The Macksey Journal


Modern medical advancements in resuscitation and life support shifted the idea of death from a cardio-respiratory view to that of a neurocentric view. As a result, the definition of brain death (BD) emerged, which is the irreversible loss of brain function in both the brainstem and cerebral cortex. Consequentially, guidelines for determining BD were defined under law, and it is now legal to remove a patient from life support if they are diagnosed as brain dead. According to policy, one is considered brain dead if they have no brainstem reflexes, a lack of cerebral blood flow, and an absence of cerebral electrical activity. However, in all but two states, the individual or their surrogate cannot refute this diagnosis if it is against their personal or religious beliefs. Despite the fact that the legal definition of BD is necessary in light of technological advancements, the updated definition does not leave room for individual autonomy in select cases. The definition of BD was written by intellectuals that consider death to be the loss of higher order functioning, rather than the absence of both mind and body function. Even though advance directives provide individuals with the freedom to express their wishes regarding medical treatment, BD is an official diagnosis with little room for negotiation. Due to the fact that current technology cannot reverse severe brain damage and that death is now assessed on a graded scale, an individual and/or their surrogate should have the right to determine at what point they are no longer alive.