Towards an effective definition of death and disorders of consciousness.
There exists much controversy in providing an effective definition of human death, largely due to the lack of a rigorous separation and ordered formulation of three distinct elements: a universally accepted definition of death, the medical criterion (anatomical substrata) for determining that death has occurred, and the tests to prove that the criterion has been satisfied. The papers herein review medical standards, philosophical arguments, neurophysiological knowledge, behavioural and cognitive theory and the legal ramifications of the brain-oriented standards of death (whole brain, brainstem and higher brain). The papers examine the notion of connectivities and networks of conscious experience in order to formulate an effective definition of death, based on the basic physiopathological mechanisms of consciousness. We cannot simply differentiate and locate arousal as a function of the ascending reticular activating system, and awareness as a function of the cerebral cortex. Substantial interconnections among the brainstem, subcortical structures, and the neocortex are essential integrating components of human consciousness. This paper attempts to reconcile the brain-oriented standards that are currently inconsistent. The thread of the arguments is the basis for a standard of human death that includes consciousness as the most important function of the body, because it provides the capacity for integrating the functions of the body. The notion of consciousness as the ultimate integrative function is more consistent with the biologically-based systems than the more philosophically-based notions of personhood. Both sides of the argument are presented herein.
Machado
Calixto
C
Institute of Neurology and Neurosurgery, Havana, Cuba. braind@infomed.sld.cu
Leisman
Gerry
G
D001921:Brain / Q000473:pathology / Q000503:physiopathology; D003244:Consciousness Disorders / Q000175:diagnosis / Q000503:physiopathology*; D003643:Death; D006801:Humans; D009434:Neural Pathways / Q000473:pathology