I agree with Bharat it all depends upon the context. Clinically we tend to view patient as a whole so may be easiler to say clinically dead. But, if you say brain stem function is your criteria then most of the newborn babies can not be declared as dead clinically. Typical senario is the anencephalic babies. Noone can tell us why the babies can not be an organ donor because we do not know how to define the death.
In case of confirmed brain-death (Unreceptivity and unresponsiveness, no movement or breathing, no brainstem reflexes, in absence of sedation associated with a flat electroencephalogram repeated at least four hours, in absence of hypothermia or absence of cerebral blood flow on CT scan), I consider that this a “typical clinical” or legal death, whereas patients in cardiac arrest and prolonged no flow may be considered as “biological death” secondary to anoxia and cellular apoptosis.
Sorry, but I cannot help for the death definition of anencephalic babies…..and thus the possibilities of being an organ donor,..a discussion with the parents….??
We could mention the following concepts:
Biological Death as the irreversible cessation of cardiorespiratory function followed by the appearance of signs of decomposition.
Clinical Death: Cardiac arrest potentially reversible with resuscitation maneuvers. If the maneuvers fail, can pass biological death, brain death or minimal consciousness state.
Brain death: irreversible injury intracranial neurological structures of both hemispheres and the brainstem.
Minimum State consciousness. The so-called, years ago, "coma vigil" with preserved brainstem reflexes and spontaneous breathing
It has been many years of coma depassé of Goulon and Mollaret ¡¡¡
Of course i agree with the concepts of Biological Death and Brain Death.
I think that "Minimun state Consciouness" should be reserved for spontaneous and prolonged ( X days?) neurological status , to eliminate reversible consciouness alteration, such as intoxications.
"Coma Dépassé" reported by Goulon and Mollaret , is no more used in French ICU, being impossible to explain to the relatives. We prefer " severe and irreversible brain lesions without any possibility to communicate", and then start the discussion about therapeutic limitations
Furthermore, if we define Clinical Death by Cardiac arrest potentially reversible, the risk for nurses, students and relatives is to call 911 or SAMU with this "diagnosis", whereas with a" Cardiac arrest " call, primary aid will start immediately resuscitation.
I agree that with today's technology, we can keep someone artificially alive for a long time fed by tubes and breathing on a respirator. No brain function should be the criteria for declaring someone as clinically dead.
Clinical death occurs when heart beat, pulse and breathing stop. But in biological death, tissues in brain and other part of body are degenerated.
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