DOCSLIB.ORG

Whole-Brain Death Reconsidered- Physiological Facts and Philosophy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Whole-Brain Death Reconsidered- Physiological Facts and Philosophy Journal ofmedical ethics, 1983, 9, 32-37 J Med Ethics: first published as 10.1136/jme.9.1.32 on 1 March 1983. Downloaded from Commentary Whole-brain death reconsidered- physiological facts and philosophy C Pallis Reader Emeritus, Royal Postgraduate Medical School, Consultant Neurologist, Hammersmith Hospital Author's abstract the recognition ofthe important clinical, physiological, pathological and prognostic differences between the Four main areas generating confusion in discussion on vegetative state, whole-brain death and death of the brain death are identified as a) the relation ofcriteria of brain stem. Unless agreed definitions are reached con- death to concepts ofdeath, b) the argument about whether cerning these states, terminological problems soon death is an event or a process, c) the inadequate render meaningful communication impossible; differentiation ofdifferent neurological entities having The difference between 'identifying death' and different cardiac prognoses, and d) insufficient 'allowing to die'. Discussions about what have been awareness ofthe separate issues of'determining death' called the 'uncomfortable dimensions ofthe care ofthe and 'allowing to die'. It is argued that ifby death we mean dying'(i) have nothing to do with identifying a dead the dissolution ofthe human 'organism as a whole', then brain stem. whole-brain death is death. Behavioural patterns, legitimate in thepresence ofa cadaver, should be legitimate from the time whole-brain death is diagnosed. Concepts and criteria Discussions between philosophers and neurologists on the subject of death require a double commitment. As Two boys were walking in a field, arguing fiercely. One to differentiate their patients more was carrying a butterfly net, the other a mousetrap. neurologists begin Each was claiming that his was 'the better' instrument. carefully, philosophers will have to ask their questions http://jme.bmj.com/ more precisely. And as philosophers probe deeper into They almost came to blows. A third boy (an obvious what it really means to be alive, physicians will have to candidate for a First in philosophy) came up and asked abandon some of their more traditional attitudes. the necessary question: 'Better for what?'. Neither philosophers nor neurologists can any longer This apocryphal tale emphasises that all talk about accept death as a brute empirical fact, the recognition the criteria of death - and ipso facto about 'better' of which is just a technical problem. Whether we real- criteria or 'new' criteria - must be related to some ise it or not there are philosophical implications to both overall concept of what death means. Dr Browne our acts, and our failures to act. There is no harm in rightly stresses that important behavioural conse- on September 26, 2021 by guest. Protected copyright. seeking to make our assumptions explicit. In fact quences flow from the recognition that a person is recent developments in the fields of resuscitation and dead. But we cannot argue about whether a neuro- intensive care render the task imperative. And if logical or a cardio-respiratory approach is 'better' for their skills to this recognising such a state, unless we are agreed on what philosophers wish help endeavour, we are to When we rather than hinder it, they will have to familiarise exactly it is that seeking identify. themselves with these developments. consider death, the tests we carry out and the decisions Four main areas of confusion bedevil most discus- we make should be logically derived from agreed con- sions about brain death. They concern: ceptual and philosophical premises. of I find it a novel experience to have to argue with a the kind of relation necessary between concepts philosopher who asserts that 'even granting that ... death and criteria of death; important legal, moral and medical consequences flow what is meant by the 'biological fact' of death? Inti- from the determination of death . it still does not mately related to this are the twin questions as to to the definition ofdeath'. event or a and whether follow that we ought precise whether death is an process, Even more surprising is his statement that 'we can what is ofclinical significance is 'death ofthe organism remove any uncertainty in practical affairs without as a whole' or 'death of the whole organism'; fiddling with the definition of death'. Dr Browne seems here to be donning the garb of the pragmatic, Key words unreflecting physician. It is not reassuring when Brain death; whole-brain death; death; philosophy; medical philosophers, ofall people, tell us that we can leave the ethics. concept of death in. its present 'indeterminate' state, Whole-brain death reconsidered - physiologicalfacts and philosophy 33 J Med Ethics: first published as 10.1136/jme.9.1.32 on 1 March 1983. Downloaded from and that we should get on with the job of specifying situation. Dr Browne, on the other hand, does not 'what can appropriately be done to whom' - and define death at all. This makes it very difficult to get to 'when'. Dr Browne questions the desire to solve practi- grips with what he writes. He seems opposed both to a