Death: the concept to the diagnosis: controversies and ethical dilemmas

• Autor(a) principal: Lima, Cristina
• Data de Publicação: 2005
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1668
• topic: ética; morte; morte cerebral; Neurologia; Ethics; Death; Brain death; Neurology

In the last fi fty years the technical and scientifi c advances in fifty years the technical and scientific advances in the area of medicine have introduced into clinical practice new concepts of death, the diagnosis of which entails the production of an elaborate list of evidence. The coexistence of various criteria of death has been a controversial issue and subject to intense debate.With discussions caught up in a stalemate of unclear concepts and defi nitions, criteria of cerebral death were ratifi ed in most countries. Portugal adopted the death of the brain stem as the criterion that has been applied since 1994.In this article, after putting the issue into historical perspective, the different defi nitions, criteria and testing of death are revised, mainly from an ethical point of view, in reference to the main arguments put forth by advocates of each position.It is concluded that the inexistence of a single concept of death, together with the variation of criteria and testing methods are the evidence of the weakness of these defi nitions. Therefore clinical situations which are considered irreversible may no longer be so, depending on the scientifi c knowledge about the physiopathology of diseases and therapeutic resources. In relation to the tests used in the diagnosis of death, it is concluded that performing the apnea testing violates the most elementary rules employed to avoid irreversible brain damage in the treatment of patients with intracranial hypertension.This makes a serious effort of therapeutic investigation into the situations of coma and apnea mandatory at the same time as an overall revision of testing methods in order to exclude the apnea testing.