The Whole-Brain Concept of Death Remains Optimum Public Policy

"Brain death," the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: (1) agreeing on the paradigm of death, a set of preconditions that frame the discussion; (2) determining the definition of death by making explicit the consensual concept of death; (3) determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; and (4) determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is "the cessation of functioning of the organism as a whole." The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies.     

Owning up to our Agendas: On the Role and Limits of Science in Debates about Embryos and Brain Death

The ethical issues integral to embryo research and brain death are intertwined with comprehensive views of life that are not explicitly discussed in most policy debate. I consider three representative views – a naturalist, romantic, and theist – and show how these might inform the way practical ethical issues are addressed. I then consider in detail one influential argument in embryo research that attempts to bypass deep values. I show that this twinning argument is deeply flawed. It presupposes naturalist commitments that are at issue in the embryo research debate, and exhibits a blindness to alternative philosophical viewpoints. By considering the work of Hans Driesch, the discoverer of the facts of embryology integral to the twinning argument, I show how the twinning facts are compatible with romantic and theistic accounts that affirm full moral status for the early embryo. While these alternative interpretations might have a tenuous status in current scientific debate, they should be respected in ethical and policy debate.     

脑死亡若干法律问题研究

脑死亡是刑法学中与人的生命保护界限密切相关的问题。脑死亡的新观念虽然面临挑战 ,但其科学合理性毋庸置疑。脑死亡的时间应当以全脑机能不可逆性丧失时为准。脑死亡的概念与判定标准 ,有必要在器官移植法中予以规定。     

Diagnosis of stress preceding the fatal outcome

Postmortem examinations of cytomedines of internal organs in 181 men showed a possibility to use their (cytomedines') quantitative and qualitative characteristics as diagnostic criteria of stress influencing the human organism shortly before the death onset. Bioregulatory peptides were obtained by using Morozov's and Khavinson's method of acetous extraction. The composition of cytomedines was determined by spectrophotometer, while their biological activity (BA) was studied through affecting the phagocytic activity of blood neutrophils. It was concluded that, under stress, there are a significant inhibition of BA and a reduced count of cytomedines in the internal organs. The found data can be used to detect the stress preceding death.     

The neurological determination of death: what does it really mean?

The recent Canadian forum's recommendations regarding "neurological determination of death" claim to have determined a "Canadian definition, criteria, and minimum testing requirements for neurological determination of death." In this review the problems with this statement are discussed. The criterion of neurological determination of death does not fulfill the definition of death, because there is continued integration of the organism as a whole. The tests for neurological determination of death do not fulfill the criterion of neurological determination of death because they do not show the irreversible loss of all critical brain functions. The forum has provided no coherent argument for why neurological determination of death should be considered death. I suggest that one cannot invoke expert opinion to clarify a criterion of death, and tests for this criterion of death, without a clear concept of what death is. The forum has clarified tests for what they call "neurological determination of death," but this is not death itself; rather, it is a neurologically devastating state. Whether this state of "neurological determination of death" is enough to justify the morality of harvesting organs prior to death is the real question. A potential solution to this question is discussed.     

Aspects of brain death

The different aspects of brain death are discussed. It is pointed out that the diagnosis of poisoning as the cause of brain death can be checked by toxicological examination of brain tissue and of blood in the sinus of the dura mater, since the metabolism in the brain and sinus blood is markedly reduced while drugs and toxic substances continue to be broken down in the other organs. Particular importance attaches to this difference in the case of crimes of violence creating conditions that predispose to brain death when the significance of a further violent act, e.g. stabbing with resultant haemorrhage, has to be assessed. The simple vital reaction of bleeding does not of itself constitute proof in such a situation, unless it is possible to say with a good degree of certainty that brain death did not occur at the moment when the victim was stabbed. It may, however, be possible to state that brain death that could have been caused by violence has not yet occurred if complex vital reactions, such as inflammation of a wound, are seen.     

