The practice of transplantation of vital organs from "brain-dead" donors is in a state of theoretical disarray. Although the law and prevailing medical ethics treat patients diagnosed as having irreversible total brain failure as dead, scholars have increasingly challenged the established rationale for regarding these patients as dead. To understand the ethical situation that we now face, it is helpful to revisit the writings of the philosopher Hans Jonas, who forcefully challenged the emerging effort to redefine death in the late 1960s.
Brain death is accepted in most countries as death. The rationales to explain why brain death is death are surprisingly problematic. The standard rationale that in brain death there has been loss of integrative unity of the organism has been shown to be false, and a better rationale has not been clearly articulated. Recent expert defences of the brain death concept are examined in this paper, and are suggested to be inadequate. I argue that, ironically, these defences demonstrate the lack of a defensible rationale for why brain death should be accepted as death itself. If brain death is death, a conceptual rationale for brain death being equivalent to death should be clarified, and this should be done urgently.
Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives and patients. We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases.
Britain’s Orthodox Jews have been plunged into the centre of an angry debate over medical ethics after the Chief Rabbi ruled that Jews should not carry organ donor cards in their current form. London’s Beth Din, which is headed by Lord Jonathan Sacks and is one of Britain’s most influential Orthodox Jewish courts, caused consternation among medical professionals earlier this month when it ruled that national organ donor cards were not permissible under halakha (Jewish law). The decision has now sparked anger from within the Orthodox Jewish community with one prominent Jewish rabbi accusing the London Beth Din of “sentencing people to death”.
The United Kingdom’s chief rabbi, Jonathan Sacks, has issued an edict that carrying donor cards is unacceptable and that the current organ donor system is incompatible with Jewish law. The ruling comes after years of debate among rabbinical authorities over the definition of death and when an organ may be removed for transplant purposes. The new statement from the chief rabbi and his rabbinical court, the London Beth Din, says that organs may be removed for transplantation only at the point of cardiorespiratory failure, rather than at brain stem death. The latest figures for 2010 show that 66% of donations came from donors after brain death and 34% from donors after cardiovascular death, NHS Blood and Transplant said.
The number of patients in Israel who die while waiting for a transplant rose last year, and the number of transplantations fell by 20%, the annual report of the Ministry of Health’s National Transplant and Organ Donation Centre has said. As a result the shortage of organs has become more acute. Rafi Biar, chairman of the centre’s steering committee and director of the Rambam Medical Centre in Haifa, said that the main cause of the decrease is a new law that changed the protocol for defining “brain death” after discussions with the Chief Rabbinate. According to Jewish law death can be determined only after cardiopulmonary failure, and until recently the Chief Rabbinate had prohibited organ donation, as it did not recognise brain stem death. However, in 2008 the Israeli parliament passed a law that defines “brain respiratory” death as an indication of death for all legal purposes and also outlined the procedure that should be carried out to ensure that death had occurred.
There needs to be international agreement on when and how death is diagnosed, two leading doctors suggest. At a European meeting of anaesthetists they said improvements in technology mean the line between life and death is less clear. They called for precise guidelines and more research to prevent the rare occasions when people are pronounced dead but are later found to be alive.
S. Suissa, S. Dell'Aniello, и C. Martinez. Epidemiology (Cambridge, Mass.), 21 (6):
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