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.     

The End: Thoughts on Humanism and Death

Extending earlier work on a nontheistic theology, in this article I explore a humanist framing of death. I begin with a critique of theistic framings of death as a matter of isolation and transition to a greater situation. In place of theistic understandings of death, here I argue that humanist theology, drawing insights from literature and Albert Camus' moralism, provides a way to “naturalize” death, to understand death as already and always a dimension of life.     

The development and validation of a Fear of Death Scale based on the cognitive approach of Avicenna

ABSTRACT

The aim of this study was to develop a culturally sensitive approach assessment instrument that measures cognitive beliefs related to Iranian Muslim salient fear of death. This paper discusses the development and validation of Avicenna Fear of Death Scale (AFDS). The results of confirmatory factor analysis resulted in an instrument (AFDS) consisting of five cognitive concerns related to the fear of death including complete annihilation, severe pain of death, consequences of sins, interpersonal attachment, and attachment to estate. Twenty-two statements overall were offered using a Likert scale to measure related cognitive beliefs. Results from a convenience sample of 291 college students, showed the AFDS to have favourable psychometric properties (e.g., adequate reliability and validity). The total alpha coefficient was .85, suggesting that the items have relatively high internal consistency and the item-total correlation between .28 and .63 (p<.001) indicates that the items are discriminating well. Overall, results suggest that cross-cultural differences render a culturally sensitive approach to assessment and diagnosis essential, and therefore a culture-based scale like Avicenna AFDS might be fruitful extensions of the current death anxiety scales like Templer Death Anxiety Scale within the context of Iranian-Islamic culture. This diagnostic tool can help in the cognitive treatment of fear of death.     

AGREEING TO DISAGREE: Indigenous Pluralism from Human Rights to Bioethics

David Hollenbach, working within the context of human rights theory, has developed the notion of "indigenous pluralism" as a means of coping with the problems that arise when different religious traditions hold distinct or incompatible interpretations of human rights. It will be argued that indigenous pluralism is a theoretically and practically useful concept for bioethics as well and hence should be incorporated into bioethical methodology and processes of bioethical policy formation. Subsequently, the notion of indigenous pluralism will be discussed in relation to determinations of death as a means of illustrating this concept's applicability to bioethical inquiry.     

Nursing Home Adaptation in Visually Impaired Older Adults Using a Narrative Approach1,2

This study used a narrative approach to examine the difficulties that older visually impaired people experience when adapting to life in a nursing home. The interview data were collected from one blind aged person (n = 1), focusing on the adaptation process from moving into the nursing home to the present and maintaining context of narrative that included the life history. Subcategories were extracted based on a framework of temporal coherence, causal coherence, thematic coherence, and situational coherence. This study revealed three factors related to adaptation to life in a nursing home for a visually impaired person, including psychological adaptation: becoming accustomed to life in the facility after changes in the living environment, having gratitude and maintaining “moderating human relationships,” and participating in activities connected to one's purpose in life. He was able to psychologically adapt and came to accept his death through an awareness of aging.