Hypothermia Secondary to Glioblastoma Multiforme? Autopsy Findings in Two Cases

Death due to accidental primary hypothermia in cold climates is relatively common, with previous case series reflecting this. In contrast, hypothermia‐related death as a result of an underlying medical cause, such as a brain tumor, is rare. The literature clearly illustrates a theoretical causal relationship between brain neoplasms and hypothermia through the infiltration of the hypothalamus; however, the number of reported cases is minimal. Two cases are presented where autopsy confirmed hypothermia as the cause of death with both cases revealing widespread glioblastoma multiforme in the brain. Both decedents were elderly with a number of comorbidities identified during autopsy that could explain death; however, hypothermia was deemed the most likely cause. It is proposed that both decedents died of hypothermia as a result of the tumor's effect on thermoregulation. These cases underline the importance of forensic pathologists to be aware of the relationship between brain tumors and hypothermia and to not dismiss death as being due to other disease processes.     

刍论中国脑死亡立法

＂脑死亡＂立法属于科技含量高,人权及伦理学混杂的法律进程。全文对脑死亡立法作了理论基础分析,对脑死亡立法的必要性,目前面临的主要问题作了探讨,提出对脑死亡立法的建议。     

A critique on the concept of "brain death"

Since the concept of "brain death" was introduced in medical terminology, enough evidence has come to light to show that the concept is based on an unclear and incoherent theory. The "brain death" concept suffers by internal inconsistencies in both the tests-criterion and the criterion-definition relationships. It is also evident that there are residual vegetative functions in "brain dead" patients. Since the content of consciousness is inaccessible in these patients who are in a profound coma, the diagnosis of "brain death" is based on an unproved hypothesis. A critical evaluation of the role and the limitations of the confirmatory tests in the diagnosis of "brain death" is attempted. Finally it is pointed out that a holistic approach to the problem of "brain death" in humans should necessarily include the inspection of the content of consciousness.     

Sudden death caused by parasites: postmortem cerebral malaria discoveries in the african endemic zone

This survey presents several cases of sudden deaths in Africa, specifically in Cote d'Ivoire, where the postmortem diagnosis of human cerebral malaria was determined after autopsy followed by pathologic examination of the brain. It is thought that cerebral malaria may be the primary cause of sudden death in nonimmunized persons during or after traveling in such endemic areas of Africa. The target population is composed of tourists, business travelers, and sailors. Because death caused by cerebral malaria occurs so suddenly, it can lead to forensic issues. Therefore, in any cases involving sudden death, it is very important for the forensic scientist to do a systematic evaluation, including pathologic examination of brain tissue, to rule in or exclude cerebral malaria. This practice will reinforce and aid research in progress directed at developing a vaccine and elucidating the role of tumor necrosis factor in this disease. Furthermore, this study will alert the physician to the importance of an effective and well-followed prophylaxis.     

Chapter 8: General Concepts of Mental Diseases (Causes,Course, Classification,Diagnosis, and Treatment)

Mental disease is a disturbance of the functioning of the human organism, principally disease of the brain, primarily its higher levels. Inasmuch as the brain is the regulator of all body functions, damage to it results not only in disturbance of its most important function, mental activity, but also, unavoidably, of the activity of other organs and systems, to some extent.     

MicroRNA在创伤性脑损伤的研究进展

MicroRNA是一类非编码小分子RNA,可调控人类基因组中20%-30%的基因,对细胞分化、增殖和凋亡起着重要调控作用。部分microRNA在哺乳动物中枢神经系统呈高水平表达,在神经元发育、突触发生和可塑性等过程中发挥关键作用,对认知功能亦有重要影响。创伤性脑损伤所致认知障碍的鉴定是法医学领域的重点及难点问题,识别其相关的特异性microRNA及其靶基因、阐明相应的信号传导通路对明确颅脑损伤的诊断、鉴别、预后及判断致伤机制、推断死因等方面可能均具有重要价值,应是今后的研究重点。本文简介microRNA在中枢神经系统中的分布与功能,对microRNA在创伤性脑损伤中所发挥的作用以及法医学研究进展做了重点阐述。     

