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Dec 15, 2011

Hospital and legal issues: Somatic versis Brain death for common man


With advances in medical treatement, defining death of humans is also subject of discussion across scientific, legal,   relatives of dead person and society.
More often in hospitals, patient are put on ventilator (machine attached to patient for purpose of breathing) can keep person alive for greater extended time. In a situation, underlying illness responsible ventilator support dictates the outcome. If underlying illness is non-correcteble then outcome is bad.
To decide regarding continuation of ventilator support is matter of relatives decision hospital alone can decide all by itself.
What is death?
For common person, death appears not an issue at all. In legal or medical world, death is bit confusing. For reasons mentioned below
Once circulation stops brain is first organ sustain injury, because  brain stops function permanently within four minutes of stoppage of circulation, if in case it has become possible that we reestablish circulation of blood and breathing with in this narrow time of four minutes, then we may be able prevent brain death. If there is delay in establishing circulation and breathing within this narrow four  minutes brain dies but body still is alive heart beat may be reestablished and breathing can be taken care of by ventilator.


So types of death are
·        Clinical death :- this starts from event of heart stop beating, and CPR (cardio-pulmonary resuscitation) started
·        Brain death: - body is still alive, heart is beating and patient’s respiration is supported
·        Somatic death: - outcome, brain is dead and heart has stopped beating, in spite of all possible support to heart.
To diagnose the last i.e. somatic death is not much difficult, but to diagnose  person as brain dead, it needs thorough and multiple time examination by more then one specialist, at different of point at least spread over 24 to 48 hours. This is because clinical signs of coma and brain death closely mimic. Although coma is grave condition, it is sometimes recoverable.
More often brain dead persons, don’t pull on long on ventilator, still  it is crucial to diagnose a person as brain dead, because of two important issues
·        Legal, Social, cultural and economic reasons
Third reason, I suppose hospital should not get a bad name “that hospital continued treat a dead person”.  This comment we have heard commonly.