Brain Death: Redefining the End of Life (34)

This lesson only discusses one problem-the end of life.

Most people may think that the end point of life is that the heart stops beating and there is no breathing.

However, such an idea confuses the relationship between vital signs and life.

Let me explain.

No matter what brand of monitor, it will definitely include pulse, blood pressure, respiration and ECG waveform.

In most cases, having vital signs means having life. Whether the vital signs are normal or not represents the critical degree and severity of the disease.

So, does having vital signs necessarily mean that life is still there?

2. Litigation caused by brain death diagnosis

20 13 12 12 A children's hospital in California, USA, diagnosed a girl of 13 years old with brain death.

In the United States, diagnosing brain death means declaring the end of life. But the baby still has a heartbeat.

Therefore, family members think that since the child still has a heartbeat and vital signs, how can it be counted as death? The hospital has no right to stop the rescue and must always treat it.

The two sides can't stand each other and sue to the court.

The presiding judge is very cautious. First, he signed a temporary restraining order, informing the hospital not to stop treatment during the trial.

Then, the judge appointed another independent medical expert to re-evaluate. In other words, in order to ensure fairness and objectivity, this expert comes from a third-party medical institution.

After the expert evaluation, he wrote a report to the judge very rigorously, and the report said this:

The child has irreversible brain damage and has completely lost the function of brain and brain stem. This diagnosis meets all the criteria of brain death set by California Law and Professional Association.

It means that the child has indeed passed away, both medically and legally.

Let me explain, as early as 1968, Harvard Medical School in the United States formulated the first diagnostic standard for brain death in human history. Today, more than 30 countries around the world, including the United States, have passed brain death legislation. More than 80 countries are using brain death as a diagnostic criterion for death.

Later, the judge ordered the family to take the children out of the hospital within a time limit.

On October 6th, 65438/KLOC-0, on the 26th day after the death of the child was diagnosed, the family members took the child's body away from the hospital by ambulance.

What does this case show?

First of all, many people confuse the relationship between vital signs and life, thinking that with vital signs, there is life.

Secondly, once brain death is diagnosed, it is death.

Finally, even in the United States, where the standard of brain death has been implemented and legislated for decades, it is still difficult for some people to accept this diagnostic standard.

3. Scientific diagnostic criteria of death

Why use the diagnostic criteria of brain death?

First of all, due to historical reasons, before the birth of science, people regarded the heart as the carrier of thinking.

Until today, traces of this concept can still be seen everywhere. Many words regard the heart as the source of thinking and consciousness, such as sadness, care, carefulness and mind.

But later, with the more and more clear understanding of the human body structure, it proved that the brain is the carrier of thinking and consciousness and the headquarters of the human body.

Brain death means that consciousness, as an essential feature of human beings, has disappeared, and this is the end of life. Therefore, cardiac arrest is the concept of death, which is influenced by the concept of historical residue.

Secondly, from a physiological point of view, modern medicine can maintain vital signs since life support technology has been available. If the heart stops beating, it can be maintained by drugs, stopped breathing, or supported by a ventilator. Blood pressure is low, and blood pressure can be maintained with pressor.

Even in the laboratory, we found that the isolated hearts of some animals can keep beating for a long time. That is, the experimental animal is dead, but the heart can still beat.

However, once brain death occurs, it can never be reversed.

Because nerve cells can't regenerate, it is only a matter of time before the brain stem, which is the heart center of breathing and heartbeat, dies.

Therefore, judging death by cardiac arrest is not in line with the physiological basis.

This is the second cause of brain death as a diagnosis of death, and medicine cannot reverse brain death.

Many times, we can maintain vital signs, but this is not the same as saving lives.

Let's do a thinking experiment.

If a person has renal failure and uremia is irreversible, he can still live healthily after transplanting a kidney.

If the liver fails, you can also transplant the liver.

Even if the heart fails and a heart is transplanted, this person is still himself.

Then, if a person's brain dies, give him a big brain transplant. Regardless of whether it is technically feasible, even if the technology is mature, is the person who transplanted the brain still himself?

5. The difference between brain death and vegetative state

At this point, you must be worried that once brain death is diagnosed, the doctor will not give rescue. What if this patient has a miracle of resurrection? Because on the internet or in stories, there is often a place where a person diagnosed with brain death miraculously resurrects.

My answer is: this kind of thing is either a diagnosis error or a rumor. As long as brain death is diagnosed by scientific methods, it is impossible to reverse it.

According to the American Academy of Neurology, once brain death is accurately judged, so far, there has never been an example of brain activity recovery.

The reason why there is a saying of "resurrection" is because people preach, or that vegetative people are brain dead.

The concepts of vegetative state and brain death are often confused. Vegetarians are alive and a few vegetarians may wake up again.

Let me give a famous example.

