enerbol and Brain-Diseases

The current debate regarding the suitability of anencephalics as organ donors is due primarily to misunderstandings. The anatomical and neurophysiological literature shows that the anencephalic lacks a cerebrum because of the failure of neuralplate fusion. However, even the incomplete function of an atrophic brain stem is currently accepted at law in most if not all countries as sufficient for brain life: which is to say, cessation of breathing is currently required in order to make the diagnosis of brain death. Because of the extensive incompleteness of the anencephalic's brain, it is not possible to postpone death significantly by mechanical ventilation and intravenous feeding. It is acceptable to maintain life for a short period of time in order to allow organ transplantation subsequent to the declaration of death at the point of cessation of the capacity for spontaneous respiration. The most important issue is not transplantation, but the issue of brain life raised by the case of anencephalics. Since brain life in any significant sense begins only after the closure of the neural tube on the 30th day after conception, it is reasonable to take this as the point at which brain life begins. Laws should be amended in all countries to allow the abortion of anencephalics at any time, in that they do not at any time possess brain life.

Topics: Aborted Fetus; Abortion, Induced; Anencephaly; Beginning of Human Life; Brain; Brain Death; Brain Diseases; Ethics, Medical; Female; Fetus; Humans; Infant, Newborn; Internationality; Life; Personhood; Philosophy, Medical; Pregnancy; Pregnant Women; Tissue and Organ Procurement; Tissue Donors

Transplantation technology has been refined in recent years and now offers hope to pediatric patients with a variety of end stage disease processes. The lack of available donors for the smallest potential organ recipients has led to the suggestion that anencephalic infants be used as organ donors. This suggested policy is contrary to current law and raises fundamental ethical issues relating to the definition of death and the treatment of the dying. The technical issues in the potential organ supply from this source are described and the opposing ethical positions developing in this debate are discussed.

Topics: Aborted Fetus; Anencephaly; Beginning of Human Life; Brain Death; Brain Diseases; Ethical Theory; Ethics, Medical; Human Body; Humans; Infant, Newborn; Legislation, Medical; Life; Nontherapeutic Human Experimentation; Personhood; Tissue and Organ Procurement; Tissue Donors; Transplantation, Homologous; United States; Value of Life

Some form of potential or "capacity" is often seen as evidence of human moral status. Opinions differ as to whether the potential of the embryo should be regarded as such evidence. In this paper, I discuss some common arguments against regarding the embryo's potential as a sign of human status, together with some less common arguments in favour of regarding the embryo's potential in this way.

Topics: Adult; Animals; Beginning of Human Life; Brain Diseases; Embryo, Mammalian; Ethics, Medical; Female; Fertilization; Fetal Research; Fetus; Health Care Rationing; Human Characteristics; Human Rights; Humans; Infant; Life; London; Male; Moral Obligations; Morals; Personhood; Socioeconomic Factors

The dominant conception of brain death as the death of the whole brain constitutes an unstable compromise between the view that a person ceases to exist when she irreversibly loses the capacity for consciousness and the view that a human organism dies only when it ceases to function in an integrated way. I argue that no single criterion of death captures the importance we attribute both to the loss of the capacity for consciousness and to the loss of functioning of the organism as a whole. This is because the person or self is one thing and the human organism is another. We require a separate account of death for each. Only if we systematically distinguish between persons and human organisms will we be able to provide plausible accounts both of the conditions of our ceasing to exist and of when it is that we begin to exist. This paper, in short, argues for a form of mind-body dualism and draws out some of its implications for various practical moral problems.

Topics: Beginning of Human Life; Brain; Brain Death; Brain Diseases; Brain Injuries; Cognition; Comprehension; Death; Embryo, Mammalian; Euthanasia; Euthanasia, Active; Euthanasia, Passive; Humans; Individuality; Life; Persistent Vegetative State; Personhood; Philosophy; Self Concept

Detection of fetal hydrocephalus with head enlargement in the third trimester raises questions concerning the extent of the physician's obligations to the fetus and to the mother. Here Strong develops and defends an approach to these questions that he discussed in an earlier essay ("Ethical conflicts between mother and fetus in obstetrics," Clinics in Perinatology 1987 Jun; 14(2): 313-328), dividing the ethical issues involved into two main topics. He first explores under what circumstances a physician is ethically justified in draining fluid from the fetal cranium to reduce head size. This procedure, which usually causes fetal death, facilitates vaginal delivery. A cesarean section, which is less stressful for the fetus, exposes the woman to the risks of surgery. Secondly, Strong applies this discussion to the issue of how the physician should counsel the woman, and what recommendations, if any, the physician should make concerning the method of delivery.

