Iltis Ana Smith, Cherry Mark J
Saint Louis University, 221 North Grand Blvd., St. Louis, MO 63103, USA.
J Med Philos. 2010 Jun;35(3):223-41. doi: 10.1093/jmp/jhq017. Epub 2010 May 9.
Traditionally, people were recognized as being dead using cardio-respiratory criteria: individuals who had permanently stopped breathing and whose heart had permanently stopped beating were dead. Technological developments in the middle of the twentieth century and the advent of the intensive care unit made it possible to sustain cardio-respiratory and other functions in patients with severe brain injury who previously would have lost such functions permanently shortly after sustaining a brain injury. What could and should physicians caring for such patients do? Significant advances in human organ transplantation also played direct and indirect roles in discussions regarding the care of such patients. Because successful transplantation requires that organs be removed from cadavers shortly after death to avoid organ damage due to loss of oxygen, there has been keen interest in knowing precisely when people are dead so that organs could be removed. Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized by all 50 states in the United States as an acceptable way to determine death. We explore the ongoing debate over definitions of death, particularly over brain death or death determined using neurological criteria, and the relationship between definitions of death and organ transplantation.
传统上,人们依据心肺标准来认定死亡:那些永久停止呼吸且心脏永久停止跳动的个体即为死亡。二十世纪中叶的技术发展以及重症监护病房的出现,使得在严重脑损伤患者中维持心肺及其他功能成为可能,而这些患者在脑损伤后原本会很快永久丧失这些功能。照料此类患者的医生能够且应该怎么做呢?人体器官移植方面的重大进展在关于此类患者护理的讨论中也发挥了直接和间接的作用。由于成功的移植要求在死亡后不久就从尸体上摘取器官,以避免因缺氧导致器官受损,所以人们一直热衷于精确知晓人何时死亡,以便能够摘取器官。基于神经学标准的死亡判定标准得以发展,如今全脑死亡定义被广泛使用,并且在美国所有50个州都被认可为确定死亡的一种可接受方式。我们探讨了关于死亡定义的持续争论,尤其是关于脑死亡或依据神经学标准判定的死亡,以及死亡定义与器官移植之间的关系。