From the Division of Critical Care Medicine (A.R.J.), Department of Pediatrics, and John Dossetor Health Ethics Center (A.R.J.), University of Alberta, Edmonton, Canada.
Neurology. 2023 Jul 25;101(4):181-183. doi: 10.1212/WNL.0000000000207403. Epub 2023 Jul 10.
I argue that death is irreversible and not merely permanent. Irreversible means a state be reversed and entails permanence. Permanent means a state be reversed and includes cases where the state could still be reversed though a decision has been made not to attempt this reversal. This distinction is important, as we shall see. Four reasons are given for why death must be irreversible and not merely permanent: no mortal can return from the state of death; unacceptable implications regarding culpability for actions and omissions; death is a physiologic state; and irreversibility is inherent in the standards to diagnose brain death. Four objections are considered including the following: permanence is the medical standard, permanence was the intent of the President's Commission on defining death, irreversible requires many hours to occur, and we should change terminology to reflect our case intuition. These objections are discussed and rejected. Finally, I clarify my views to conclude that the criterion for biological death is irreversible loss of circulation.
我认为死亡是不可逆转的，而不仅仅是永久性的。不可逆转意味着一种状态不能被逆转，并包含永久性。永久性意味着一种状态不能被逆转，包括尽管已经做出不尝试逆转的决定，但状态仍然可以被逆转的情况。这个区别很重要，我们将看到。有四个原因说明死亡必须是不可逆转的，而不仅仅是永久性的：没有凡人可以从死亡状态中复活；对行为和疏忽的罪责的不可接受的影响；死亡是一种生理状态；并且不可逆转性是诊断脑死亡的标准所固有的。考虑了四个反对意见，包括以下内容：永久性是医学标准，永久性是总统委员会定义死亡的意图，不可逆转需要几个小时才能发生，我们应该改变术语来反映我们的案例直觉。这些反对意见进行了讨论和反驳。最后，我澄清了我的观点，得出结论，生物死亡的标准是循环不可逆转的丧失。
