary – when the heart and lungs ceased to function. this definizion became increasingly problematic with the development of medical technology that enaabled physicians to prolong heartbeat and respiration after a person´s brain was no longer capable of doing so.

Definition of Death

Advances in organ transplantation also fueled the controversis, because of increased interest in cadaveric organ procurement

(Pierce, J., Randels, G., (2010) Contemporary Bioethics. A Reader With Cases. Oxford University Press, Oxford and New York, p. 117)

Definition of Death

Acceptance is not universal. Japan, for example permits its citizens to choose between the brain standard and the traditional cardiopulmonary model

In USA, New Jersey state law provides an exemption frm the vrain standard in order to accommodate religious objections.

(Pierce, J., Randels, G., (2010) Contemporary Bioethics. A Reader With Cases. Oxford University Press, Oxford and New York, p. 117)

The day will come when my body will lie upon a white sheet,

Tucked neatly under the four corners of a mattress, located in a hospital busily occupied with the living and the dying . At a certain moment a doctor will determine that my brain has ceased to function and that for all intents and purposes my life has stopped.

“When that happens, do not attempt to install artificial life into my body by the use of a machine and don’t call this my deathbed. Let it be called the bed of life and let my body be taken from it to help others lead fuller lives.

Give my sight to the man who has never seen a sunrise, a baby’s face or love in the eyes of a woman. Give my heart to the person who has nothing but endless days of pain. Give my blood to the teenager who was pulled from the wreckage of his car so that he may live to see his grandchildren play. Give my kidneys to a person who depends upon a machine to exist from week to week. Take my bones. Every muscle fiber, every nerve and try to find a way to make a crippled child walk. Explore every corner of my brain, take my cells, if necessary, and let them grow so that someday a speechless boy will shout at the crack of a baseball bat or a deaf girl will hear the sound of rain against her window.

Burn the rest and scatter the ashes to the wind to help the flowers grow.

If you must bury something, bury my faults, my weaknesses and my prejudices against my fellow man. Give my sins to the Devil, give my Soul to God.

If by chance you wish to remember

me, do it with a kind deed or a word to someone who needs you. If you do all I have asked, I will live forever.

40 000 - 10 000 yrs ago

Death does not exists

Once a central ritual of social and religious life, death has been privatized, desacralized, hidden behind institutional walls, and implicitly made taboo.

(Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press, p.67)

Preparation for the Death

The Catholic sacrament of Anointing of the Sick, formerly known as Last Rites or Extreme Unction, is a ritual of healing appropriate not only for physical but also for mental and spiritual sickness.

All Soul´s Day 02/11 - 08/11

Human Society needs Rites...

Easter

Sacrament of Initiation

Hierarchy

Feast of Corpus Christi

marek vácha 2011. once a central ritual of social and religious life, death has been privatized,...

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