[Death and dying - definition and determination.].
For the first half of this century there was no major dispute over the criteria for death. This was to change dramatically with major technological breakthroughs in modern medicine starting with the advent of the respirators. The consequences of their use raised serious questions about the traditional ways of diagnosing death. Today there are two different philosophical positions about what it means to be dead in terms of brain functions: One, which is not currently law in any jurisdiction, would pronounce a person dead when there is an irreversible loss of higher brain functions. This has been called cognitive death. The patient is not in a coma, because arousal mechanisms are present, the brain stem functions being relatively intact. The other philosophical position considers a person dead if there is an irreversible loss of the functions of the brain stem or the entire brain. The neurologic syndrome of brain death has been accepted by the medical profession as a distinct clinical entity that experienced physicians can diagnose with an extremely high degree of certainty, and can usually easily be distinguished from other neurologic syndromes. However, we must not lose sight of the fact that this is less a conclusion than a beginning. It is the task of philosophy to offer analyses of personhood and of personal identity that might support practical formulations for the determination of death and theology has reflected upon the meaning of death, if not its definition, from time immemorial. To define the death of a human being we must recognize the characteristics that are essential to humaneness. It is quite inadequate to limit the discussion to the death of the heart or the brain.
Bjarnason
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Landspitali University Hospital, Eirísgata 5, 101 Reykjavík, Iceland.