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Starting from Abe’s death: When does a person die?

  In ancient costume movies and TV dramas, people often put their hands in front of each other’s noses to test whether there is breathing, so as to judge “whether the person in front of them is dead”. Although this approach may seem sloppy, it is not without basis.
  Clinically, to confirm a person’s death, three aspects need to be combined: cardiac arrest, respiratory arrest, and loss of pupillary reflexes.
  However, the standard of death in the world is not uniform. Some take the moment when the heart stops beating; others believe that the moment the “brain dies”, a person dies.
  That is to say, there is not only one answer to the question “When does a person die?”
Abe dies

  On July 8, Shinzo Abe was shot in the chest while giving a speech on the streets of Nara. According to media reports that morning, Abe was still conscious when he got into the ambulance, and soon “cardiopulmonary function stopped” – as the name suggests, stopped breathing and heartbeat. But without a doctor’s confirmation, this situation does not directly declare death.
  After Abe was transferred to the hospital, the hospital once considered installing an artificial heart and lungs for Abe; if it succeeds, it is not impossible for Abe to be “resurrected”. But things didn’t work out, and that afternoon, Abe was pronounced dead.
  After Abe was shot in the chest, the “cardiopulmonary function stopped” is similar to the “cardiac arrest” caused by a heart attack. Cardiopulmonary resuscitation is required immediately after cardiac arrest. If rescue fails, clinical death will be declared.
  In medicine, death is not an “instantaneous action”. When the brain is dead, there may be a heartbeat; the brain may still be alive for a few minutes without a heartbeat. Clinical death generally refers to cardiac arrest and respiratory arrest; biological death refers to the death of all human cells 24 hours after cardiac arrest.
  At present, the method of death determination recognized by Chinese law is still “heart death”. But with the development of organ transplantation surgery technology, the medical community is more inclined to take “brain death” as the standard of death. That is to say, when a person’s entire brain function, including the brain stem, is permanently lost, his life is ended.
  Today, more than ten countries, including the United States, the United Kingdom, Germany, and India, have legislated to define “brain death” as the standard of death. Although Belgium and South Korea have not yet formally recognized this standard, they have also begun to use the concept of “brain death” in clinical practice.
  During the two sessions this year, Chen Jingyu, a deputy to the National People’s Congress and director of the Jiangsu Lung Transplant Center at Wuxi People’s Hospital, also suggested that China’s “brain death” legislation be accelerated.
How to accept “brain death”?

  Taking the United States as an example, except for special circumstances such as organ donation, clinicians will end the treatment of patients soon after determining that the patient is “brain dead”, which has been the case for many years.

Bedridden Jassie McMarsh with family in January 2018

  However, a case in 2013 challenged the law.
  That year, the little black girl Jahi McMath (Jahi McMath) was only 13 years old. She suffered hemorrhagic complications after a complicated oropharyngeal operation and was declared “brain dead” on December 12 of the same year, and received a death certificate.
  Her mother did not accept this conclusion and asked the doctor to continue to maintain the treatment of Jassie, but was refused by the hospital, which thought it was just a waste of medical resources.
  Shortly thereafter, Jassie was transferred from California to New Jersey and continued to “live” as a comatose patient for four and a half years, eventually dying of abdominal complications on June 18, 2018.
  Surprisingly, she experienced puberty phenomena such as menarche during this time. Home video shows she also responded to some commands.

  A person who still has body temperature, how can his (her) relatives accept that he or she is dead?

  In March 2015, Jassy’s family filed a malpractice lawsuit against Oakland Children’s Hospital and the surgeon who operated on Jassy. They said Jassie was not dead but was severely disabled. A death certificate issued on June 22, 2018, revealed that Jassy’s eventual cause of death was massive bleeding related to liver failure.
  In this case, should “brain death” or “heart death”, or both, be the criterion for judging death? This question has left American doctors unconvinced.
  On the other hand, the ethical issue of the “brain death” standard has always been an insurmountable obstacle for people: a person who still has body temperature, how can his or her relatives accept that he or she is dead?
The “right to die” of vegetative people

  Regarding “brain death”, there is still a misunderstanding: many people think that brain death is equivalent to a vegetative state, but there is a big difference between the two.
  Brain-dead people generally need equipment to maintain their heartbeat and breathing, while vegetative people generally have normal cardiopulmonary function; brain-dead patients are generally in a deep coma, and all nerve reflexes are absent, while vegetative people often have partial cranial nerve function, and individual patients may even wake up.
  A vegetative person (PVS) breathes naturally, wakes and sleeps periodically, and can digest, defecate, grow and develop. However, the human body in this state has completely lost its cognitive ability, and only retains some instinctive neural reflexes and metabolizes substances and energy.

  Vegetative people often have partial cranial nerve function, and individual patients may even wake up.

  It is not difficult for a vegetative person to survive with the help of external aids, but because of the loss of consciousness, the patient’s right to life is often controversial.
  On February 25, 1990, Terri Schiavo of St. Petersburg, Florida, USA, suffered a sudden cardiac arrest and severe brain damage due to prolonged hypoxia. After being in a coma for two and a half months, she was diagnosed with a permanent vegetative state and never woke up.
  In 1998, Terri’s husband filed a petition to terminate Terri’s life. But Terri’s parents disagree, they believe Terri is still conscious. From April 24, 2001, when Terri was first removed from life support, to her final death on March 31, 2005, the case was appealed 14 times in Florida courts, raising concerns about biological A series of debates on ethics, right to life, and euthanasia.
  Before that, an incident in 1975 directly led to the “right to die” movement in the United States.
  On April 15, 1975, 21-year-old Karen Ann Quinlan drank alcohol and took sedatives at a party. Later, she fell into a coma due to lack of oxygen and eventually became a vegetative state.
  Her parents felt that prolonging her life would be a greater harm to her. So, her father, Quinlan, applied to the court to become her legal guardian and requested that Karen’s respirator be removed. But the court held that doing so would lead to Karen’s death, contrary to law and morals.
  Quinlan’s attorney countered that removing the respirator was simply “allowing Karen to die naturally.” In the end, the Quinlans won and were named legal guardians of their daughter. Karen was taken off his respirator in 1976 until his death from pneumonia in 1985.
  One of the key points in this case is whether the patient (and guardian) has the right to refuse or interrupt treatment. Whereas the right to die view is that human beings have the right to end their life or to be euthanized voluntarily.
  At present, more than ten countries including the Netherlands, Belgium and Spain have legalized euthanasia. However, the understanding of euthanasia varies from country to country. In the UK, euthanasia is defined as “a deliberate intervention to end life to relieve suffering”; in the Netherlands and Belgium, euthanasia is “a doctor who terminates life at the request of a patient”.
  Unfortunately, whether it is a brain-dead person or a coma in a vegetative state, there is no way to make any choice.

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