When are we really dead? Delicate case of a brain-dead young woman triggers debate

The occurrence of the death is not necessarily a single Moment, but a process to postpone the result of progress in medicine, or even reversed. As is the case of brain-dead Jahi shows, is also the cessation of brain waves, no clear time of death.

Jahi McMaths in bed, with closed eyes, and carefully made up. In the picture, the 17-Year-old American from California, seems to be sleeping. However, at the time of the recording, you did not leave your bed for many years. It was held by a machine – and therefore was in the USA recently the focus of a debate about when life ends and death begins.

In the age of modern medicine, it is doctors, ethicists, lawyers and, not least, for family members of people who are in the grey zone between life and death – a real challenge to answer this question. Because modern imaging techniques and new treatment options are blurring the boundary increasingly.

Today, the principle of brain death is valid

Until well into the 20th century. Century were no longer considered people as dead when their heart beat, the breathing was suspended. Today, the cardiac death is death as a sole criterion is no longer valid. Instead, the diagnosis of brain death is valid as a safe determination of death of a human being. Brain death means that the is down overall function of the cerebrum, cerebellum and Brain stem irretrievable and irreversible. The brain-stem death will need to find two experienced specialist physicians independently of each other according to set criteria.

However, this Definition, so clear it first sounds, is met in the practical implementation limitations, such as the case of Jahi shows. After a dramatic botched tonsil surgery 2013 Jahis EEG showed no brain waves for more. It was declared in California for dead.

A doctor said, Jahis body will decompose soon. But her parents wanted to wait and took Jahi in the U.S. state of New Jersey. There it is possible to refuse, on religious grounds Off of the Ventilator.

After that Jahi was breathing with machine help, seemed to stabilize. You grew up, got their rule. In the summer of 2014, a modern MRI Scan showed that Jahis brain was largely lifeless, in a small, for the consciousness of the major part but still the blood flowed. A doctor certified that the girl also minimal responses – here and there they moved, therefore, to address point fingers and feet, so that a state have time, minimal consciousness seemed possible.

A revival can also work after hours

On the basis of the Definition of brain death , crazy visibles a coma with no measurable brain waves, and dependence on breathing machines – where are people like Jahi? Robert Truog, Director of the center for bioethics, Harvard Medical School, describes in the journal "Jama" the difficulty of this gray area to explore: "While legal definitions are usually marked by clear lines, with a tendency in biology to be a continuum." As a comparison, he mentions the legal age of majority at 18. Birthday – a line is drawn, although to this date, biologically hardly anything changed.

In other words: the occurrence of The death is not necessarily a single Moment, but rather a process. Long advances in modern medicine, even the death can stop it, sometimes even to a kind of reversible condition.

An example: it Meant a ten-minute cardiac arrest, the death to stand judgement for a long time, patients today are revived in extreme cases, even after hours. This is made possible by significant advances in the field of hypothermia, the cooling of an injured body.

The constant cooling to 32 to 34 degrees for up to 24 hours prevents runaway inserting the end of all processes of Decay, especially in the brain. During or after resuscitation are used for this purpose, special Cooling Pads, infusions or ice packs. The procedure is in most Rescue Standard already.

Life-support measures buy time for a rescue

"Meanwhile, more than 80 percent of those who survive have a good neurological Ergebnis", Bernd Böttiger, Director of the clinic for anesthesiology and Operative intensive care medicine, University hospital of Cologne reported. That is, you survive the cardiac arrest without – or at least without serious brain damage.

Also new, portable heart-lung machine to help doctors in the death of a person at the scene to postpone, if a recovery fails first. At least for a while, heart beat, breathing and oxygen supply drives the machine.

"This may give time, about a particular heart problem in peace sondieren", Böttiger reported. He remembers a case where a young Pregnant woman, who had initially been more than resuscitated for one hour, unsuccessful, after three days in the life came back.

Much more effective to avoid a death after cardiac arrest, however, was something else: early on in the revival. Therefore, does Böttiger in a large campaign that already in school children heart learn massage. "What you learn before puberty, you never forget more."

A state of suspension between life and death

A step further Kryoniker, the cool complete people after death in liquid nitrogen, and optimistic patients call go, in the hope to bring them with the forefront of medicine in the future, a new life. "For Kryoniker only an irreversible death is a Tod", the sociologist Thomas Lemke, the research at the Goethe University in Frankfurt am Main on the border of life and death says.

He is engaged in a EU-project for Cryobiology, especially with the past few years, the existing possibility of the body tissue freeze, such as eggs, sperm or embryos. He starts from the Thesis that kryobiologische practices a specific Form of life and calls this "suspended life" – deferred life. "This is a life in limbo, the afterlife or between life and death. It plays a role of hope and anticipation."

The biological substances are neither completely alive nor completely dead. It is a matter of the offer, certain decisions "on ice to legen". "As a result, the life appears as something Controllable." This is not necessarily the case. So not all women would be after a "Social Freezing" pregnant.

Eventually, death occurs, but

The traditional Definition of death will change step by step, says Lemke. "What was once familiar and known, is now no longer a matter of course. It comes to end-of-life processes. And it is a task to synchronize these processes with the legal binary breakdown of death and life."

To us cases like that of Jahi McMath will remind also, in the future, again and again. The 17-Year-old is now dead. She died at the end of June to the consequences of liver failure. To a will change, despite all the medical progress has nothing to do: at some point he wins, but then, death.