ADULT;
ARTICLE;
ARTIFICIAL VENTILATION;
BEHAVIOR;
CASE REPORT;
CLINICAL PROTOCOL;
CONSULTATION;
DEATH AND EUTHANASIA;
DECISION MAKING;
DONOR;
ETHICS;
FAMILY;
HEALTH CARE AND PUBLIC HEALTH;
HUMAN;
INFORMED CONSENT;
LIVING WILL;
LONG TERM CARE;
MALE;
MEDICAL ETHICS;
PASSIVE EUTHANASIA;
PERSONAL AUTONOMY;
PROFESSIONAL PATIENT RELATIONSHIP;
PROGNOSIS;
PSYCHOLOGICAL ASPECT;
QUADRIPLEGIA;
RIGHT TO DIE;
TRANSPLANTATION;
TREATMENT REFUSAL;
TREATMENT WITHDRAWAL;
DEATH AND EUTHANASIA;
HEALTH CARE AND PUBLIC HEALTH;
PROFESSIONAL PATIENT RELATIONSHIP;
ADULT;
ADVANCE DIRECTIVE ADHERENCE;
CLINICAL PROTOCOLS;
CONSULTANTS;
DECISION MAKING;
ETHICS CONSULTATION;
ETHICS, MEDICAL;
EUTHANASIA, PASSIVE;
FAMILY;
HUMANS;
INFORMED CONSENT;
INTENTION;
LIFE SUPPORT CARE;
MALE;
PERSONAL AUTONOMY;
PROGNOSIS;
QUADRIPLEGIA;
RESPIRATION, ARTIFICIAL;
RIGHT TO DIE;
TISSUE AND ORGAN PROCUREMENT;
TISSUE DONORS;
TREATMENT REFUSAL;
WITHHOLDING TREATMENT;
Standard organ donation is limited to persons who are dead by brain criteria but are still on a ventilator. The ventilator keeps the body perfused until the machine is turned off and the organs are harvested. However, some patients who are dependent on ventilators but not dead by brain criteria have expressed a desire to be organ donors following death. To accommodate these patients and increase the number of organs available for donation, many organ procurement centers will allow life support to be withdrawn and allow the harvesting of patients' organs after death by cardiopulmonary criteria has been declared. In order for organs to be viable, death must occur and the organs must be harvested within a short period of time following death, at most 45 minutes. If this interval cannot be predicted by the patient's ventilator status, the patient cannot be considered as a candidate for NHBD. See R. Herdman and J.T. Potts, Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement (Washington, D.C.: National Academy Press, 1997).
Physicians' Responsibilities in the Care of Suicidal Patients: Three Case Studies
Fall
A suicide attempt does not necessarily preclude a decision to discontinue life support. See J. Spike, "Physicians' Responsibilities in the Care of Suicidal Patients: Three Case Studies," The Journal of Clinical Ethics 9, no. 3 (Fall 1998): 306-13.
ed. J.C. Fletcher et al. Hagerstown, Md.: University Publishing Group
M.F. Marshall, "Treatment Refusals by Patients and Clinicians," in Introduction to Clinical Ethics, 2nd ed., ed. J.C. Fletcher et al. (Hagerstown, Md.: University Publishing Group, 1997), 109.
Persistent Brain Death: Must a Person Believe in Death to Die?
Fall
For reports on brain death as a sustainable clinical state, see J. Spike and J. Greenlaw, "Persistent Brain Death: Must a Person Believe in Death to Die?" Journal of Law, Medicine & Ethics 23, no. 3 (Fall 1995): 291-4; J. Spike, "Brain Death, Pregnancy, and Posthumous Motherhood," The Journal of Clinical Ethics 10, no. 1 (Spring 1999): 57-65.
For reports on brain death as a sustainable clinical state, see J. Spike and J. Greenlaw, "Persistent Brain Death: Must a Person Believe in Death to Die?" Journal of Law, Medicine & Ethics 23, no. 3 (Fall 1995): 291-4; J. Spike, "Brain Death, Pregnancy, and Posthumous Motherhood," The Journal of Clinical Ethics 10, no. 1 (Spring 1999): 57-65.
This is not an entirely new insight. David Hume wrote in 1755: Were the disposal of human life so much reserved as the peculiar province of the almighty that it was an encroachment on his right for men to dispose of their own lives; it would be equally criminal to act for the preservation of life as for its destruction. If I turn aside a stone which is falling on my head, I disturb the course of nature, and I invade the peculiar province of the almighty by lengthening out my life beyond the period which by general laws of matter and motion he had assigned it. D. Hume, "Of Suicide," in Dialogues Concerning Natural Religion and the Posthumous Essays, ed. R. Popkin (Indianapolis, Ind.: Hackett, 1980), 100-1.
S.J. Youngner, R.C. Fox, and L.J. O'Connell, Madison, Wis.: University of Wisconsin Press
See the comments by R.C. Fox in S.J. Youngner, R.C. Fox, and L.J. O'Connell, Organ Transplantation:Meaning and Realities (Madison, Wis.: University of Wisconsin Press, 1996).
