Introduction: Brain dead and its technical aspects
The total and permanent nonexistence of all the activities of the functions of a brain can be defined as brain dead. Here all brain functions cease to exist and the patient starts to demonstrate apnea and coma and all his brain stem reflexes become absent. After brain death a person’s brain reaches an irreversible condition where even certain involuntary actions of the brain required for sustaining life comes to an end. Brain dead was first diagnosed in 1953 and it can be caused by suicide, meningitis, primary tumor of brain, drug overdose, intracranial hemorrhage, homicide, near drowning experience, cardiac arrest followed by resuscitation causing hypoxia and trauma.
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Being brain dead is actually being dead because once all the functioning capabilities of an individual’s brain get destroyed spontaneous breathing ceases to exist and soon the heart beat of the person also stops. Due to this the concept, regarding life support treatments that may have been provided to the patient before his or hers brain died, all the artificial systems may be removed since without them the patient is actually dead. (Ploeg, 2006)
Brain death technically occurs when total necrosis develops in our cerebral neurons due to which there is loss of oxygenation and blood flow. However, being brain dead and persistent vegetative state are completely different since the latter cannot be considered as death. A brain dead person can only be mechanically resuscitated through the functions of the lungs and heart. Since today the medical world have established the fact that being brain dead is actually dead, doctors can now obtain the organs of the patients with brain death, with their consent, and use them to save the lives of other people through transplantation as long as the organs are in working condition. (Frid, 2007)
Public policy on being brain dead
Brain death has now been legally established as a criterion of death of an individual significantly moving away from the more traditional manners by which death was pronounced. For many years medical professionals have been debating over the public policies and ethical issues concerning brain death. Today, legal and ethical consensus concur with medical professionals in agreeing that if a person’s brain is completely dead then he or she is actually dead. (Böttiger, 2008)
Although doctors have established that being brain dead means that a person is actually dead, the families of the patients are sometime not as comfortable with the idea as the doctors and thus need to be informed about this physiology. Not only they but also certain healthcare providers and workers and religious groups find it very difficult to deal with the concept of brain dead. They think that even if a person’s brain is dead his or hers heart may still be beating. Thus, they are against doctors wanting to remove the brain dead patients from life support systems and want them to wait till their heart beat completely ceases to exist before the patients can be pronounced dead. (Kenny, 2008)
It is quiet normal to view brain death as a criterion for the determination of a person’s death as the social formulation that is justified when it comes to organ transplantation and donation. A number of public policies and guidelines have been grafted by various neurosurgical and neurological societies on the notion of brain death. They all emphasize on the importance of apnea testing for determination of brain death and evaluation of the functions of the brain through bedside assessment. A number of people oppose to the use of cerebral angiography or electroencephalography as a means of confirmatory testing for brain death. (Böttiger, 2008)
Even though electrophysiological testing shows a lot of promise in this area it is not considered sufficient to validate brain death and is also technically difficult to interpret and perform. These policies are applicable for both children and adults and in order to pronounce a person brain dead the policies and techniques that need to be conducted include cerebral perfusion testing, apnea testing, electroencephalography and repetitive bedside diagnosis of the functions of the brain. (Hutton, 2009)
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Personal opinion about brain dead
Although some people think of brain death as a lost of personhood which is completely irreversible they tend to forget how many lives can be saved as a result of it. According to me brain death should not be considered as real death since even if a patient’s brain is not functioning, the heart still beats, blood still flows through the body which is apparent from the warmth of the body proving that he or she is still alive. So brain death cannot be considered as the criteria for actual death. But when the needs of a brain dead person are compared to one who is completely healthy but needs an organ to survive, then the difficulty arises. (Böttiger, 2008)
In that case I totally support the idea of organ transplantation. If the brain dead patient or their immediate family has given his or her consent then their organs should be extracted when they are still in working condition so that it can be used by someone else. By helping another person live the life a brain dead person could not, he or she is actually living a second life through the other person. Thus, I feel that doctors should carefully distinguish between situations that imitate brain death and an actual brain death. They should never give false hope to the family members since brain death is a reality which is difficult to accept.
Brain death most arguably has a number of positive aspects but its usage has certainly brought up a number of legal and ethical issues. Although a physician might find it difficult to confidently ascertain the condition of a brain dead person, it is not an impossible task. When pronouncing a person brain dead doubt and uncertainty is always apparent since no human can clearly define the line present between death and life. A huge number of legal guidelines are present in the world concerning brain death and due to this a doctor’s self belief relating to life and death can cause a hindrance when pronouncing brain death.
Even advanced medical directives or consent means cannot be used when it comes to pronouncing brain death. Although these topics are rarely discussed when it comes to brain death, they are significant since the patient’s family may reject brain death since it is only concerned with the functioning of the brain or rather its absence. Brain death also creates a conflict between the traditional views of identity and autonomy since if an individual has been declared brain dead then their rights and desires as a liberal individual is either totally eliminated or restricted.
Böttiger, E.L. (2008). Medical ethics: new horizons. Journal of Internal Medicine 238(6), 507-508.
Frid, I. (2007). Brain death: close relatives’ use of imagery as a descriptor of experience. Journal of Advanced Nursing 58(1), 63-71.
Hutton, J.L. (2009). Are distinctive ethical principles required for cluster randomized controlled trials? Statistics in Medicine 20(3), 473-488.
Kenny, N. (2008). Lifelong learning in ethical practice: A challenge for continuing medical education. Journal of Continuing Education in the Health Professions 21(1), 24-32.
Ploeg, R.J. (2006). Time-Dependent Changes in Donor Brain Death Related Processes. American Journal of Transplantation 6(12), 2903-2911.