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January 16, 2014 | Posted By Jane Jankowski, LMSW, MS

Our society is once again grappling with the challenges presented when medical technology (e.g. mechanical ventilation) is used to sustain physiological function in the absence of brain function. How we should define death, and who should be allowed to decide, is part of a very public debate in the wake of the Jahi McMath case out of Oakland, California and the Munoz case in Texas (NY Times). Though this is hardly a new issue for bioethics, the reality is that there is a clearly a chasm between the acceptance of brain death criteria as a sufficient definition of death.

The acceptance of brain death criteria in the 1980s as a legally and medically sanctioned definition of death was established in response to the controversy surrounding the obligation to sustain a patient’s respiratory function despite the absence of any brain function. When this irreversible loss of brain function occurred it was widely agreed there was no benefit to any further medical intervention and machines could be turned off, organs harvested, and the loved ones could move forward with processing the traumatic loss.  If a patient was brain dead, this was dead enough to qualify as no longer living. What drives the resistance to this definition? That the life function of circulation of blood and a beating heart continues indeed suggests the body is still alive.

The paradoxical success of advanced medical technology is that it effectively supports some life functions the body to allow for healing, but when the body is not able to heal, the technology becomes an interloper that forestalls what would otherwise be a natural death. Depending on the patient, life support either buys time to recover, or prolongs an inevitable death. The machines do not make a person alive or dead, but interrupt the cessation of respiratory function. This makes the line between life and death blurry when we use a brain death definition of death. If we call it ‘life support’ in brain death cases, it seems it is a misnomer that leads to a perception that withdrawing these interventions is a decision to no longer support life functions (JME). The reality is, that while the machines do support some physiological functions, the removal of mechanical supports does not cause the death. The underlying injury or illness is the cause, and halting the machines is simply a decision to get out of the way. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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