Call to Revamp Death Definition

[Guest guest]

It may be wrong to define death purely in medical terms, an academic

argues.

Professor Allan Kellehear said the medical diagnosis of brain death

was at odds with society's view of when death actually occurs.

 

He said a debate was needed about whether it was right to use brain

death as the key criterion for switching off life support, and

removing organs.

 

Professor Kellehear, of the University of Bath, will put this views

at an international conference on Wednesday.

 

Corpses are not warm, they are not pink, they do not move, they are

not pregnant - but a person who is brain dead can be all of these

things

 

Professor Kellehear

University of Bath

 

He argues that the current emphasis on brain death has come from a

select cabal of doctors, and is at least in part driven by the need

to harvest organs for transplant.

 

He said that although relatives were consulted about whether or not

to switch off life support, many did not truly understand what they

were agreeing to - or sign up to brain death as the definitive

measure of end of life.

 

A diagnosis of brain death is made using factors such as fixed and

dilated pupils, lack of eye movement and the absence of respiratory

reflexes.

 

However, it is not based on whether or not the heart is still

beating - for most people the most telling sign of death of all.

 

Difficult decisions

 

Professor Kellehear said this made the decisions potentially

unsettling for the bereaved.

 

He said: " Forty years ago, being dead used to be very simple - it was

the point at which your heart stopped beating.

 

" Now death itself has been complicated by the fact that we can keep

alive people who are brain dead almost indefinitely.

 

" Brain death is the point at which doctors can switch off machines or

begin harvesting organs, but, to relatives, being brain dead is not

the same as being a corpse.

 

" Corpses are not warm, they are not pink, they do not move, they are

not pregnant - but a person who is brain dead can be all of these

things. "

 

Professor Kellehear said there was little apparent difference to the

untrained observer between a person who was brain dead, and somebody

who was asleep.

 

Rare chance of recovery

 

He said the situation was further complicated by the fact that one in

1,000 people who are brain dead survive when life-support machines

are switched off.

 

There has never been a really serious national debate about whether

this is socially acceptable, or just medical pragmatism

 

Dr Richard Nicholson

Bulletin of Medical Ethics

 

" If it is your daughter lying there, your idea of a remote chance is

very different from that of your daughter's doctor.

 

" The situation at present is that these decisions are based on

medical information alone.

 

" I would argue that these should be social decisions. To better

inform these decisions, we need a closer look at the social

implications of brain death. "

 

Dr Richard Nicholson, editor of the Bulletin of Medical Ethics, said

the current medical definition of death had partly arisen out of the

need to ensure that organs harvested for transplant where still fit

for purpose.

 

Medical technology in the 1960s and 1970s was such that if the heart

had been allowed to stop beating the chance of retrieving usable

organs was slim.

 

He said: " There has never been a really serious national debate about

whether this is socially acceptable, or just medical pragmatism. "

 

" I suspect it does create real problems for an awful lot of relatives

when they are asked if organs can be removed when the patient's heart

is still beating. "

 

Professor Kellehear will speak at the international conference on

death, dying & disposal at the University of Bath.