Informed consent for the diagnosis of brain death: a conceptual argument

Background

This essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference.

Methods

Conceptual, philosophical, and ethical analysis.

Results

I first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act.

Conclusions

My intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death.

     

The fibrinolytic tissue activity of various brain tumors

In tissue samples of 45 operated astrocytomas and of 45 meningiomas the fibrinolytic and proteolytic activity was determined by means of fibrin-agar-plate-method. In astrocytomas significant higher values of fibrinolysis were found than in the meningiomas. In the course of tumor cell necrosis or as a result of brain damage caused by the operation, proteins inducing fibrinolysis are liberated. In some cases they can lead to localized or generalized disturbances of haemostasis.     

Confirmatory tests in the diagnosis of brain death: The role of the radioisotope brain scan

In recent years physicians have used a variety of laboratory studies as confirmatory tests in the diagnosis of brain death. The most widely used test has been the EEG. However, with the development of newer technologies capable of measuring other parameters of brain functions, other laboratory studies are playing an increasingly important role in confirming brain death. In this article, we discuss the role of one of these newer tests, the radioactive brain scan, and compare its advantages and limitations with the EEG.     

论医疗刑事责任的根据

医疗行为具有很强的专业性,也具有极高的风险性,因此,在诊疗护理活动中医疗过失难免会发生.因此,对于医疗过失行为承担刑事责任的范围不宜过于宽泛.结合1997年刑法的规定及刑法基本理论,阐述了认定医疗刑事责任的根据,限定了医疗过失行为承担刑事责任的范围,以期对司法实践有所裨益.     

Criteria for the design and evaluation of cognitive architectures

Cognitive architectures are unified theories of cognition that take the form of computational formalisms. They support computational models that collectively account for large numbers of empirical regularities using small numbers of computational mechanisms. Empirical coverage and parsimony are the most prominent criteria by which architectures are designed and evaluated, but they are not the only ones. This paper considers three additional criteria that have been comparatively undertheorized. (a) Successful architectures possess subjective and intersubjective meaning, making cognition comprehensible to individual cognitive scientists and organizing groups of like-minded cognitive scientists into genuine communities. (b) Successful architectures provide idioms that structure the design and interpretation of computational models. (c) Successful architectures are strange: They make provocative, often disturbing, and ultimately compelling claims about human information processing that demand evaluation.     

针灸与心理——电针对心理的调节作用

古今中外文献中针灸治疗躯体疾病的报告很多,治疗精神障碍报道较少,治疗轻型精神障碍(心理障碍)更少．本文在回顾以前研究的基础上总结了本研究所得的研究成果,并力图对其机制进行了探讨。     

Spoilt for choice: The role of counterfactual thinking in the excess choice and reversibility paradoxes

Contrary to popular belief many choice options and the ability to reverse one's initial choice are sometimes associated with decreased chooser satisfaction. Two studies investigated the role of counterfactual thinking in explaining these paradoxes. Participants chose drawing implements from either a limited (6) or extensive (24) choice set (Study 1), or an expected reversible/non-reversible selection (Study 2). Following a drawing task, satisfaction with their chosen implement was rated under either high or low cognitive load to manipulate the availability of counterfactual alternatives. In Study 1 satisfaction was higher with limited vs. extensive choice under low load. The number of counterfactuals generated mediated this effect. Under high load the pattern was reversed. Participants in Study 2 generated more counterfactuals when reversibility was expected under low but not high load and this partially mediated the impact of expected reversibility on revealed satisfaction. Implications for theoretical understanding of these paradoxes are discussed.     

Towards Establishing Criteria for the Ethical Analysis of Artificial Intelligence

Science and Engineering Ethics - Ethical reflection on Artificial Intelligence (AI) has become a priority. In this article, we propose a methodological model for a comprehensive ethical analysis of...     

Results of combined treatment of malignant brain tumors with various cytostatic protocols

Nowadays best results in the treatment of malignant brain tumors can be obtained with an interdisciplinary combined treatment (operation, radiation, antineoplastic chemotherapy). We treated 83 patients with gliomas after operation with a combined radiation/chemotherapy. Chemotherapy was performed by two different schemas (Israel n = 49, COMP n = 34). Both groups had the same structure concerning the 10 most important prognostic factors. The median survival time was found to be 26.1 months in the Israel-group and 22.8 months respectively in the COMP-group. The number of the long-time survivors is increasing in the COMP-group.     

On the predictor variable for choice reaction time

A survey of published research using the Sternberg task was made for the period 1966 to early 1973. A majority of the data are better described by a linear equation involving log positive set size than by one involving set size per se as the scale of the predictor variable.