Topics: Beginning of Human Life; Brain Diseases; Brain Injuries; Cesarean Section; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Counseling; Decision Making; Disclosure; Embryonic and Fetal Development; Ethical Analysis; Ethics; Fetus; Homicide; Human Rights; Humans; Hydrocephalus; Individuality; Infant, Newborn; Infant, Premature; Infanticide; Informed Consent; Labor, Obstetric; Liability, Legal; Life; Maternal Welfare; Methods; Moral Obligations; Morbidity; Mortality; Patient Care; Personhood; Physician's Role; Physicians; Policy Making; Pregnancy; Pregnant Women; Prognosis; Risk; Risk Assessment; Self Concept; Social Responsibility; Treatment Refusal; Value of Life

The connection between brain life and brain death is neither as simple nor as defensible as it might at first appear. The problem rests with the two dominant competing definitions of death:...the loss of that which is necessary for the organism to continue to function as a whole;....the loss of that which is essentially significant to the nature of the organism... If death is understood as the loss of that which is necessary for the continued functioning of the organism as whole, then the apparent symmetry breaks down. If...death could be understood as the loss of that which is essentially significant to the nature of the organism....consciousness, then the symmetry would hold. However, that definition of death is indefensible. Therefore...statements about the status of anencephalic infants and early human embryos based upon a connection between brain death and brain life are unfounded.

Topics: Adult; Anencephaly; Beginning of Human Life; Brain; Brain Death; Brain Diseases; Brain Injuries; Death; Embryo, Mammalian; Embryonic and Fetal Development; Human Characteristics; Humans; Individuality; Infant; Life; Persistent Vegetative State; Personhood; Philosophy; Self Concept

Kuhse and Singer, the editors of this special issue of Bioethics, introduce seven articles on conflicting concepts, public policies, and standards for the determination of cardiorespiratory and brain death and the relationship of brain death to the beginning of "brain life" and to organ donation, especially from anencephalic infants. The articles are "Consciousness, the brain and what matters," by Grant Gillett; "Brain death and the anencephalic newborn," by Robert D. Truog and John C. Fletcher; "Brain death and brain life: rethinking the connection," by Jocelyn Downie; "A plea for the heart," by Martyn Evans; "The importance of knowledge and trust in the definition of death," by Bo Andreassen Rix; "Death, democracy and public ethical choice," by Reid Cushman and Soren Holm; and "Misunderstanding death on a respirator," by Tom Tomlinson.

Topics: Anencephaly; Attitude; Beginning of Human Life; Brain; Brain Death; Brain Diseases; Brain Injuries; Cognition; Community Participation; Comprehension; Death; Decision Making; Denmark; Embryo, Mammalian; Embryonic and Fetal Development; Ethics; Heart; Humans; Individuality; International Cooperation; Internationality; Life; Life Support Care; Nurses; Persistent Vegetative State; Personhood; Physicians; Public Opinion; Public Policy; Reference Standards; Self Concept; Tissue and Organ Procurement; Tissue Donors; United States; Withholding Treatment

Cutter's essay is one of eight in this issue of the Journal of Medicine and Philosophy on controversies surrounding the use of tissues and organs from anencephalic fetuses and newborns for transplantation. She reviews some of the disagreements clustering around three major issues concerning the status of anencephalics as donors: the definition of brain life, the definition of personhood, and the definition of brain death. She also assesses how the other essayists in this issue offer solutions to the debate in light of a pluralism of moral beliefs in Western culture.

Topics: Anencephaly; Beginning of Human Life; Brain; Brain Death; Brain Diseases; Cultural Diversity; Ethics, Medical; Female; Humans; Infant, Newborn; Life; Morals; Personhood; Philosophy, Medical; Pregnancy; Prenatal Diagnosis; Tissue and Organ Procurement; Tissue Donors; Value of Life

Topics: Beginning of Human Life; Brain Death; Brain Diseases; Consciousness; Ethics, Medical; Humans; Life; Life Support Care; Moral Obligations; Morals; Patient Advocacy; Personhood; Resource Allocation; Stress, Psychological; Tissue and Organ Procurement; United States; Withholding Treatment

A member of a medical center fetal treatment program and division of pediatric surgery discusses the technical feasibility and unique suitability of fetal tissue and organ transplants for treatment of diseases and congenital defects in children. He argues that anencephalic fetuses would be ideal donors. Although some maintain that the anencephalic newborn is incapable of achieving personhood because it lacks the forebrain necessary for characteristic human activity, Harrison rejects using this claim because of the controversy concerning personhood, the potential for lack of respect for the fetus and its parents, and the possibility that less severely handicapped fetuses might be denied personhood. He proposes that the anencephalic fetus be considered a dying person because of clearly definable brain absence, and that such a fetus be recognized as brain dead for medicolegal purposes. The family could then be approached concerning donation.

Topics: Aborted Fetus; Anencephaly; Beginning of Human Life; Brain Diseases; Ethics, Medical; Female; Fetus; Graft Survival; Human Body; Humans; Kidney Transplantation; Life; Liver Transplantation; Parental Consent; Personhood; Pregnancy; Pregnant Women; Prenatal Diagnosis; Risk Assessment; Tissue and Organ Procurement; Tissue Donors

Topics: Abortion, Induced; Adult; Beginning of Human Life; Bioethical Issues; Bioethics; Brain Death; Brain Diseases; Brain Injuries; Death; Dementia; Ethicists; Ethics; Euthanasia, Passive; Fetus; Human Characteristics; Humans; Individuality; Infant; Infanticide; Life; Moral Obligations; Persistent Vegetative State; Personhood; Philosophy; Reference Standards; Self Concept; Social Responsibility; Value of Life

Topics: Brain; Brain Diseases; Child; Cryptococcosis; Humans; Infant; Life; Portugal

Topics: Aged; Brain; Brain Diseases; Humans; Life; Mental Disorders; Mental Health; Stress, Physiological