Monday, January 13, 2014
Definitions of Death (due Sun 19Jan14)
After reading chapter 1 of Barry, which definition of death do you find most persuasive? Gently respond to 1-2 (or more!) classmates' postings. Point out strengths and weaknesses of their positions. Use examples from the news or your own experience if possible to illustrate your point.
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The definition of death that I find most persuasive is the "whole brain death" definition. Without a functioning brain, a person would need artificial or mechanical ventilation for a period of time until the heart stops beating. A person would be in a state to where they would begin to have outward signs of death, like tissue breakdown, as well as inward signs like liquifying organs. The brain is responsible for producing the hormones needed to sustain systemic function of the body's organs. When brain death occurs this is not happening, the body will not accept nutrition, even with a feeding tube in a person who is pronounced brain dead. An example of this in the news is 13 year old Jahi McMath who had an outpatient procedure performed in a hospital in California in Dec 2013. She had post op complications and suffered a cardiac arrest. She was resuscitated to a point where her heart began to beat however she did not regain any activity in her cerebellum or brain stem. According to the UDDA or Uniform Determination of Death Act, Jahi McMath meets all criteria and legal standard for brain death- cessation of all functions of the cerebellum and brain stem. Her mother, however, did not permit Jahi to be removed from the ventilator because she believes her daughter is still alive because her heart is still beating. If Jahi were removed from the ventilator her heart would cease to beat shortly thereafter.
ReplyDeleteSo, do you think that Jahi's mother is keeping her alive because she is not ready to admit to herself that her daughter is dead?
DeleteDestiny, Jahi's mother has stated she is praying for a miracle. On the other hand Jahi's uncle has stated that the 250,000 malpractice cap in CA is "chump change." This leads me to believe his motives are different from Jahi's mom. Due to HIPPA privacy laws, unless the ending of this plays out in court we will never know Children's Hospitals side of the story. I have heard rumors, but nothing concrete concerning post op care that led up to her hemorrhage.
DeleteThe definition of death that I find most persuasive is the "higher brain death" definition. If the higher brain is dead then the person can still be able to breathe and remain "alive" physically, but how many people would say they would be ok with this being there way of life? No one would want to chose to "live" the rest of their days laying in a hospital bed not being able to eat food normally, not being able to get up and go to the bathroom on their own, not being able to walk outside, ect. Once the higher brain is dead, the person is unable to enter consciousness again. Many hold hope that since the brainstem is still alive and the body can still function, that a "miracle" could happen. The good thing about seeing a person as dead once the higher brain is dead, is that the rest of the organs can be donated to others. Essentially that person will "live" on as many others. An example of this is the well known Terri Schiavo, as mentioned in the text. I do not know anyone that would want to remain "alive" and in that state of vegetation. I do not view that as being "alive" that is merely existing.
ReplyDeleteI agree that there are many people who would not want to live out their last days simply existing, unaware that they are actually still 'alive'.
DeleteI agree that no one would want to live out their life in a vegetative state. However, by using the higher-brain definition of death, Sunny von Bulow, mentioned in our book, is technically dead even though she can breath on her own and her eyes occasionally open and she shows sleep-wake sequences. By removing Sunny von Bulow's feeding tube, she would become malnourished and eventually die of malnutrition if using the heart-lung or whole-brain definition of death. To be a family member of someone who occasionally opens their eyes but is in an irreversible coma, removing the feeding tube could seem as if you are killing them, depending on the family member's definitions of death. Terri Schavio's husband obviously believed in the higher-brain definition of death while her family believed that because she was able to breath on her own and her heart was still functioning properly, she was still alive and her husband killed her by removing her feeding tube. If I was faced with the decision, I could not remove a source of nutrition and wait (possibly weeks) for their body to become malnourished so they stop breathing and their heart stops beating.
DeleteI agree with Destiny that the most persuasive definition of death is the "higher-brain" formulation. Although most people would traditionally define death as when a person's heart stops beating I believe this is not truly living if you are not conscious of it. The most persuasive part of the definition for me is that the cerebral cortex no longer functions, meaning the person does not even know that they are alive. The cortex of the brain controls functions such as thought and action, but does not affect respiration or circulation. This means a person cannot think or move despite their continuing body functions. So is this really living? I do not believe it is and I believe there are many people that would also be against spending their lives in a bed actually unaware they are there.
ReplyDeleteI completely agree. I know that I wouldn't want that for myself.
DeleteI agree completely, Abby. Those people are no longer of this world. Whatever it is that made them who they were is gone. And allowing the bodies of these people to be sustained is almost like housing an interactive cemetery.
DeleteI agree as well. When your personality goes and you do not know who you are then you are not living and you are just another biological organism.
