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An eight-year-old girl demonstrated severe and persistent neurological damage following an uneventful anaesthetic for a planned appendicectomy. The perioperative period was remarkable only in that the patient experienced very severe hyperglycaemia and an epileptiform convulsion. A possible mechanism for neurological damage as a result of severe hyperglycaemia is described.
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Grant Gillett argues that it is consciousness which makes a human or other being the 'locus of ethical value'. Since cortical functioning is, in Gillett's view, necessary for conscious activity, an individual whose neocortex is permanently non-functional is no longer a locus of ethical value and cannot be benefited or harmed in a morally relevant sense. This means that there is no obligation to continue treating those who have suffered neocortical death.
The connection between brain life and brain death is neither as simple nor as defensible as it might at first appear. The problem rests with the two dominant competing definitions of death:...the loss of that which is necessary for the organism to continue to function as a whole;....the loss of that which is essentially significant to the nature of the organism... If death is understood as the loss of that which is necessary for the continued functioning of the organism as whole, then the apparent symmetry breaks down. If...death could be understood as the loss of that which is essentially significant to the nature of the organism....consciousness, then the symmetry would hold. However, that definition of death is indefensible. Therefore...statements about the status of anencephalic infants and early human embryos based upon a connection between brain death and brain life are unfounded.
Martyn Evans believes that it is a 'shocking feature' of brain-centred conceptions of death that they require us to regard as dead a person whose heart may continue to beat spontaneously. When it comes to neocortical conceptions of death, we might even be burying or cremating a 'breathing corpse'. If proponents of neocortical definitions of death suggest active interventions to stop the remaining spontaneous functions, in what sense, asks Evans, is this different from killing? Also, does it make sense to accept, as many proponents of brain-centred conceptions of death do, that it is proper to 'explant' organs from 'beating-heart cadavers', whilst squirming at the thought of cremating a 'breathing corpse'?
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CONCLUSION: One can appreciate and understand why doctors take action to terminate life without being requested by the patient who is suffering unbearably and pointlessly. But in my opinion such action is not permissible from a moral point of view. In the first place there is a danger that interests other than those of the patient will play a decisive role. Furthermore, it is not permissible because the interest of society as a whole is at stake. The safety of all future patients would no longer be guaranteed. It is also not allowed because the medical profession must constantly be on its guard so that it does not become caught up in the situations described above. In nearly every case it should be possible for doctor and patient to discuss the termination of life explicitly and at an early stage. The ultimate reason why termination of life without request of the patient is not permissible is that in principle it will never be possible to draw a clear dividing line between unrequested and unwanted termination of life. However, it is conceivable that in certain cases the conflict of loyalties will be such that unrequested termination of life is justified. In the rare extreme case of an inescapable conflict of equally stringent duties, it may just be necessary to do something which in essence is impermissible.
In October 1992 a young woman died in a car accident. She was pregnant and her fetus appeared to be unhurt, so a decision had to be made: should the mother's body be artificially supported in order to give the fetus a chance to live? The situation became a public question that split the nation in two. One side demanded -- that the young woman -- and her child -- be left to die in dignity. The other side referred to the unborn child's right to live and therefore wanted the body of the woman maintained until the fetus could be born. The following report consists of four parts. The first describes the case. In the second part the decision and its official justification are presented. The third part offers an impression of the unusual emotional reactions to which the case of the "Erlanger Baby" has given rise. The final part is a discussion of the issue and some comments.
This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.
This paper argues that living wills are typically nebulous and confused documents that do not effectively enable you to determine your future treatment. Worse, signing a living will can end your life in ways you never intended, long before you are either incompetent or terminally ill. This danger is compounded by the fact that those who implement living wills are often themselves dangerously confused, so that, for example, they cannot be relied upon to distinguish living wills from DNR orders. In addition, the paper argues that advance directives concerning resuscitation are often so confused that they end the lives of healthy, alert people who have not suffered cardiac or pulmonary arrest. Finally, the paper argues that advance directives establishing durable power of attorney for health care often preserve the chief dangers of living wills. Suggestions are offered as to how you can most effectively direct your future treatment without endangering your life.
The dominant conception of brain death as the death of the whole brain constitutes an unstable compromise between the view that a person ceases to exist when she irreversibly loses the capacity for consciousness and the view that a human organism dies only when it ceases to function in an integrated way. I argue that no single criterion of death captures the importance we attribute both to the loss of the capacity for consciousness and to the loss of functioning of the organism as a whole. This is because the person or self is one thing and the human organism is another. We require a separate account of death for each. Only if we systematically distinguish between persons and human organisms will we be able to provide plausible accounts both of the conditions of our ceasing to exist and of when it is that we begin to exist. This paper, in short, argues for a form of mind-body dualism and draws out some of its implications for various practical moral problems.
Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient?
In 'The Pro-Life Argument from Substantial Identity: A Defence', Patrick Lee argues that the right to life is an essential property of those that possess it. On his view, the right arises from one's 'basic' or 'natural' capacity for higher mental functions: since human organisms have this capacity essentially, they have a right to life essentially. Lee criticises an alternative view, on which the right to life arises from one's 'developed' capacity for higher mental functions (or development of some other accidental property). I argue that his criticisms of this alternative view are misguided or self-defeating, and that there are good reasons to hold we have a right to life accidentally rather than essentially.
I investigate Thomas Aquinas's metaphysical account of human death, which is defined in terms of a rational soul separating from its material body. The question at hand concerns what criterion best determines when this separation occurs. Aquinas argues that a body has a rational soul only insofar as it is properly organised to support the soul's vegetative, sensitive, and rational capacities. According the 'higher-brain' concept of death, when a body can no longer provide the biological foundation necessary for the operation of conscious rational thought and volition, a substantial change occurs in which the rational soul departs and the body left behind is a 'humanoid animal' or a mere 'vegetable.' I argue that the separation of soul and body does not occur until the body ceases to function as a unified, integrated organism. A rational soul is not only the seat of a human being's rational capacities; it is also the principle of the body's sensitive and vegetative capacities. Since Aquinas defines a human being as a composite of soul and body, and not with merely the exercise of rational capacities, the determination of death requires incontrovertible evidence that the body has ceased all the operations that correspond to the soul's proper capacities. The evidence of this is the body's loss of its integrative organic unity and the criterion for determining when this loss occurs is the irreversible cessation of whole-brain functioning.