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Culture & Society, Featured, Health Policy, Law, Medical Ethics, Medicine, Politics, What's New

America Out Loud PULSE: Defining Death with Dr. Heidi Klessig

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From my America Out Loud Pulse podcast with Dr. Heidi Klessig – https://www.americaoutloud.news/defining-death-with-heidi-klessig-md/

Historically, people advocated for at least 24 hours between the diagnosis of death and burial in case a mistake was made in the diagnosis. For years physicians searched for a sure sign of death. Some thought putrefaction of tissues was the only sure sign. Ultimately it seemed reasonable to define death as when all spontaneous vital functions ceased permanently. Then came organ transplantation and the whole concept of the moment of death has changed— irreversibly, like death itself.

The advances in medical science have made adherence to medical ethics more essential than ever. Cardio-pulmonary resuscitation (CPR), mechanical ventilation and artificial nutrition were only the beginning. We now are experimenting with pig to human transplants and freshly obtained aborted fetal tissue is being used to create “humanized mice”. We can’t get carried away with the technology and forget the humanity. First and foremost, a patient has the right to self-determination and the physician’s duty is to respect the patient’s decisions and to do no harm to the patient. Incidents where patients were labelled DNR (Do Not Resuscitate) without their (or their family’s) consent are unacceptable.

Unfortunately, along with the innovations that can prolong life and sometimes cure, we have drifted into a utilitarian mindset when considering patient treatment alternatives. Often times, the suggested treatment—or non-treatment—pathway is at odds with the concept of the innate dignity of being a living human being. All involved persons must remember that we are far more than clumps of cells or a collection of body parts for future use.

Also disturbing is the popularity of euthanasia and physician assisted suicide, euphemistically called “medical aid in dying” (MAID). In Canada, assisted suicide has been in effect since 2016. In 2022 medically assisted deaths constituted 4.1 per cent of all deaths in Canada. This was a 30 percent increase from 2021. The patient who partakes need not be terminally ill. According to a BBC news report, social problems like poverty, lack of housing, or extreme loneliness may contribute to the patient’s willingness to request MAID, and this “prompted fears it could be used as a solution for societal challenges.” As of March 17, 2024. Now persons suffering solely from a mental illness will be eligible for MAID.

As there is more and more discussion of scarce medical resources, we have to be vigilant that as physicians we maintain our commitment to respect human life. Marilyn believes death is a separation of body and spirit, but Dr. Singleton must deal with ethics, legal definitions and guidelines.

Today my guest will discuss the past, present, and future of the concept of “brain death.”

Dr. Klessig’s website: https://www.respectforhumanlife.com

Dr. Klessig’s latest book: https://www.respectforhumanlife.com/books

Bio

Dr. Heidi Klessig attended medical school at University of Wisconsin, where she also completed her residency in anesthesiology. She received the American Board of Anesthesiology’s certificate of added qualification in pain management. She was a founding partner of the Pain Clinic of Northwestern Wisconsin and was an instructor for the International Spinal Injection Society. She recently authored The Brain Death Fallacy. Dr. Klessig and Christopher W. Bogosh, RN-BC also maintain a website called Respect for Human Life that deals with issues surrounding organ transplantation

Culture & Society, Doctors, Health Policy, Law, What's New

America Out Loud PULSE: Should Man or God Decide Whether We are Dead?

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From my America Out Loud Pulse podcast with Paul A. Byrne, MD –https://www.americaoutloud.com/should-man-or-god-decide-whether-we-are-dead/

Our brave new world of medicine can keep the people alive who at an earlier time would not survive. But prediction of death is not the same as death.

Defining death matters most importantly to the living human being who is being declared dead.  It also matters for a variety of reasons having nothing to do with medical care. Life insurance, homicide charges, wrongful death lawsuits. Of course, medically, health professionals think of maintaining organs for donation and the holders of the purse strings think of “wasted” resources. But a bigger reason is defining the limits of our humanity and our status of our souls.

When does a patient cross the line between life and death? The Uniform Determination of Death Act (UDDA) was created in 1981 in an attempt to resolve that question. The UDDA is a model state law that has been adopted is some form by all states. It was approved by the American Medical Association, the American Bar Association, and the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.

The Act states:

“An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”

The Act now is being revised. One suggestion is to change the word “irreversible” to “permanent.”  Another is to allow a bedside determination without laboratory testing. These changes seem to make it easier to ration care and make more organs available for transplant

Today my guest, a pioneer in neonatology and perinatology, a pioneer in saving babies who were given up as certain to die has been writing on matters of life and death for over 40 years.

Featured, Health Policy, Law, Medical Ethics, What's New

America Out Loud PULSE: Ethical Considerations in Organ Donation

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From my America Out Loud Pulse podcast with Dr. Heidi Klessig –https://www.americaoutloud.com/ethical-considerations-in-organ-donation-with-heidi-klessig-md/

Organ donation is a wonderful gift to a fellow human. One organ donor of critical organs such as the heart, lungs, liver, and kidneys can save up to 8 lives. According to the Department of Health and Human Services (HHS) 105,820 Americans are awaiting organs and over 40,000 transplants were performed in 2021. But like so many things in today’s culture, the zeal to procure organs for transplant may have, as they say, gone too far.

Death is always an uncomfortable topic. And organ harvesting is even more so. I remember the first time I was delivering anesthesia for an organ harvest. I was thinking, if the patient is dead, why do they need me? Of course, the patient’s heart was beating and his kidneys were still functioning. I gave a good anesthetic, keeping all the vital signs stable with multiple drugs and every tool I had at my disposal. Then the surgeon looked up and instructed me to turn it all off. I could not walk away. I stayed until the patient’s heart stopped beating quite as while later.

So what death is for purposes of organ harvesting? In the United States, if a person is pronounced brain dead, they are legally dead. Death is defined in the United States by the Uniform Determination of Death Act (UDDA), proposed in 1981, as either (1) irreversible cessation of circulatory and pulmonary functions or (2) irreversible cessation of all functions of the entire brain, which means brain death. The need for human organs for transplants has spawned some eye-popping processes.

Currently, surgeons are experimenting with a Frankensteinian-sounding procedure whereby terminal patients are allowed to die, then their hearts are resuscitate while blood flow to the brain is clamped off. In January 2022, surgeons implanted a genetically modified pig heart into a human. The patient lived for 49 days. The surgeons got their transplants, but medical ethics may have died.

The American Medical Association’s Code of Medical Ethics addresses issues regarding organ transplantation, including xenotransplantation, that is, organs from a non-human. The first guideline states: “(1) . . . A prospective organ transplant offers no justification for a relaxation of the usual standard of medical care for the potential donor.”

Organ transplantation is a great medical breakthrough that saves and improves lives. As with any medical procedure, informed consent with a full discussion of all the available information and assurance that the highest ethical standards are essential. Unfortunately, sometimes the unattractive details of organ donation are glossed over. Today’s conversation will provide some food for thought.

 

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