Whither Brain Death?

The American Journal of Bioethics, Volume 14, Issue 8, 2014
Author: James L. Bernat
“The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human death but remains poorly understood by the public and by health professionals. The current controversies over brain death are largely restricted to the academy, but some practitioners express ambivalence over whether brain death is equivalent to human death. Brain death remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public.”
Find abstract here and related articles ‘Changing the Conversation About Brain Death’ and ‘Brain dead and pregnant in Texas‘. Find related commentaries on main articles here.

India’s Supreme Court consults on right to die for terminally ill people

BMJ 2014;349:g4936
Author: Sanjeet Bagcchi
“India’s Supreme Court issued notices on 16 July to the country’s state governments for their responses on euthanasia, calling for a national debate on the issue and giving them eight weeks to respond. A constitution bench, comprising Chief Justice RM Lodha and Justices JS Khehar, J Chelameswar, A Sikri, and Rohinton F Nariman, heard a petition filed by an Indian non-governmental organisation, Common Cause, and agreed to examine the issue that the right to refuse treatment and the right to die with dignity be incorporated in the right to life.”
Find article here.

Why the delays in counting the dead?

BMJ 2014;349:g4305
Author: Nigel Hawkes
“Death may be final, but in England and Wales it isn’t the last word: you aren’t officially dead until somebody else says so. That depends on establishing a cause of death—and if that should require an inquest, the fact of death goes unrecorded, sometimes for years. Just how long depends on local coroners, who enjoy considerable autonomy. A group of charities recently wrote a letter to the prime minister calling for urgent changes to the law, saying that it can take from six months to two and a half years to register a death. Such delays have a significant effect on research and public health, not to mention the burden on grieving families who cannot close the book on the life of a loved one.”
Find article here.

Let’s be clear about what we mean when we say euthanasia

The Conversation, online 26 May 2014
Author: Peter Saul
“Debate about euthanasia flares up in Australia every few months but, for some reason, it never gets very far. The latest round started late last month, when urologist and campaigner for voluntary euthanasia Rodney Syme confessed to an act of mercy killing, and said he was prepared to be charged and jailed for it.”
Find article here.

How do we decide the value of death (and life)?

The Conversation, online 3 April 2014
Author: Peter Saul
“Allowing people with incurable and unsupportable illness to die is ethically acceptable to most people, even though it’s unlikely there will ever be unanimity about when and how we allow such deaths. But as we move into an era of treating chronically ill people with technology that tempts us to try achieve the hopeless, it’s more important than ever that we talk about what kind of death (and life) is acceptable to us – and why.”
Find article here.

Canada needs a “dialogue about death” says CMA president

CMAJ, early release online 24 February 2013
Author: Jack Lawson
“Canada is facing a severe crisis surrounding end-of-life care due to the stigma surrounding it and funding concerns, Dr. Louis Hugo Francescutti, president of the Canadian Medical Association told the Economic Club of Canada in Ottawa, Ontario on February 19. The end of life is difficult to face at the best of times, but Canadians need to open a “dialogue about death,” said Francescutti. This is particularly important in light of the upcoming vote on Quebec’s Bill 52:  An Act respecting end-of-life care.”
Find article here.

Bioethics and the Dogma of “Brain Death”

Bioethics Forum, The Hastings Center, 3 February 2013
Authors: Franklin G. Miller and Robert D. Truog
“Two cases involving “brain death” have received considerable public attention, including commentary by several well-known bioethicists. In commenting on these cases the bioethicists have stated, in no uncertain terms, that an individual correctly diagnosed as “brain dead” is dead, pure and simple.  Contrary to appearances of being alive, in reality the “brain dead” individual is a corpse.  These statements are misleading because they have ignored the long-standing controversy and debate in the professional literature over the determination of death:  specifically, whether individuals diagnosed as “brain dead” should be considered dead and, if so, why they are dead.”
Find article here.

Don Hutchinson: Euthanasia — a ‘settled’ issue still up for debate

National Post, By Don Hutchinson, October 9, 2013

“The Government of Quebec is wrapping up public hearings on what may decide whether June 12, 2013 becomes a forgotten date, or one that lives on in infamy. It was on that date that Quebec’s health minister introduced pro-euthanasia legislation designed to plunge both province and nation into debate over the limits of personal autonomy and the meaning of healthcare. All this less than five years after Bloc Quebecois’ Member of Parliament Francine Lalonde’s third failed attempt to have euthanasia and assisted suicide legalized in Canada. It was soundly defeated 228 to 59 in the House of Commons.  First, it creates the new term “medical aid in dying,” a euphemism for physician administered lethal injection. This is known as euthanasia, categorized under the Criminal Code as murder. In short, provincial government spin-doctors are seeking to authorize medical professionals to step outside the Criminal Code prohibition on murder in order to kill patients if a doctor agrees with the patient — or the patient’s care giver — that the patient’s life is not worth living. How is this care?  Second, the administration of “medical aid in dying” — in my opinion it is entirely appropriate that the Government of Quebec and others are using the acronym MAD — is not confined to those in pain on a hospital bed at the end of life. 

When we’re sick we go to the doctor — Quebeckers included — and we expect help to get better. In the Netherlands and Belgium, which have their own MAD regimes, it is now reported that outcomes from a visit to the doctor may include legal euthanasia (following patient decision after conversation with a doctor) or involuntary euthanasia (following doctor decision after conversation with a patient). If you think the same won’t happen here, or what happens in Quebec stays in Quebec, you could not only be wrong but dead wrong.”

Find article here.

Nicklinson & Anor, R (on the application of) v A Primary Care Trust [2013] EWCA Civ 961

The Lord Chief Justice, the Master of the Rolls, and lord Justice Elias, 31 July 2013
“[1] These appeals concern individuals who suffer from permanent and catastrophic physical disabilities. They are of sound mind and acutely conscious of their predicament. They do not want to suffer a painful and undignified process of dying. They wish to die at a time of their choosing. However, they are not physically capable of ending their own lives unaided. AM (known as “Martin”, but that is not his real name) can end his own life but only with the assistance of a third party. Paul Lamb is so disabled that he cannot even commit suicide with assistance; he requires a third party to terminate his life. (That was also the position of Tony Nicklinson, although he died soon after the judgment below was delivered.) Each has a settled and considered wish that his death should be hastened by the requisite assistance. Each contends that as a matter of both common law and European Convention of Human Rights law (“the Convention”), those who provide him with assistance to bring about his death ought not to be subject to any criminal consequences. The current understanding of the law is that those providing such assistance will be committing the offence of assisted suicide contrary to section 2(1) of the Suicide Act 1961 (“the 1961 Act”) if they merely assist a person to take his own life, and murder if they actually terminate life themselves.”
Find judgment here.