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ReplyDeleteThe definition of death that I find the most persuasive is the “higher brain death” definition. To me, a person who has received severe trauma to their brain and is unable to respond to things and be aware of things around them, or aren’t able to breathe and/or eat on their own completely aren’t really at a true state of being alive. One might be living on a ventilator and/or being fed by tubes but it is not a way of life that a lot of people would want. As hard as it would be to make the decision on what to do, I believe that at this point a person could be called “dead,” and that while their organs are still viable and could be used (if that is their wishes) then I believe that efforts should be made to do so. If someone isn’t consciously aware of what is going on around them then how can that be called life. I struggled a bit with trying to decide which definition persuaded me the most, higher brain death or whole brain death. When I finally decided that if I personally was in a situation where I had some sort of brain activity but wouldn’t be aware of things, like the Terry Schiavo case, I believe that I would want my family to do what her husband did.
ReplyDeleteI agree. I think Terri Shiavos husband did the right thing.
DeleteThe Terry Schiavo case also persuaded me to choose the higher-brain definition. Even though she expressed facial movements at times, as the book stated, I do not think this constitutes a state of consciousness that someone has when they are alive.
DeleteI think what scares people about accepting this definition is that they won't be given time to accept what has happened and grieve. It becomes very difficult because they can see their family member in a state that looks very much like sleep. To immediately accept that they're "gone" would be psychologically scarring. But if you asked just about anyone what they would want for themselves, living in a PVS and everything that entailed would probably not be it.
DeleteI agree with you Abby, I think that it has to be much more then just some facial movements. If Terry Schiavo was able to function in some sort of capacity on her own then I might look at the case differently.
DeleteChristine, you are probably right, I think that it would be hard to immediately accept that such a person is "gone", which is probably why some loved ones choose to keep their loved ones on ventilators and feeding tubes over time.
The definition I find most persuasive is whole-brain death. Without a functioning cerebellum and brainstem, the person is unable to breathe on their own, thus requiring mechanical ventilation. If mechanical ventilation is not provided, the heart would stop beating, leading to the traditional heart-lung definition of death. If the person is supported with various machines to keep their heart beating and their lungs expanding but are considered brain dead, there is no chance that if taken off the mechanical ventilation they will survive.
ReplyDeleteI agree Alexis. Those were some of the same reasons that went into deciding which definition was appropiate to me. Without those functions we would not be able to survive and do the things that constitute us being alive.
DeleteThe definition I find most persuasive is higher-brain death. A person does not seem to be living if they are unable to realize that they are. It seems like a person should be aware of what is going on around them. If they are unable to function and have irreversible damage then they should be considered dead it seems.
ReplyDeleteSo even if a person has a distinct heartbeat and pulse, if the person is not self-aware, then they should be defined as dead?
DeleteI also agree that the "higher-brain death" definition is the most persuasive. There are still specifics to be worked out about it. And, it's really hard for people to disconnect machines when it appears as if their loved ones are actually alive. However, like the book points out, the higher brain functions are what allow the mind and body (and possibly the soul depending upon your beliefs) to integrate fully and function as we are designed to function. Without out the ability to do that, the body is merely an empty vessel. Everything that made that being an individual is gone and cannot return. Once that fact is firmly established, why draw out the inevitable? With technology being what it is today, doctors & nurses can keep what's left going. But is what's left truly alive?
ReplyDeleteI agree. And you do make some very convincing points. However I don't think i would be able to make that decision if I was put into that situation.
DeleteAnd, truly, that's the rub of all of it. It's always easier to talk about this in the abstract. When all of us are faced with similar choices at some point in the future, I don't think any of us will be judged harshly for struggling with the decisions.
DeleteCompletely agree with that. One might have a viewpoint or idea now, but who knows what the future brings and how we change as people.
DeletePersonally I find that the Whole Brain definition of death is most convincing. I believe that if the person is not responsive to stimuli, cannot breathe on they're own and does not show any reflex action it does not qualify as living. However i do not think this qualifies them as dead either. I believe it is more suitable to say that a person is in the process of death, as they talk about it at the end of the chapter, and that the medical and technological advances that our society has been blessed with can only prolong this process so that loved one may have time to say goodbye. That being said I also believe that having to make the choice as to whether to "pull the plug" or not would be extremely hard to do given that there is a relationship between you and the person in the vegetative state. I do think that it is appropriate for someone to be kept "alive" with machines as i stated before but as others have already mentioned in their posts i personally do not know anyone who would like to be kept in such a state.
ReplyDeleteJacob, I agree with you that the Whole Brain definition is most convincing. Allowing a person to continue to pursue future life when there is some hope is the best way to go about a death like this. I also agree with what you said about "pulling the plug." This is something that is very hard, but I believe that when that happens, death has occurred.
