This is the amount of time that has elapsed since a person's biological processes have stopped and they were pronounced dead. We use several methods to determine this—rigor mortis, algor mortis, palor mortis, stage of decomposition, insect activity, etc.
But any estimate given is in a time span of several hours to days. It is not like TV and movies where they narrow it down to minutes. But the time listed on your death certificate is the time you were pronounced. If you were in the hospital, this most likely will be at, or very close to, the time your biological processes stopped, i. It sometimes takes days to declare someone brain dead and days more for the organ-donation process to be carried out.
If someone is on life support, during all that time, blood will continue to circulate in the body and energy will continue to be created. When, then, did that boy die?
Was he dead, right then and there, when we made that small observation of his two gaping-wide pupils, black as night? Was it the next morning around ten, when we formally declared death? Or was it two days after that, when a surgeon cut out his heart and raced it off to a stranger, who would later become a transplant survivor?
It was the first time the clear black-and-whiteness of whether or not my patient was alive or dead became one big grey fuzzy question that seemed better answered by a philosopher than a physician. Suddenly, I saw death as complicated. The question of who gets to decide when life has ended is one that is still challenged in courts to this day.
A s technologies and medicines have grown in sophistication, the line between alive and dead has become more difficult to determine for some. A previous lack of written documentation led experts, guided by rigorous science, to create guidelines for death determination in Canada. Written in , these guidelines outline how neurological death can be declared. They are strict and, in the case of organ donation, require two physicians to verify irreversible death of the brain.
Also known as brain death, neurologic death represents irreversible loss of consciousness and brain-stem function, including the ability to breathe. The challenge with the latter is that sometimes a person can still look alive after neurologic death has occurred. And, occasionally, when families disagree with a diagnosis of brain death, they can fight the declaration in court. Recently, two high-profile cases have been brought before Canadian courts.
Near the end of , there were two Toronto-area families who filed applications with the Ontario Superior Court to challenge, respectively, Brampton Civic and Humber River hospital doctors who had made declarations of brain death.
Both families saw initial victories, obtaining court injunctions to force the hospitals to maintain their loved ones on life support. At the time, Taquisha McKitty was a twenty-seven-year-old Christian woman who was declared brain dead after a drug overdose and was then kept on life support until her heart failed in December , a full fifteen months after doctors initially declared her dead.
Shalom Ouanounou, an Orthodox Jewish man who was twenty-five when he suffered a severe asthma attack, remained on life support until his heart stopped March , six months after doctors had declared him dead. In both cases, the families argued that it was within their rights to define death in accordance with their interpretation of their religion. In the case of each religion, according to the respective families, that final line is marked only by cessation of a heartbeat.
Discord between religion and science has plagued many medical-school lectures for centuries, and to me, it seems like it likely always will. Sometimes, that discord brings us to more compassionate and human places; sometimes, it does not.
To me, many people who are arguing against the medical definition of death—i. To try to understand life and death how they see it, I reached out to Mark Handelman, a lawyer with Whaley Estate Litigation, who represents the family of Ouanounou.
Instead, he took me into the minds of the Ouanounou family, which practises Orthodox Judaism. There is a detailed process to ascertain no higher brain activity, including a patient's inability to respond to voice, touch, pain or other stimuli.
The second step involves determining the brainstem, the primitive part of the brain, no longer functions to regulate the patient's breathing. No patient with a proper diagnosis of brain death ever has recovered to come off life support. Even with life support, no one has survived for a prolonged period, and when life support is withdrawn the heart invariably stops within minutes. One important caveat is that there is some variability in the medical community on specific requirements for the diagnosis.
This question has gained immediacy because of the case of year-old Jahi McMath. In December, the Oakland, Calif. A surgical complication occurred, and Jahi suffered a massive brain insult. Several neurologists confirmed that afterward Jahi had no sign of electrical activity, no blood flow to her brain, and was unable to breathe on her own.
An independent neurologist confirmed Jahi was brain dead. Although a California coroner issued a death certificate, Jahi's family went to court arguing, based on religious convictions, that brain death is not death and that Jahi should not be removed from the ventilator. Her family subsequently received court approval and removed her body, attached to a ventilator, from the hospital to a facility that accepts responsibility for a patient declared dead.
As an intensive care unit director, I dealt with similar cases, and certain themes recur. In the process of pronouncement, condolences can be offered and the bereaved consoled.
Even if no one else is present, pronouncement provides an opportunity for clinicians to say goodbye, to reflect on care delivered, and to bear witness to the passing of another human being Hallenbeck Death Pronouncement If called to pronounce someone unknown to you: Inquire as to the circumstances of the death anticipated or not Inquire as to whether family is present and, if present, their condition quietly grieving, dazed, angry, etc. In entering the room of the deceased: First, calm yourself If family are present: Assess their initial reaction actively grieving — anxious waiting for your evaluation.
Do NOT ask them to leave — you should be able to do a brief examination with family present — pulse, respirations, and heartbeat. Clearly communicate that the person has died and offer condolences.
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