Death: the concept to the diagnosis: controversies and ethical dilemmas
Keywords:
Ethics, Death, Brain death, NeurologyAbstract
In the last fi fty years the technical and scientifi c advances in fifty years the technical and scientific advances in
the area of medicine have introduced into clinical practice new
concepts of death, the diagnosis of which entails the production
of an elaborate list of evidence. The coexistence of various criteria
of death has been a controversial issue and subject to intense
debate.
With discussions caught up in a stalemate of unclear concepts
and defi nitions, criteria of cerebral death were ratifi ed in most
countries. Portugal adopted the death of the brain stem as the
criterion that has been applied since 1994.
In this article, after putting the issue into historical perspective,
the different defi nitions, criteria and testing of death are revised,
mainly from an ethical point of view, in reference to the main
arguments put forth by advocates of each position.
It is concluded that the inexistence of a single concept of death,
together with the variation of criteria and testing methods are the
evidence of the weakness of these defi nitions. Therefore clinical
situations which are considered irreversible may no longer be so,
depending on the scientifi c knowledge about the physiopathology
of diseases and therapeutic resources. In relation to the tests
used in the diagnosis of death, it is concluded that performing
the apnea testing violates the most elementary rules employed
to avoid irreversible brain damage in the treatment of patients
with intracranial hypertension.
This makes a serious effort of therapeutic investigation into
the situations of coma and apnea mandatory at the same time
as an overall revision of testing methods in order to exclude the apnea testing.
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