The tissue survival problem in using current methods of morphological study]

Time course of ultrastructural changes and RNA production in human brain and myocardial cells during the period between clinical and biological death is studied. Changes in the cytoplasm of brain neurons develop 4 hours after death, and 8 h post mortem the destructive changes in the cytoplasm and nuclei progress. During the period of 4-13 h post mortem the endotheliocyte nuclei are capable of producing RNA. Active production of RNA is on-going in the myocyte nuclei 4 h after death; the synthetic activity decreases by 8 h and by 13 h the synthetic activity in autopsy material is over.     

Common Wealth

After reviewing developments in human rights law and international law – in particular the domestication of international human rights law and the rise of the democratic norm in international law – the importance of these developments for the Commonwealth and for its member states is highlighted and linked to many of the programmes and policies that the Commonwealth Secretariat has recently launched. This paper discusses these developments and others in order to stress the wealth of potential advantages for Commonwealth member states and their citizens that flow from a common commitment under the rule of law to human rights and democracy. The authors endeavour to show that such wealth is more than mere economic benefit – as important as that undoubtedly is – and that citizens stand to reap a moral system of government, one which expands the opportunities for popular participation in political processes and puts an end to social practices that marginalise some citizens and empower others.     

Postmortem changes in cytochrome c oxidase activity in various organs of the rat and in human heart

Cytochrome c oxidase (COX), a mitochondrial enzyme, is inactivated by cyanide or carbon monoxide (CO) intoxication. To test whether cytochrome c has potential as an indicator of these toxins in cadavers, we measured COX activity in the main organs of the rat, and in the human heart, at various times after death. Each tissue sample or organ was homogenized and the COX activity in the mitochondrial fraction was measured using ferrous cytochrome c as the substrate. COX activity was significantly higher in rat brain, heart and kidney than in lung and liver from 0 to 4 days after death. The loss of COX activity was significantly slower in the brain and heart than in the lung, liver and kidney. Most importantly, COX activity correlated with the time-since-death for each of the rat organs we tested (r2=0.70-0.95), but for the human heart (r2=0.47). It may be possible that COX activity is likely to be a useful indicator of the time-since-death, and is worth pursuing as an indicator of the tissue cyanide and CO content.     

The death of a living soul

We are bedevilled with varying definitions of death, ranging from higher brain death to cardiovascular or somatic death. They all try to capture what is essential to our reasoning about the importance of human death. This column argues that what they all neglect is the Aristotelian inspiration of many of the attempts at reformulation of the definition. Aristotle's work on the soul focuses on the loving soul as the form of humanity that makes human living and dying the morally significant phenomenon that engages law-makers and ethicists alike. The form of humanity comprises a holistic package of properties which cannot be dealt with in a reductive manner and which our criteria for death must answer to. When that is clarified, the role of these criteria and their importance both become more transparent.     

从人权保护的视角考察宣告死亡制度

统摄现代法治社会的灵魂是人权,为失踪人设置的宣告死亡制度与人权保护紧密相关,人权的绝对性使宣告死亡的设置缺乏依据,而人权的相对性又使宣告死亡成为现代法治社会的良好制度,严格宣告死亡的条件,合理规定死亡的法律后果,使宣告死亡与人权保护相协调。     

Assessment of edema fluid distribution in the brain

The technique is proposed allowing quantitation of brain edema and typing of liquor distribution in different parts of brain tissue. In combination with other assays this test can determine a variant of tanatogenesis, detect cause of death and duration of the terminal period. The method application is illustrated by the study of brain hydration in mechanical strangulation asphyxia. It is shown that this death is associated with hypohydration of cerebral structures, especially pronounced in the cortical compartments.