Division of Critical Care Medicine, Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital and Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
Pediatrics. 2020 Aug;146(Suppl 1):S75-S80. doi: 10.1542/peds.2020-0818O.
Death is defined biologically as the irreversible loss of the functioning of the organism as a whole, which typically occurs after the loss of cardiorespiratory function. In 1968, a Harvard committee proposed that death could also be defined neurologically as the irreversible loss of brain function. Brain death has been considered to be equivalent to cardiorespiratory arrest on the basis of the belief that the brain is required to maintain functioning of the organism as a whole and that without the brain, cardiorespiratory arrest and biological death are both rapid and certain. Over the past 20 years, however, this equivalence has been shown to be false on the basis of numerous cases of patients correctly diagnosed as brain-dead who nevertheless continued to survive for many years. The issue reached national attention with the case of Jahi McMath, a young woman diagnosed as brain-dead after a surgical accident, who survived for almost 5 years, mostly at home, supported with a ventilator and tube feedings. The fact that brain death is not biological death has many implications, notably including the concern that procurement of organs from brain-dead donors may not comply with the so-called dead donor rule, which requires that vital organs be procured from patients only after they are dead. In this article, I conclude with an analysis of options for moving forward and among them advocate for reframing brain death as a "social construct," with implicit societal acceptance that patients diagnosed as brain-dead may be treated legally and ethically the same as if they were biologically dead.
死亡在生物学上被定义为整个生物体功能不可逆转的丧失，通常发生在心肺功能丧失之后。1968 年，哈佛委员会提出，死亡也可以从神经学角度定义为大脑功能的不可逆转丧失。脑死亡被认为等同于心肺停止，基于这样一种信念，即大脑是维持整个生物体功能所必需的，没有大脑，心肺停止和生物死亡都将迅速而确定。然而，在过去的 20 年里，许多被正确诊断为脑死亡的患者继续存活多年，这证明了这种等同性是错误的。这个问题在 Jahi McMath 的案例中引起了全国的关注，这位年轻女子在手术事故后被诊断为脑死亡，但她在家中存活了近 5 年，依靠呼吸机和管饲维持生命。脑死亡不是生物学死亡这一事实有许多含义，特别是包括人们担心从脑死亡供体获取器官可能不符合所谓的“死亡供体规则”，该规则要求只有在患者死亡后才能从患者身上获取重要器官。在本文中，我对前进的选择进行了分析，并在其中主张将脑死亡重新定义为“社会建构”，隐含着社会接受这样一种观念，即被诊断为脑死亡的患者在法律和伦理上可以被视为与生物学死亡的患者相同。
