Legal and Ethical Considerations for Requiring Consent for Apnea Testing in Brain Death Determination

Abstract

The past decade has witnessed escalating legal and ethical challenges to the diagnosis of death by neurologic criteria (DNC). The legal tactic of demanding consent for the apnea test, if successful, can halt the DNC. However, US law is currently unsettled and inconsistent in this matter. Consent has been required in several trial cases in Montana and Kansas but not in Virginia and Nevada. In this paper, we analyze and evaluate the legal and ethical bases for requiring consent before apnea testing and defend such a requirement by appealing to ethical and legal principles of informed consent and battery and the right to refuse medical treatment. We conclude by considering and rebutting two major objections to a consent requirement for apnea testing: (1) a justice-based objection to allocate scarce resources fairly and (2) a social utility objection that halting the diagnosis of brain death will reduce the number of organ donors.     

脑死亡立法的伦理辩护

"脑死亡"立法是必要的并可以得到充分的伦理辩护:尊重人,特别是尊重人的自主性是"脑死亡"立法的伦理基础."脑死亡"立法符合有利和公平的伦理原则,符合功利主义伦理学追求社会利益最大化的目的.但我们在立法时,应尽量贯彻不伤害原则,注意保护患者及其亲属的利益.     

认识脑死亡

脑死亡是指脑功能永久性不可逆的完全丧失,而不考虑呼吸心跳是否停止.目前脑死亡临床诊断标准已具有高度准确性.脑死亡的确立对树立新的道德观念、节约社会资源、促进器官移植发展意义重大,但要在中国立法可能还需要一个漫长的过程.     

认识脑死亡

脑死亡是指脑功能永久性不可逆的完全丧失,而不考虑呼吸心跳是否停止。目前脑死亡临床诊断标准已具有高度准确性。脑死亡的确立对树立新的道德观念、节约社会资源、促进器官移植发展意义重大,但要在中国立法可能还需要一个漫长的过程。     

脑死与放弃治疗

符合医学标准又为亲属认定已死亡者,理应放弃治疗;符合脑死亡标准,应说服亲属同意作放弃治疗决策;对已确无救治希望,或虽经抢救治疗必然发生植物生存状态的极重病例,或已是植物生存状态者,也应作出放弃治疗的决策,除遵循医学原则和生命的价值、伦理原则外,要充分尊重病重的意志。放弃治疗的决策还应考虑到亲属的心理承受问题。     

"脑死亡=死亡"生物医学定律的逻辑论证

心脏具有顽固自律性、可多次复苏性、功能可人工替代性、可多次置换性四大特点,因而已失去作为死亡判定权威器官的地位.而大脑由于具有统领性、损坏后不可恢复性、功能不可替代性、全脑不可置换性四大特点,已替代心脏成为死亡判定的靶器官."脑死亡=死亡"在相当长时期内都将是一个严格的科学定义.     

"脑死亡"立法的伦理学思辩

目前 ,欣闻一份符合中国国情的“脑死亡”诊断标准 ,已经由卫生部初步制定了出来 ,正广泛征求各方意见加以修改和完善。这标志着我国的“脑死亡”立法工作已经进入了实质性的准备阶段。然而 ,立法背后引发的伦理学讨论告诉我们 ,让承载着数千年道德标准的生死观让位于新锐的“脑死亡” ,我们仍有一段漫长的路要走。1　生死观之辩人类文明的发展 ,如果从生死哲学的立场来看 ,即是对生死 ,尤其是死亡逐渐加深认识及理解的过程。中国千百年来形成的乐生恶死的传统观念根深蒂固 ,“天覆地载 ,万物备悉 ,莫贵于人”强调的正是人生命的重要性。人…     

Death,Pain and Time

Philosophical Studies -     

对我国脑死亡立法问题的反思

在对1999年以来我国脑死亡问题的研究成果进行初步梳理的基础上,针对我国学者主张脑死亡立法的主要论据,提出并分析了脑死亡问题的三个主要问题：（1）脑死亡是真正的死亡吗？（2）能否以经济效率的考量来定义生死？（3）器官移植和脑死亡到底有什么关系？还提出,脑死亡立法需要在我国现实的医疗卫生条件下进行讨论。     

关于"脑死亡"立法科学与伦理的纷争

我国对脑死亡的研究起步于 2 0世纪 80年代。1980年 ,学者李德祥提出脑死亡应是全脑死亡 ,从而克服了大脑死、脑干死等脑的部分死亡等同于脑死亡的缺陷[1] 。中国医学界开始讨论建立我国自己的脑死亡标准。 1997年在全国第七届卫生立法讲习班上 ,有 2 0多位国内的知名专家 ,联名提出关于脑死亡标准的立法问题。 1999年中华医学会组织了脑死亡标准 (草案 )专家研讨会 ,并提出了脑死亡诊断标准[2 ] 。同年 ,解放军总医院的人大代表李炎唐教授在全国人大会议上提交了关于脑死亡及器官移植的立法提案 ,促使我国脑死亡立法的步伐越来越快。2 0 0 …     

Time to Death and Cognitive Performance

We review a program of research that examines people's judgments about how they are seen by others. The research indicates that people tend to anchor on their own experience when making such judgments, with the result that their assessments are often egocentrically biased. Our review focuses on two biases in particular, the spotlight effect, or people's tendency to overestimate the extent to which their behavior and appearance are noticed and evaluated by others, and the illusion of transparency, or people's tendency to overestimate the extent to which their internal states "leak out" and are detectable by others.     

Neuroscience and Brain Death Controversies: The Elephant in the Room

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.     

脑死亡立法的若干法律问题探讨

因为关系到基本人权,脑死亡立法应当由全国人民代表大会立法通过。制定科学的脑死亡标准和严谨的脑死亡判定程序是保障其接近正义的必需。在脑死亡判定方面应充分地保障患者生命权、自主选择权,尊重患者以及家属的知情同意权,保障患者的基本权利是脑死亡立法的核心所在。器官移植不是脑死亡立法的理由。     

从社会文化的角度看脑死亡

从社会文化的角度思考脑死亡,有多方面的重要性.它既影响到人们对脑死亡事实的认定.更影响到人们相应的价值选择.中国传统社会中蕴含着赞同脑死亡的文化因子,同时.儒家传统的孝文化以及死亡仪式化的深远影响也成为脑死亡社会化的重大障碍.要使脑死亡观念在社会上广为接受,除了要进行科学普及,更需要重塑相关的社会文化.     

诊断脑死亡的伦理思考

随着医学的进步和社会的发展,死亡的定义、诊断标准和医生道德责任有了新的内容,脑死亡就是生命终结已为医学界普遍接受.诊断脑死亡是非常专业的技术性工作,有权进行脑死亡诊断的医疗单位和医生必须达到相应的资质要求.确诊和宣布脑死亡应遵循的伦理准则包含多方面的内容,如家属应有死亡标准选择权、脑死亡的诊断程序、脑死亡诊断结果的宣布和生效等方面的问题.