Biomedical Engineering Reference
In-Depth Information
may open periodically, and the individual may exhibit sleep-wake cycles. Some patients
even yawn, make chewing motions, or swallow spontaneously. Unlike the complete unre-
sponsiveness of individuals in a state of brainstem death, a variety of simple and complex
responses can be elicited from an individual in a persistent vegetative state. Nonetheless,
the chances that such an individual will regain consciousness are remote. Artificial feeding,
kidney dialysis, and the like make it possible to sustain an individual in a state of neocorti-
cal death for decades.
If brainstem death is death, is neocortical death also death? Again, the issue is not a
straightforward factual matter. For it, too, is a matter of specifying which features of living
individuals distinguish them from corpses and so make treatment of them as corpses mor-
ally impermissible. Irreparable cessation of respiration and circulation, the classical crite-
rion for death, would entail that an individual in a persistent vegetative state is not a
corpse and so, morally speaking, must not be treated as one. The brainstem death criterion
for death would also entail that a person in a state of neocortical death is not yet a corpse.
On this criterion, what is crucial is that brain damage be severe enough to cause failure of
the regulatory mechanisms of the body.
Is an individual in a state of neocortical death any less in possession of the characteristics
that distinguish the living from cadavers than one whose respiration and circulation are
mechanically maintained? It is a matter that society must decide. And until society decides,
it is not clear what counts as beneficent or nonmaleficent treatment of an individual in a
state of neocortical death.
CASE STUDY: TERRI SCHIAVO AND THE BRAIN DEATH
DEBATE
In February 1990, an otherwise healthy 27-year-old Terri Schiavo suffered heart failure in her
home and fell into a coma. While Schiavo ultimately woke and initially proved responsive, after
a year of multiple rehabilitation facilities and nursing homes, the by then 28-year-old was diag-
nosed as in an irreversible persistent vegetative state (PVS). In 1998, Schiavo's husband, Michael
Schiavo, made a petition to the Florida courts to remove his wife from life support, a petition
fought vehemently by the woman's parents.
In 2001, after a doctor confirmed brain death with a report of significant brainstem damage and
80 percent loss of upper brain function, Schiavo's feeding tube was removed, but was replaced
days later, following a Court Appeal by her parents. Ultimately, the feeding tube was ordered
to be removed on three separate occasions, each time her legal guardian and husband fighting
to allow his wife to “die in peace,” while her parents insisted that their daughter maintained
cognitive function and requested more tests.
Finally in 2005, 15 years after her injury, and under constant national media coverage, Schiavo
died from dehydration two weeks after her tube had been removed for the final time and while
her case was still pending with the highest word in the nation: the Supreme Court.
1.
Without a Living Will, who is responsible for deciding the would-be intentions of a victim of
brain death? Who is responsible for mediation when loved ones disagree?
2.
Who is responsible for the years of health care costs of a potentially brain dead individual?
In 2006, RomHouben, a man presumed brain dead for 23 years, was discovered to have full brain
function after a series of advanced brain scan imaging tests. Houbenwas paralyzed in an accident