20 13 12 while skiing in the French Alps, German Formula One driver michael schumacher unfortunately slipped off the snowy road and hit his head directly on a rock.

Schumacher suffered a serious brain injury and fell into a deep coma.

Then he was rushed to the hospital for brain surgery. After operation, I was monitored and treated in ICU, and also supported by ventilator.

Finally, Schumacher struggled to survive. According to scattered media reports, Schumacher has recovered the most basic body reflexes such as opening his eyes, but he is still not fully awake.

By August of 20 18, some media revealed that Schumacher sometimes shed tears involuntarily.

Based on these evidences, I judge that this is a vegetable.

Although at the end of 20 18, some media reported that Schumacher stood up, and later denied this rumor. But in any case, we are all waiting for the former car king to create a miracle.

Physiologically speaking, when the brain dies, all brain functions disappear, there is no reflex, no spontaneous breathing and no pupillary reflex. The EEG is a straight line, which means there is no trace of brain activity.

But vegetative people are different, and the brain stem function of vegetative people is still there.

The brain stem is the center responsible for heartbeat and breathing, so vegetative people can have spontaneous breathing, heartbeat and nerve reflex, and they will open their eyes unconsciously; You can even have basic reflexes such as sucking and avoiding pain.

Moreover, the EEG of a vegetative person is not a straight line, and there will be some chaotic waveforms, indicating that there are some chaotic electrical activities in the cerebral cortex.

6. The value of diagnostic criteria for brain death

Therefore, the establishment of diagnostic criteria for brain death is the embodiment of social civilization and progress.

Tell me a case that I experienced personally.

A young man was rescued in ICU because of severe brain injury. After many expert appraisals, it was proved that the patient had irreversible brain death.

His parents are both doctors, and they were very sad when they realized that their child was brain-dead. I'm sure you can think of the great pain of white-haired people facing the death of their children.

However, the parents asked for organ donation as soon as possible. Because this patient signed a consent form for voluntary organ donation before his death.

In their eyes, only by fulfilling the child's last wish and returning the dead son's organs to those in need can the son's life be extended to the maximum extent.

However, the patient's wife opposes organ donation. She believes that as long as there is a heartbeat, it is not death, let alone organ donation.

A few days later, my wife finally figured it out and asked for organ donation.

But at this time, the patient has already had a serious systemic infection, which means that he missed the best period of organ donation.

This case touched us.

The patient's parents and wife love the patient deeply, and they are both people with great love.

Parents' love is deeper, and they look at death more rationally, hoping to bring greater value to society. The wife's love is more emotional, because she confuses vital signs with life and misses the best opportunity to donate organs.

Get it now:

1. Basic vital signs include: respiration, blood pressure, pulse and temperature. When doctors write hospital medical records, they will first record these four vital signs.

2. Breathing cessation is more scientific as the diagnostic standard of death.

First of all, due to historical reasons, before the birth of science, people regarded the heart as the carrier of thinking.

Secondly, from a physiological point of view, modern medicine can maintain vital signs since life support technology has been available. If the heart stops beating, it can be maintained by drugs, stopped breathing, or supported by a ventilator. Blood pressure is low, and blood pressure can be maintained with pressor.

3. Brain death is the cause of death diagnosis.

0 1, with the more and more clear understanding of the human body structure, it is proved that the brain is the carrier of thinking and consciousness and the headquarters of the human body. Brain death means that consciousness, as an essential feature of human beings, has disappeared, and this is the end of life.

02. Once brain death happens, there is no possibility of reversion. This is the second cause of brain death as a diagnosis of death, and medicine cannot reverse brain death.

03. The third reason for using brain death as the standard of death is that the brain is irreplaceable. It is more scientific to use the standard of brain death.

According to the American Academy of Neurology, once brain death has been accurately judged, so far, there has never been an example of brain activity recovery.

5. The concepts of vegetative state and brain death are often confused. Vegetarians are alive and a few vegetarians may wake up again.

The difference between a vegetative state and brain death, in a word, is the difference between life and death.

Vegetative people are alive and have therapeutic value. Maybe one day there will be a miracle, and the vegetative person may wake up. But brain death means that people are dead and there will never be a miracle.

6. The value of diagnostic criteria for brain death

First of all, the diagnostic criteria of brain death not only define the end of life, but also guide the correct decision. Establishing the diagnostic criteria of brain death can make the deceased more dignified, let patients leave quietly and reduce the pain caused by unnecessary treatment.

Secondly, timely confirmation of death can save a lot of medical resources and the economic burden of family members.

Finally, the diagnostic criteria of brain death can provide more possibilities for organ transplantation.

7. Key points: Brain death is more scientific as the diagnostic standard of death. The difference between brain death and vegetative state is the difference between life and death. Diagnostic criteria of brain death have certain value and significance.

8. Only when the only end point is determined can there be a starting point for unlimited choices.