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ReplyDeleteto me, Whole brain death seemed the most convincing out of all of them. While having the higher brain is what makes us conscious and gives us our personality and humanity, it's not mandatory to have in order to remain alive. This aspect also allows patients who are still breathing and still have circulation to be considered alive, as opposed to higher brain, which adds psychology to a conflict that that is based on biology. however, perhaps an easier question for us to ask is "what does it mean for a person to be living?" instead of "what does it take to consider a person to be dead?"
ReplyDeleteI agree Dave I liked the way you rephrased the question.
DeleteI think that the question you're posing exposes the difficulty with how we define the term person in the first place. With persons existing in both psychological, biological, and social dimensions, which context is the primary area which defines personhood?
DeleteI personally lean towards higher brain functioning due to the consciousness acting as a sort of bridge between the social, biological, and psychological aspects of the person, and might then consider death the splitting of that united persona into its parts due to the loss of consciousness.
However, you're correct in that in the end this comes down to the fundamental question, which is hard for us to nail down without an objective standard of what it means to be living.
The most convincing perception of death to me was the whole brain death. Whole brain death falls under the category of biological death. I believe that a person remains alive until all parts of the body have stopped functioning. The higher-brain function describes death while a person may still have several functions still working. Both of these bring of many questions and opinions, but I believe the most important question is, if a person has some chance of living, shouldn't we do everything possible to allow this small chance to take action?
ReplyDeleteThe Defintion that i felt was the most appropiate is the Whole-Brain death defintion. Like all other defintions so far, there are challenges with each of them. That being said, this defintion fits into my idea of life and death more than the others do. Also I like the idea of the confirmatory test becasue it confirms a nonfunctioning brain. Once a person unfortuantely fails each of these tests, i believe they are no longer living. Unfortunately no one really talks about what they would want to happen to them if they were in this position and it ultimately puts a lot of pressure on the people who have to make the decision for them.
ReplyDeleteI found that the heart-lung definition of death was most appropriate for me. I believe that we are all alive biologically not just as a "human." I believe that death is when we stop our most human functions such as breathing. We are not dead until all functions stop.
ReplyDeleteI understand what you are saying Chris. I can see it from that perspective where we can't function on our own and need a machine to breath and live then that is not what you said "human".
DeleteI say that the definition of death is when you lose the higher function of the brain. When the higher function is lost then you are just another organism on this planet doing the basic survival needs. You do not have a personality anymore and you do not know what anything is, so you lose the "living" part of live.
ReplyDeleteI believe death must occur when higher brain activity such as cognition and consciousness come into play. This activity is what makes a person uniquely human rather than just an animal. When higher brain activity ceases, the person is no longer aware, able to think, reason, or recall. This leads to a lack of meaningful existence. The person is no longer able to choose, think, or feel. Quite simply, they have no social existence. Thus, when the body and cognitive process fail to work permanently, death occurs. When cognitive process is lost, opportunities for enjoyment, feeling, and acting are lost. Dying is the process that either slowly or rapidly takes away these things that make life worth living, as well as deteriorating the health of the individual.
ReplyDeleteI opinion I agree with the heart-lung approach to death. I have always seen death as when you stop breathing and your heart stops beating, whether its sustained artificially or on your own. Its a hard decision to make cause I can see the argument you can make with the brain theories of death. You may not be able to function when damage to the brain but as long as air is going in and out of your lungs and your heart is still pumping blood then to me you are alive.
ReplyDeleteIn my opinion I agree with the whole brain term of death. When a person is in a vegetative state and can no longer breath or have circulation on their own they are considered dead. Once a person is put on a machine and can no longer perform anymore natural bodily functions on your own is considered dead.
ReplyDeleteI agree with you Jake. When a person cannot breathe on their own and are put on a respirator I believe that they are dead.
DeleteI am personally oriented towards higher brain functioning as the hallmark of death. We associate our personality not with our base subconscious behaviors, but as an expression of the higher functioning aspects of our brain, primarily that of consciousness and conscious action and thought. The loss of that factor is the loss of the person inhabiting the organism, as well as representing a severing of the social person and the biological organism from their united identity.
ReplyDeleteI believe, when somebody needs a machine to keep them alive for a long period of time that they are dead. It is not natural for a person to be kept alive by a machine and have no chance of recovering. I completely understand short term use of a respirator in order to recover from some sort of trauma. When a person is unresponsive to simple tests of reflexes and brain activity, they are dead in my opinion.
ReplyDeleteI agree with Tyler the fact when someone gets to that point in their life and needs a machine in order to stay alive the are no longer able to live an adequate quality of life. To have a person being kept alive by artificial means is no way to live especially if they have no means of being able to make a decent recovery. When a person however becomes fully brain dead and losses all bodily functions then they are considered to be officially dead
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