Materials

Issue 112: Spittler, Johann F.: Sterbeprozeß und Todeszeitpunkt - Die biologischen Phänomene und ihre Beurteilung aus medizinischer Sicht. August 1996

In the discussion of brain-death the terms 'process of dying' and 'event of death' are of fundamental significance. In order to achieve a basis of better understanding some terms have to be explained at first: A 'human being' in the sense of a 'personal being' is characterized by identity over time and modification during ontogenis. The brain allows a variety of 'mental and spiritual' capabilities e.g. perceiving, sensing, experiencing, thinking, promptly reacting, or considerate acting. Between the two states of a 'living body' and 'dead corpse' (cadaver) a third state, namely the 'brain-dead but still surviving body' has to be differentiated. The terms 'dying' and 'death' express a variation of meanings according to plant, animal, and man that was termed 'evolutionary semantical dispersion'. The variation reflecting on cell, organ, and organism was termed 'micro-macroscopical semantic dispersion'. Furthermore the asyncrony of events in different processes of dying is pointed out and the aspects of reversibility and irreversibility, loss of function, resuscitability, and death are analysed. Based on these definitions two principally different processes of dying can be discussed: dying from a general disease leading to primary cardiac arrest or from a primary brain disease resulting in brain-death. Descriptive biological and normative perspectives are distinguished. Obviously the 'process of dying' is a biological occurrence whereas the 'event of death' is a normative decision. The latter has to be based on an analysis of the biological process and must be discussed towards a general agreement. On the biological level brain-death is followed by the process of dying of the surviving body, that can be delayed by intensive care with artificial ventilation. Based on these biological and neuropsychiatric concepts the discussion can be reconsidered again: Which of the events in the biological process should be chosen as the very moment of death, looking for a necessary consensus between scientific accuracy and general understanding? Outward appearance can no longer be the measure: beating heart, circulating blood, breathing or regulatory mechanisms between the organs of the body alone do not constitute a personal human being, but 'mental' and 'spiritual' capabilities do. In this world these are necessarily bound to a living brain. Therefore, from an anthropological point of view only the moment of brain-death can be considered the death of a human being.