Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
Until recently determination of death was simple. The heart stopped. There was no pulse, no recordable blood pressure, and no heart sounds. There was no breathing. Now, methods of cardiopulmonary resuscitation are common knowledge, both to the layman and to the physician. Hospitals have special “Code Blue” teams; emergency rooms and intensive care units are superbly equipped for life support; hearts that stop are started again. Machines do an excellent job of respiration. Nevertheless, the patient’s brain may be dead and damaged beyond recovery, either in whole or in part. When the whole brain is seriously damaged, including the cerebral cortex and brain stem, there is no possibility of return to an independent existence and even machines cannot keep the person alive longer than a week or two. When the brain is partially damaged, particularly with destruction of portions or layers of the cortex, or connections to the cerebral cortex, the patient may indeed survive with brain stem function alone in a so-called “vegetative state.”
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