What is death? For the average person, this may be no need to answer simple questions. However, in medicine, determination of death is not easy. For doctors, when the patient is near death, they have to do, it is not so simple.
Reversible brain refuses, stopped breathing and heartbeat may resume
For "What is death", the current mainstream standard, there are two: say brain heart rate, respiratory arrest said.
The definition of brain death is relatively simple, the human brain activity irreversible stop. The criteria will contain more than one index, which generally must meet a number of projects in order to identify, such as: irreversible deep coma, respiratory arrest, brain stem reflexes (such as mydriasis, eye to strong light does not respond), EEG map is a straight line, the brain blood circulation stopped completely. This is one of the EEG and cerebral angiography, are determined by means of assisted medical equipment, is relatively objective indicator.
The heartbeat, respiratory arrest that although there is still a death universal use criteria (our law currently recognizes only a heartbeat, respiratory arrest criteria, does not recognize brain death criteria), but it is increasingly being questioned. This is mainly because with the advances in medical science, it is difficult to exactly "stop" to designate a time limit, that is, heart rate, respiratory arrest, how much time, in order to determine who is dead?
This is because with the advent of artificial breathing machine, cardiac pacemakers, cardiac massage resuscitation techniques, and there have been many at home and abroad have been several tens of minutes after cardiac arrest is still successful rescue cases.
And after respiratory arrest, artificial respiration correct operation may be completely restarted, so difficult to determine the time limit. Currently, the standard used in many countries, after the removal of the ventilator within three minutes, the patient's spontaneous breathing still not appear, it is determined that no spontaneous breathing.
In addition, a person may appear completely brain dead, but breathing, heartbeat instrument is maintained at an embarrassing situation persists, according to brain death standard, which is already one of the bodies. Note that brain death and the "vegetable" is not the same, when the vegetative state, part of the advanced features of the brain temporary or permanent loss, but still maintained most of the autonomic functions, such as breathing, maintaining body temperature, and metabolism regulatory activities.
In theory, patients with brain death, it has been cherished big month of pregnancy if dead, with the support of external instruments under entirely possible birth to healthy babies. So, in the end you count the mother had died of it? I am afraid this is not only a scientific issue, it is an ethics, sociology of the problem.
Revive the phenomenon of suspended animation
The judge, whether a diagnosis of people have died, in fact, is a very complex process, by a variety of factors.
In clinical practice, for those who have stopped breathing and heartbeat, usually also continue rescue efforts allowed to resume spontaneous breathing and died after a period of time, it will be declared dead in the legal sense. The length of this period, in fact, more dependent on the views of family members, rather than the physician's professional judgment.
This aspect has to consider emotional factors, some of the families could not bear to let their loved ones longer unnecessary torment, but some families desperately want to keep their loved ones at all on the other hand, is quite high because the cost of the rescue, not every family can afford It plays. For such a serious problem, doctors can not make decisions for them.
For those who have family members to sign away patients treated, usually this time will be relatively short, once the heartbeat, breathing stopped, the doctor will respect the views of the families, issuing death family requested rescue for patients, and it will pass relatively long rescue, although the rescue in most cases and can not play a decisive role.
And now, as mentioned above, heart rate, respiratory arrest is not necessarily irreversible, the external stimuli (such as vibration, low temperature, etc.) may be completely autonomous and for some patients, pulse and breathing may be very weak and difficult to detect, resulting in a miscarriage of justice, the "suspended animation."
For the serious damage caused by suffocation, bleeding, shock, and other sedative hypnotic poisoning caused, may lead to the phenomenon of suspended animation. Furthermore, premature children, newborns with congenital diseases are more prone to feign death. Therefore, physicians encounter these circumstances, it must be more careful, more cautious, patient judgment is indeed dead, or in a state of suspended animation. If you take an active treatment, patients may be saved suspended animation.
However, a stage usually dying of suspended animation, so even if they are saved, their prognosis is often poor. However, patients with their families, meaning large Needless to say. So long as the patient's family did not give up until the last moment doctors can not give up easily. It is important for families to understand the patient's condition, and what might happen next. The so-called "to cure sometimes to relieve often to comfort always" probably mean.
Determination of death, cautious carefully indeed
In the medical advances of the ancient enough, this miscarriage of justice is particularly common. In this regard, as well as specialized foreign developed a coffin buried alive to prevent, if the "dead" wake up in the coffin, you can breathe through a snorkel, and pull a rope, let alone to the outside of the bell sounded. Of course, the middle of the night, if the cemetery sounded tones, the living will is probably scared to death of it.
For China, the ancient people had just died, the need to put a wisp of silk or cotton gently on its new snout, if silk wadding move, it shows there are shallow breathing, still alive, this practice is called "it is a fine cotton."
In view of this, in the modern clinical and judicial practice, the use of composite death criteria: first confirm spontaneous breathing and heartbeat have stopped, together with other indications death occurred, in order to ultimately determines whether or not someone has died . These additional indications include: Shiban (after circulation stops, because gravity sedimentation in some parts of the body, appear brown spots), rigor mortis (the body becomes stiff and difficult to move), cold corpse ( after the death of the human body temperature decreased), corneal opacity and so on. Tong said that Shiban, rigor mortis death is coming, reliable, precise indications.
For doctors the authority to issue death certificates, forensic, we must be very careful and responsible approach every death is determined to avoid the state of suspended animation identified as dead. Even family members of patients have to sign away their treatment, doctors still must follow strict medical norms independent judgment. It must be pointed out that this decision process must be performed by the physician personally, never with others, oral and concluded in advance but does not allow the issuance of death certificates. After all, human life, there is no reason to perfunctory.
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