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Is "brain death" a grave misunderstanding?
"But Daaarling, where are you going? ..." |
Why wait until death for organ donation, asks Canadian bioethicist
"More erosion of the dead donor rule in the latest issue of the
Cambridge Journal of Healthcare Ethics.
To the public, it probably seems axiomatic that vital organs should not
removed until the donor is dead. But an increasing number of
bioethicists are questioning this, especially in the light of grave
organ shortages.
Walter Glennon, of the
University of Calgary, breathes new life into
the Epicurean argument that death does not matter: 'where death is, I am
not; and where I am, death is not. So death is not to be feared, since
it is nothing.'
Glennon examines the case of a severely brain-damaged patient. He
argues: 'What matters is not that the donor is or is not dead, or when
death is declared, but that the donor or a surrogate consents, that the
donor has an irreversible condition with no hope of meaningful recovery,
that procurement does not cause the donor to experience pain and
suffering, and that the donor's intention is realized in a successful
transplant.'
Paradoxically, he argues that doctors or relatives could actually be harming a live but brain-damaged patient if they do
not
allow organ donation. Harm, he says, is thwarting a person's interests.
If a patient wanted to donate his organs, he would be harmed if they were
not donated, or if they were unsuitable for donation because doctors
waited for them to die first. 'We should reject the view that organ
donors are beyond harm only after they have been declared dead and that
they are harmed if organ procurement occurs before this time.'
If this is true, though, why can't people donate organs when they are
well - perhaps as a way of committing suicide? Highly unlikely,
Glennon
responds. Such people would be irrational and hence not capable of the
fundamental criterion, acting autonomously. 'It is usually the
experience of an irreversible, hopeless condition that makes a person
conclude that life is no longer worth living.'"
Source: Bioedge.org
Questions hover over "brain death", says US bioethicist
"The leading opponent of defining death as the death of the brain is
D. Alan Shewmon, a professor of paediatric neurology at UCLA Medical
Center. In the
latest issue of the Journal of Medicine and Philosophy, an American bioethicist,
E. Christian Brugger, defends him against a white paper written by the President's Council on Bioethics (PCB) in 2008.
Although the PCB was famed for its conservatism on many controversial
bioethical issues and its sceptical attitude toward utilitarian
reasoning, it defended the conventional standards for declaring that a
patient is 'brain dead'. These are called the 'Harvard Criteria', after a
1983 paper written at
Harvard Medical School. In summary, these are:
unreceptivity and unresponsiveness, no movement or breathing, and no
reflexes. Death was the moment 'at which the body's physiological system
ceases to constitute an integrated whole'. In other words, because the
brain is the integrator of all the body's systems, we know that death
has occurred when these systems no longer work together.
Shewmon, however, pointed out that there are many cases in which the
bodies of 'brain dead' patients - which fit the Harvard criteria - are
still functioning as a whole. There have been well-documented cases of
patients assimilating nutrients, fighting infections, maintaining
homeostasis and body temperature, and even gestating fetuses and
undergoing puberty. So, even if the brain were dead, the patients'
bodies were still functioning as an integrated whole. In one astonishing
case, a 'brain-dead' four-year-old boy lived on for 20 more years. He
fought off serious infections and went through puberty before succumbing
to pneumonia. An autopsy showed that his brain and brain stem had
calcified; there were no neurons at all.
Brugger's article is too long to give an adequate summary of his
doubts about the PCB's white paper. But he concludes that it failed to
dismiss
Shewmon's belief that the integrative capacity of a body is not
located in the brain but is a property of the whole organism. If this is
true, 'brain death' may not be the death of a person, only the death of
an organ. 'Until these reasonable doubts are removed,' says Brugger, 'an ethically justified caution requires that we should treat them as
living human beings.'"
Source: Bioedge.org
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