![]() 2 The philosophical aspect of the determination of human death has also been stressed by many investigators in past and recent years. 1 The Committee defined death in neurophysiological and philosophical terms, as irreversible loss of all brain functions (including those of brain stem) and proposed criteria to reflect that definition. The concept of ‘brain death’ was introduced in the medical literature as a new criterion of death in 1968 by the ad hoc Committee of the Harvard Medical School. Reconsideration of the current concept of ‘brain death’ is perhaps inevitable. Conclusion:Īccording to the above arguments, the assumption that all functions of the entire brain (or those of the brainstem) in ‘brain-dead’ patients have ceased, is invalidated. Fourth, not one of the current confirmatory tests has the necessary positive predictive value for the reliable pronouncement of human death. ![]() Third, many patients maintain several stereotyped movements (the so-called complex spinal cord responses and automatisms) which may originate in the brainstem. ![]() Furthermore, since there are limitations of clinical assessment of internal awareness in patients who otherwise lack the motor function to show their awareness, the diagnosis of ‘brain death’ is based on an unproved hypothesis. Second, it is impossible to test for any cerebral function by clinical bedside exam, because the tracts of passage to and from the cerebrum through the brainstem are destroyed or nonfunctional. First, many clinically ‘brain-dead’ patients maintain residual vegetative functions that are mediated or coordinated by the brain or the brainstem. We present four arguments to support the view that patients who meet the current operational criteria of ‘brain death’ do not necessarily have the irreversible loss of all brain (or brainstem) functions. Medical, philosophical and legal literature on the subject of ‘brain death’. To evaluate whether current clinical criteria and confirmatory tests for the diagnosis of ‘brain death’ satisfy the requirements for the irreversible cessation of all functions of the entire brain including the brainstem.
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