[Do we defend a brain oriented view of death?].
OBJECTIVE
To propose a new formulation of death based on the mechanisms involved in consciousness generation in human beings.


METHODS
Any complete formulation of death must include three different elements: a definition of death, its anatomofunctional substratum and the tests required to diagnose death. The three brain oriented formulations of death are: the whole brain, the brain stem, and the neocortical formulations of death. In this paper I review and discuss each of these formulations, and I propose a new formulation about human death based on the physiopathological mechanisms involved in the generation of consciousness. This contains two physiological components: arousal and awareness. Since the structures of the brain stem, the diencephalon and the cerebral cortex interact to generate consciousness, it would be a mistake to make a rigid distinction between their functions from the point of view of waking and content. Important interconnections between the brain stem, other subcortical structures and the neocortex give rise to both components of consciousness. The generation of consciousness, then, is based on the anatomy and the physiology of pathways throughout the whole brain. None of the three formulations above is wholly satisfactory.


CONCLUSIONS
I propose a new formulation of death that identifies consciousness as the most important function of the organism, because it provides the essential human attributes and the highest level of control within the hierarchy of integrating functions of the organism
Machado-Curbelo
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Instituto Nacional de Neurologia y Neurocirugia, La Habana, Cuba. braind@infomed.sld.cu
D001143:Arousal; D001364:Awareness; D001926:Brain Death / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D001933:Brain Stem / Q000502:physiology; D002540:Cerebral Cortex / Q000502:physiology; D003243:Consciousness; D004027:Diencephalon / Q000502:physiology; D006801:Humans