Death

Death

Pronouncing a patient dead in a hospital seems relatively simple: palpate for a pulse, determine the patient's lack of neurological function, and then say out loud their full name and time of death. Except it's not that simple - in institutional care. The difference between the dead and the living is easy to draw in the right context. There are professions where this skill is essential. Think of soldiers in the middle of a battlefield, military photojournalists, or field trauma EMTs at the scene of a multi-vehicle accident: each must make quick and decisive statements about a person's vitality in order to do their job effectively and decisively. through a combination of available objective information and personal experience. A hospital environment is a much more controlled environment, so it can be expected that the protocols for determining death are much more standardized. But they are hardly uniform. Here's my problem with this situation: If I declare a patient dead, neither I nor his family members (and frankly, the patient himself) should face uncertainty. For example, I should know what the definition of death is. I also know how to medically determine when a patient is no longer alive. I'm even content to be sure that someone died right when I say that, but doctors and their patients can't afford even that luxury. Let's break down my concerns one by one. First, what is the definition of in-hospital death? You might be surprised to know that the answer depends on whether you asked before or after 1968. Before 1968, death was defined in most hospitals as the cessation of all vital functions, including breathing and heartbeat, sometimes referred to as "heart and heart ." definition of "lung". As the technological ability to keep a patient's heart and lungs functioning has improved, the medical definition of living has become much more blurred. It was not until 1968, when an ad hoc committee at Harvard Medical School developed the so-called Harvard Criteria, that "brain death" was added to the commonly used definitions of hospital death. To further harmonize the definition of in-hospital death in 1981, the newly formed President's Commission on Ethics in Medicine and Biomedical and Behavioral Research (PCSEPMBBR, because no one on this planet relates to it) recommended that all states adopt the Uniform. Determination of Death Act (UDDA). The UDDA stated that "a person who has suffered (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all brain functions, including the brainstem, is dead. Determination of death must be made according to accepted medical standards. " The act sought to add this new "complete brain death" statute, in addition to the definition of heart and lungs, into the laws of all 50 states, with varying degrees of success. I would give a B-minus for effort. Most states have adopted some form of UDDA, but the variation in state laws is striking. North Carolina, for example, lacks heart and lung care. Louisiana and Texas completely remove the brain death clause from hospital death definitions. And the phrase "consistent with accepted medical standards" is absent from Georgia law, appearing in equally vague form in Minnesota ("generally accepted medical standards"), Maryland ("ordinary medical standards") and Florida ("consistent with the present") . . accepted medical standards). I dare you to find 10 doctors who can agree on what the "generally accepted" or "usual" standards of medical practice are, let alone decide whether the cessation of "all brain, including brainstem" functions is essential to establish death . It is not impossible for hospitals, states, and even countries to agree on protocols or medical definitions. Consider systemic inflammatory response syndrome (SIRS) and its relative sepsis. SIRS is a clinically measurable systemic inflammatory condition that can affect multiple body systems. And when this life-threatening organ dysfunction is caused by an irregular response to infection, it's called sepsis. SIRS is defined as at least two of the following four criteria: a white blood cell count less than ,000 per cubic millimeter or greater than 12,000/mm3; temperature below 36 degrees Celsius or above 38 degrees C; heart rate more than 90 beats per minute; and respiratory rate is greater than 20 breaths per minute.