Brain death/cessation of life - Indian Laws - General

Term `brain death / cessation of life The term `brain death has developed various meanings. While initially, death could be defined as a cessation of breathing, or, more scientifically, a cessation of heart-beat, recent medical advances have made such definitions obsolete. In order to understand the nature and scope of brain death, it is worthwhile to look at how death was understood. Historically, as the oft-quoted definition in Black s Law Dictionary suggests, death was: The cessation of life ; the ceasing to exist; defined by physicians as a total stoppage of the circulation of the blood, and a cessation of the animal and vital functions consequent thereon, such as respiration, pulsation, etc. .1 This definition saw its echo in numerous other texts and legal case law . This includes many American precedents- such as Schmidt v. Pierce, 344 S.W.2d 120, 133 (Mo. 1961) ( Black s Law Dictionary , 4th Ed., defines death as `the cessation of life; the ceasing to exist .... ); and Sanger v. Butler, 101 S.W. 459, 462 (Tex. Civ. App. 1907) ( The Encyclopaedic Dictionary , among others, gives the following definitions of [death]: `The state of being dead; the act or state of dying; the state or condition of the dead. The Century Dictionary defines death as `cessation of life; that state of a being, animal or vegetable, in which there is a total and permanent cessation of all the vital functions. ). This understanding of death emerged from a cardiopulmonary perspective. In such cases, the brain was usually irrelevant -- being understood that the cessation of circulation would automatically lead to the death of brain cells, which require a great deal of blood to survive. The invention of the ventilator and the defibrillator in the 1920s altered this understanding, it being now possible that the cessation of 1 Black s Law Dictionary 488 (4th ed., rev. 1968). 2 Goldsmith, Jason, Wanted! Dead and/or Alive: Choosing Amongst the Many Not-so-Uniform Definitions of Death, 61 U. Miami L. Rev. 871. (2007). respiration and circulation, though critical, would no longer be irreversible. Hence, a present-day understanding of death as the irreversible end of life must imply total brain failure, such that neither breathing, nor circulation is possible any more. The question of the length of time that may determine such death is significant, especially considering a significant increase in organ donations across jurisdictions over the last few years. Brain death, may thus, be defined as the irreversible cessation of all functions of the entire brain, including the brain stem .4 It is important to understand that this definition goes beyond acknowledging consciousness -- a person who is incapable of ever regaining consciousness will not be considered to be brain dead as long as parts of the brain e.g. brain stem that regulate involuntary activity (such as response to light, respiration, heartbeat etc.) still continue to function. Likewise, if consciousness, albeit severely limited, is present, then a person will be considered to be alive even if he has suffered brain stem death, wherein breathing and heartbeat can no longer be regulated and must be mechanically determined. Hence, the international standard for brain death is usually considered to include whole-brain death , i.e., a situation where the higher brain (i.e. the part of the brain that 3 Samantha Weyrauch, Acceptance of Whole Brain Death Criteria for Determination of Death: A Comparative Analysis of the United States and Japan, 17 UCLA Pac. Basin L.J. 91, 96. (1999). 4 Section 1, Universal Determination of Death Act, (The United States Legislation) regulates consciousness and thought), the cerebellum or mid-brain, and the brain-stem have all ceased to demonstrate any electrical activity whatsoever for a significant amount of time. To say, in most cases, that only the death of the higher brain would be a criteria for `brain death may have certain serious consequences -- for example, a foetus, technically under this definition, would not be considered to be alive at all. Similarly, as per this, different definitions of death would apply to human and non-human organisms. Brain death, thus, is different from a persistent vegetative state, where the brain stem continues to work, and so some degree of reactions may occur, though the possibility of regaining consciousness is relatively remote. Even when a person is incapable of any response, but is able to sustain respiration and circulation, he cannot be said to be dead. The mere mechanical act of breathing, thus, would enable him or her to be alive . The first attempt to define death in this manner came about in 1968, as a result of a Harvard Committee constituted for the purpose.5 This definition, widely criticized for trying to maximize organ donations, considered death to be a situation wherein individuals who had sustained traumatic brain 5 Ad Hoc Comm. of the Harvard Med. Sch. to Examine the Definition of Brain Death, A Definition of Irreversible Coma, 205 JAMA 337, 337-40 (1968). injury that caused them to be in an irreversible coma, and had lost the ability to breathe spontaneously 6, would be considered dead. This criticism led to the Presidents Committee, set up for the purpose, in 1981, defining death more vaguely as the point where the body s physiological system ceases to contribute a uniform whole . ARUNA RAMCHANDRA SHANBAUG VERSUS UNION OF INDIA AND OTHERS - 2011 (3) TMI 1729 - SUPREME COURT