Determining death
When does a person die? When the heart stops beating, when respiration ceases or when the brain is so badly damaged that the person will never recover? Traditionally, cessation of heartbeats has been the guiding criterion for determining the moment of death, largely because it is the easiest to determine. Modern medicine, however, makes it possible to artificially maintain heartbeat and respiration long after the brain stops functioning.
A more logical determinant of life, therefore, is the condition of the brain stem, that part of the brain which controls basic body functions. If tests prove the brain stem to be irreversibly damaged, the person can be pronounced dead even though his heartbeat and respiration are maintained artificially. Brain-stem death has been medically accepted in the West since the last 25 years and more than 50 countries have given it legal status.
Samiran Nundy, professor and head of the gastrointestinal surgery department at the All-India Institute of Medical Sciences, is a strong proponent of brain-stem death. According to him, this criterion makes available heart-beating cadavers for organ transplants, while at the same time, freeing vital life-support equipment for more needy patients. "As doctors, we are interested in saving lives, not in keeping people on life-support systems," points out Nundy.
Nundy's view is strongly endorsed by A Bagchi, an eminent neurosurgeon of Calcutta, who says, "It is our duty to treat patients, not to try to treat or ventilate corpses."
Legal opinion, however, is sharply divided on the matter. Bhaktawar Lentin of the Bombay High Court says, "It is dangerous to allow a doctor to declare a person dead if his brain is damaged just so that his organs can be utilised for others because firstly, it would be left to the sole, and perhaps arbitrary, discretion of the doctor to give such a declaration, and secondly, it would lead to malpractices where organs are sold by unscrupulous people."
Supreme Court advocate Rajeev Dhavan feels the definition of brain-stem death is "morally and clinically correct. Further, the fact that a panel of four highly qualified doctors is required to declare a person brain-stem dead is an adequate safeguard against misuse of this concept."
In answer to Lentin's argument, Nundy says, "In pronouncing a person brain-stem dead, a doctor is not killing the person because the person is already dead. The bill merely changes the criterion that determines death, not the event itself."
