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UNDERSTANDING DEATH: DEFINING DEATH
Large-scale and impersonal death seems to surround us. Often sensationalized by the news media, it is regularly woven into our entertainment. In the context of this routine exposure, it seems almost paradoxical that Western society in the twenty-first century has been characterized as \"death-denying.\"
Dying is the process of decline in body functions resulting in the death of an organism. Death can be defined as the \"final cessation of the vital functions\" and also refers to a state in which these functions are \"incapable of being restored.\" This definition has become more significant as medical and scientific advances have made it increasingly possible to postpone death.
In response to legal and ethical questions related to death and dying, a presidential commission developed the Uniform Determination of Death Act in 1981, which was endorsed by the American Medical Association, the American Bar Association, and the National Conference for Commissioners on Uniform State Laws. This act, which has been adopted by several states, reads as follows: \"An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.\"
The concept of brain death, defined as the irreversible cessation of all functions of the entire brain stem, has gained increasing credence. As the Ad Hoc Committee of the Harvard Medical School defined it in 1968, brain death occurs when the following criteria are met:
- Unreceptivity and unresponsiveness - that is, no response even to painful stimuli
- No movement for a continuous hour after observation by a physician and no breathing after three minutes off a respirator
- No reflexes, including brain stem reflexes; fixed and dilated pupils
- A \"flat\" EEG for at least 10 minutes
- All of these tests repeated at least 24 hours later with change
- Certainty that hypothermia (extreme loss of body heat) and depression of the central nervous system caused by use of drugs such as barbiturates are not responsible for these conditions
The Harvard report provides useful guidelines; however, the definition of death and all its ramifications continue to concern us.
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GENERAL HEALTH
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