Brain DeathWhat is Brain Death?Demonstrating Brain DeathDefining DeathDefining Brain DeathSlide 6Slide 7End Of Life IssuesTerri Schiavo CaseSlide 10Slide 11Slide 12Works ConsultedBrain DeathBrain DeathCourtney Bartel,Courtney Bartel,Vishruth ReddyVishruth ReddyWhat is Brain Death? What is Brain Death? Brain DeathBrain Death is defined as irreversible is defined as irreversible unconsciousness with complete loss of brain unconsciousness with complete loss of brain function, although the heartbeat may function, although the heartbeat may continue; the cessation of detectable electric continue; the cessation of detectable electric activity in the cerebral cortex.activity in the cerebral cortex.Not to be confused with a persistent, Not to be confused with a persistent, vegetative state.vegetative state.Demonstrating Brain DeathDemonstrating Brain DeathDemonstration of brain death is the accepted criterion for establishing Demonstration of brain death is the accepted criterion for establishing the fact and time of death. Factors in diagnosing brain death include:the fact and time of death. Factors in diagnosing brain death include:Irreversible cessation of brain function as demonstrated by fixed Irreversible cessation of brain function as demonstrated by fixed and dilated pupils, lack of eye movement, absence of respiratory and dilated pupils, lack of eye movement, absence of respiratory reflexes (apnea), and unresponsiveness to painful stimuli. reflexes (apnea), and unresponsiveness to painful stimuli. In addition, there should be evidence that the patient has In addition, there should be evidence that the patient has experienced a disease or injury that could cause brain death. experienced a disease or injury that could cause brain death. A final determination of brain death must involve demonstration of A final determination of brain death must involve demonstration of the total lack of electrical activity in the brain by two the total lack of electrical activity in the brain by two electroencephalographs (EEGs) taken twelve to twenty-four hours electroencephalographs (EEGs) taken twelve to twenty-four hours apart. apart. Finally, the physician must rule out the possibilities of hypothermia Finally, the physician must rule out the possibilities of hypothermia or drug toxicities, the symptoms of which may mimic brain death. or drug toxicities, the symptoms of which may mimic brain death. (Some central nervous system functions such as spinal reflexes (Some central nervous system functions such as spinal reflexes that can result in movement of the limbs or trunk may persist in that can result in movement of the limbs or trunk may persist in brain death.) brain death.)Defining DeathDefining DeathFor many centuries death has been thought to occur when the vital For many centuries death has been thought to occur when the vital functions cease—breathing and circulation (as evidenced by the functions cease—breathing and circulation (as evidenced by the beating of the heart). This view has been challenged, however, as beating of the heart). This view has been challenged, however, as medical advances have made it possible to sustain respiration and medical advances have made it possible to sustain respiration and cardiac functioning through mechanical means. cardiac functioning through mechanical means. Thus, more recently, the concept of brain death has gained Thus, more recently, the concept of brain death has gained acceptance. In this view, the irreversible loss of brain activity is the acceptance. In this view, the irreversible loss of brain activity is the sign that death has occurred. sign that death has occurred. French neurologists were the first to describe brain death in 1958. French neurologists were the first to describe brain death in 1958. Patients with Patients with coma depassecoma depasse were unresponsive to external stimuli were unresponsive to external stimuli and unable to maintain homeostasis. and unable to maintain homeostasis. In 1968 the "Harvard criteria" for determining brain death were In 1968 the "Harvard criteria" for determining brain death were published in the Journal of the American Medical Association, published in the Journal of the American Medical Association, under the title of "A Definition of Irreversible Coma.“under the title of "A Definition of Irreversible Coma.“A majority of the states in the United States had accepted brain A majority of the states in the United States had accepted brain death as an essential sign of death by the late 1980s.death as an essential sign of death by the late 1980s.Defining Brain Death Defining Brain Death Brain death is not medically or legally equivalent to severe vegetative Brain death is not medically or legally equivalent to severe vegetative state. In a severe vegetative state, the cerebral cortex, the center of state. In a severe vegetative state, the cerebral cortex, the center of cognitive functions including consciousness and intelligence, may be cognitive functions including consciousness and intelligence, may be dead while the brain stem, which controls basic life support functions dead while the brain stem, which controls basic life support functions such as respiration, is still functioning. such as respiration, is still functioning. Death is equivalent to brain stem death. The brain stem, which is less Death is equivalent to brain stem death. The brain stem, which is less sensitive to anoxia (loss of adequate oxygen) than the cerebrum, dies sensitive to anoxia (loss of adequate oxygen) than the cerebrum, dies from cessation of circulation for periods exceeding three to four minutes from cessation of circulation for periods exceeding three to four minutes or from intracranial catastrophe, such as a violent accident.or from intracranial catastrophe, such as a violent accident.Even the concept of brain death has been challenged in recent years, Even the concept of brain death has been challenged in recent years, because a person can lose all capacity for higher mental functioning because a person can lose all capacity for higher mental functioning while lower-brain functions, such as spontaneous respiration, continue. while lower-brain functions, such as spontaneous respiration, continue. For this reason, some authorities now argue that death should be For this reason, some authorities now argue that death should be considered the loss of the