Baker Andrew, Shemie Sam D
Departments of Critical Care and Anesthesia, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada; Departments of Anesthesia and Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Medical Director, Extracorporeal Life Support Program; McGill University, Loeb Chair and Research Consortium in Organ and Tissue Donation, Faculty of Arts, University of Ottawa.
J Crit Care. 2014 Aug;29(4):687-9. doi: 10.1016/j.jcrc.2014.04.013. Epub 2014 Apr 29.
The capacity for consciousness and self-awareness is uniquely synonymous with human life and personhood, and its absence is necessary and sufficient to identify that death has occurred. The presence of these functions is uniquely synonymous with human life. Ongoing organ function, response to infection, growth, wound healing, or the ability to sustain an unborn fetus do not alone constitute the unique experience of life and personhood. Death occurs after the loss of the ability to use oxygen by the brain, which occurs because of either raised intracranial pressure preventing any cerebral blood flow or, more commonly, the absence of systemic blood flow following abrupt or hypoxic circulatory cessation. The abrupt cessation of circulation leads to loss of consciousness and brain electrical activity; and when it becomes truly permanent and then irreversible, this becomes an operational definition of death. One must infer and decide that sufficient ischemic hypoxic injury has rendered the potential for reinstating any consciousness and brain stem function irreversibly lost. Progressive hypoxia that is seen in many patients after withdrawal of advanced physiologic support leads to apnea and then circulatory arrest. The outward sign of apnea that is then followed by circulatory arrest is the basis for inferring that irreversible loss of capacity for consciousness and self-awareness has occurred and that death can be identified has having occurred. The capacity for consciousness and self-awareness is the only irreplaceable emergent phenomenon—arising from physiologic function of the brain—that is necessary and sufficient to define the life of a person.
意识和自我意识的能力是人类生命和人格的独特同义词，而其缺失是确定死亡发生的必要且充分条件。这些功能的存在是人类生命的独特同义词。持续的器官功能、对感染的反应、生长、伤口愈合或维持未出生胎儿的能力，单独并不构成生命和人格的独特体验。死亡发生在大脑失去利用氧气的能力之后，这是由于颅内压升高阻止任何脑血流，或者更常见的是，在突然或缺氧性循环停止后缺乏全身血流。循环的突然停止导致意识和脑电活动丧失；当这种情况变得真正永久且不可逆转时，这就成为了死亡的操作性定义。必须推断并确定足够的缺血性缺氧损伤已使恢复任何意识和脑干功能的可能性不可逆转地丧失。在撤除高级生理支持后，许多患者出现的进行性缺氧会导致呼吸暂停，进而导致循环骤停。呼吸暂停随后伴有循环骤停的外在迹象是推断意识和自我意识能力已不可逆转地丧失且可确定死亡已发生的依据。意识和自我意识的能力是唯一不可替代的涌现现象——源自大脑的生理功能——是定义一个人生命的必要且充分条件。
