The medical diagnosis of brain death is at odds with our traditional view of when death actually occurs, says a leading academic speaking at an international conference on death, dying and disposal in Bath.
Whilst a diagnosis of brain death is made using factors including fixed and dilated pupils, lack of eye movement, absence of respiratory reflexes, the social understanding of death is that it occurs when the heart stops beating.
This makes decisions that often follow brain death, such as organ removal and the cessation of life support, potentially unsettling for the bereaved, says Professor Allan Kellehear from the Centre for Death and Society at the University of Bath.
He is calling for organ removal and cessation of life support to become social decisions, rather than purely medical ones, and for more research to be carried out into the social impact of brain death and its implications.
Brain death vs heart death
“Forty years ago, being dead used to be very simple - it was the point at which your heart stopped beating,” said Professor Kellehear.
“Now death itself has been complicated by the fact that we can keep alive people who are brain dead almost indefinitely.
“Brain death is the point at which doctors can switch off machines or begin harvesting organs, but, to relatives, being brain dead is not the same as being a corpse.
“Corpses are not warm, they are not pink, they do not move, they are not pregnant – but a person who is brain dead can be all of these things.
“To all appearances, there is little difference between a person who is brain dead and a person who is asleep.
“At the same time we ask people if it is okay to remove a beating heart or other living organ from their loved one.
Families still hold out hope
“It is further complicated by the fact that one in one thousand people who are brain dead survive when the machines are switched off.
“If it is your daughter lying there, your idea of a remote chance is very different from that of your daughter’s doctor. The situation at present is that these decisions are based on medical information alone.”
“I would argue that these should be social decisions. To better inform these decisions, we need a closer look at the social implications of brain death.
“At present, this understanding is totally lacking from the medical literature on this topic.”
Brain death - when is it all over?