The president's commission on medical ethics, attempting to provide the nation with a clear definition of death, suggested in a draft reported yesterday that the modern concept of "brain death" be combined with the more traditional one of hear stoppage to provide a working standard.
The need for such a standard has become acute in recent years with the emergence of medical technology capable of sustaining many severly ill or injured persons in a condition in which they are neither clearly alive nor clearly dead. The medical profession and the courts have been groping for a means of telling when the life-support machines must be kept on and when they may properly be turned off.
The definition now before the commission in draft form is this:
"An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical practice."
At the same time, the report emphasized that it does not expect this defintion to solve all of the ethical problems raised by new life-support technology. Many persons sustained by machinery would not be considered dead by this standard, and that is intentional.
"Doubts may exist about the value of human existence . . . for patients who are comatose but still able, with appropriate medical care, to breathe spontaneously," the report says. "But such doubts should be addressed directly and not swept away through a'definition' that would define such patients as already dead rather than as merely dying."
The report suggest that the commission deal later with the ethical questions raised by those in vegetative states, after first finding an acceptable compromise among the scores of disparate definitions of death now used by states and offered by medical and legal groups.
According to the report, the proposed new definition has been endorsed by "the major bodies in medicine, law, and legislative reform."
The reason the report chose to incorporate the traditional definition as well as the more modern one was that "the traditional means to determine death will continue to be applied in the overwhelming majority of cases."
In other words, the simple testing of pulse and respiration will continue as the standard in situations in which the sophisticated technology required to determine "brain death" is not available.
The report adds that it is important to include in the definition a concept that is universal and understood by the public in order to ease the transition to a newer, more abstract definition.
At the same time, it is important to have the more precise and encompassing "brain death" definition because of problems created by the new techology in medicine.
For example, the report notes that in Kansas there are two separate definitions -- the traditional and the newer "brain death" version.
The proposed definition marks a way-point between traditional definitions of death and the more precise and technologically demanding ones. "It is preferable for the law to move cautiously and incrementally on this subject," the report said.
The commission is expected to revise the draft and then vote on a final report to Congress within the next four months.