In-Depth Notes on Redefinition and Determination of Death

Reasons for Redefining Death:
- Technological Advancements:
- Increased use of life-support machines (e.g., artificial respirators, pacemakers, intravenous injections, feeding machines).
- Reasons against prolonging life:
  - High costs incurred.
  - Prevent suffering of dying individuals.
  - Allocate resources (machines) to patients with better survival chances.
- Organ Transplant Demand:
- Growing need for cadaver organs (eyes, heart, kidneys, bone marrow).

Physiological Definition:
- Death occurs when the heart stops beating (traditional view).
Religious/Philosophical Definition:
- Death is the separation of body and soul, view that humans are a union of both.
Brain Death Definition:
- Complete destruction of the brain, leading to inevitable organ failure.
- Requires confirmation via EEG (Electroencephalography) and ECG (Electrocardiogram).
Cellular Definition:
- Involves the irreversible breakdown of metabolic processes, focusing on neo-cortical activity loss as significant.
- Confirmed by EEG.

Brain Death Significance:
- Pertains to laws regarding organ donation act of 1991 (e.g., Republic Act No. 7170 in the Philippines).
- Cardiopulmonary Criteria:
  - Irreversible cessation of circulatory and respiratory functions.
- Neurological Criteria:
  - Irreversible cessation of all brain functions, including the brainstem.
- Philippine National Brain Death Criteria (1998):
  - Coma with known cause.
  - Absence of brainstem reflexes.
  - Apnea test results (no spontaneous breathing without ventilator support).
  - Confirmatory tests.

Cognitive Attitudes:
- Reflect thoughts about death such as acceptance and denial.
Affective Attitudes:
- Feelings about dying, including depression, sense of loss, and fear.
Behavioral Attitudes:
- Expressed through anger, irritability, bargaining, resentment, and fear.
Relation to Grief Stages:
- Includes denial, anger, bargaining, depression, and acceptance. (think abt death and connects to the feelings)

Nikolai Berdyaev:
- Death provides meaning to life; immortality is attained through death.
Epicurus:
- Death brings either immortality (which should be embraced) or liberation from pain and suffering.
Martin Heidegger:
- Death as completion of life, where one remains incomplete until death.
- Death equalizes all men in the face of mortality.
John the Evangelist (Biblical Reference):
- "I am the resurrection and the life… he that believes in me, though he were dead, shall live again" (John 11:25-26).

Natural Law Ethics:
- Considers death a natural component; death occurs when the soul departs the body.
- Morally, it opposes the prolonged suffering of dying through life support.
Utilitarian Perspective:
- Aligns brain death definition with the principle of reducing suffering by detaching life-support.
Joseph Fletcher - Situation Ethics:
- Supports using brain criteria for death in light of euthanasia and organ transplants.
Rawls's Justice Concept:
- Justifies discontinuation of life-sustaining measures if they're no longer serving the dying individual's interests.

• Reasons for Redefining Death:

Technology:
- We are using advanced machines to keep people alive longer (like breathing machines and feeding tubes), which raises ethical questions.
- It can cost a lot of money to keep someone alive this way, which could lead to suffering. Instead, we might want to help those who have a better chance of recovery.
Organ Transplant Needs:
- There’s a growing need for organs from deceased people (like hearts and kidneys) for transplants, so clear rules on when someone is considered dead are necessary.

• Several Definitions of Death:

Physiological Definition:
- Traditionally, death is when the heart stops beating.
Religious/Philosophical Definition:
- Some belief systems see death as the soul leaving the body.
Brain Death Definition:
- Brain death means the brain has stopped functioning completely, and there’s no chance of revival. This is usually checked with tests of brain activity.
Cellular Definition:
- This focuses on the breakdown of the body’s cells and processes, particularly in the brain, confirming death through brain activity loss.

• In the Medical Context:

The Importance of Brain Death:
- Laws about organ donation often hinge on defining when someone is officially dead. In the Philippines, specific laws guide this.
- Checks for brain death include confirming no heart or breathing function, and that all brain functions (including basic reflexes) have stopped.

• Attitude Towards Death:

Thinking about Death:
- People respond to death differently, some accept it while others deny it.
Feelings about Death:
- Emotions can include sadness, fear, and grief.
Behavior towards Death:
- Reactions can include anger, irritation, and bargaining (trying to negotiate for more time).

• Different Views of Death:

Berdyaev:
- He believed that through death, one finds true meaning and possibly immortality.
Epicurus:
- He said death means either eternal life or freedom from suffering.
Heidegger:
- Views death as essential to life, which gives it meaning and equality as we all face mortality.
Biblical Reference:
- In Christianity, death is seen as a transition to eternal life through faith.

• Ethical Theories Applied to Death:

Natural Law Ethics:
- Death is natural, and people shouldn’t be kept alive unnecessarily.
Utilitarian Point of View:
- It’s better to stop life-support for the suffering person and use resources for those who can survive.
Situation Ethics by Joseph Fletcher:
- He supports a flexible view of defining death for the sake of compassion in euthanasia and organ donation.
Justice by Rawls:
- The rights and dignity of the dying person should guide decisions about continuing or stopping life support.