cal problems by making definitions more precise. He 'whole-brain' definition of death (p 3I) and to the iden- calls it a temptation (implying it should be resisted). I tification of the vegetative state with death. He quotes believe a more positive approach would be to accept the definition ofdeath given inBlack's Law Dictionary Oscar Wilde's suggestion that 'the only way to get rid and states he is against the redefmiition ofdeath 'in any of a temptation is to yield to it'. I cannot endorse Dr other way'. Does he then endorse the traditional defini- Browne's view that in discussing death 'we should first tion? He is nowhere explicit enough for this confi- settle the question of what behaviour becomes appro- dently to be asserted. The problem with the traditional priate when' - and even less his conclusion that 'this definition he quotes is that it is not really a definition at can be settled independently ofthe question ofwhen a all, or at least not one that encompasses some of the person is dead'. more macabre by-products ofmodern technology. It is Dr Browne seems to be arguing for an ad hoc patch- my beliefthat ifthe concept ofdeath is left 'indetermi- work of practices, of unspecified relationship to one nate' - as Dr Browne advocates - one will not even need another, and certainly unrelated to any overall to invoke the principle ofindeterminacy to foretell that philosophical concept. I don't know if any school of some ofthe decisions reached will prove irrational and philosophy exists whose main aim is to purge harmful as well as arbitrary. philosophical awareness from the minds of human beings. If it does neurologists should caution their philosopher colleagues against it, for the only real al- Death as an event or death as a process? ternative to an overall philosophical concept ofdeath is a set of arbitrarily assembled rules of conduct. Who Dr Browne claims that 'it is not a biological fact that would issue such rules? On what basis? And would not one who has suffered whole-brain death is dead'. Is the issuing of edicts, unrelated to a widely discussed that correct? And what exactly does it mean? and generally accepted concept ofdeath, constitute the The statement is ambiguous: it can be interpreted in very 'medical paternalism' Dr Browne so rightly two different ways. Is the 'biological fact' of death, to decries? History tends to show that when prescribed which - according to Dr Browne - brain death does not observances and practices have no roots in generally relate, the 'death of the organism as a whole'? Or is it accepted conceptual frameworks they face one of two the 'death of the whole organism', that is the death of fates: they are either abandoned (and sooner rather each and every one of its cells? Both are legitimate than later) - or they are only sustained by the imposi- interpretations ofthe 'biological fact' ofdeath, but they http://jme.bmj.com/ tion offorce. Is the latter what Dr Browne means when lead to very different conclusions. he quotes proposed empirical rules that threaten those If we accept the first interpretation (namely that the who transgress them with 'the most severe sanction 'biological fact' ofdeath relates to the dissolution ofthe available' to particular jurisdictions? 'organism as a whole') Dr Browne's statement (that it is I have elsewhere sought to argue against what I have not a biological fact that brain death is death) is self- called 'free floating criteria ofdeath' and to show how, evidently untenable. The very opposite would seem to historically, different concepts of death have necessi- be nearer the truth, namely that only when the brain is tated the adoption of different criteria of can death (2). In dead the individual (the 'organism as a whole') be on September 26, 2021 by guest. Protected copyright. this context I have outlined my own concept ofhuman considered dead. Whereas the functions of lungs and death (to which criteria assessing brain stem function heart can (for a while) be taken over by a machine, those are central). The full argument for defining human of the brain cannot. In this perspective the classical death as the 'irreversible loss of the capacity for con- criteria of death (arrest of the heart beat and circula- sciousness, combined with the irreversible loss of the tion) are only indicative of death when they have per- capacity to breathe' cannot be recapitulated here. sisted for long enough for the brain to die. All human Briefly, this admittedly hybrid definition seeks to death, according to this view, is (and always has been) combine philosophical and physiological con- brain death. That is the position I hold.
Load more

Recommended publications
  • Forensic Medicine
    YEREVAN STATE MEDICAL UNIVERSITY AFTER M. HERATSI DEPARTMENT OF Sh. Vardanyan K. Avagyan S. Hakobyan FORENSIC MEDICINE Handout for foreign students YEREVAN 2007 This handbook is adopted by the Methodical Council of Foreign Students of the University DEATH AND ITS CAUSES Thanatology deals with death in all its aspects. Death is of two types: (1) somatic, systemic or clinical, and (2) molecular or cellular. Somatic Death: It is the complete and irreversible stoppage of the circulation, respiration and brain functions, but there is no legal definition of death. THE MOMENT OF DEATH: Historically (medically and legally), the concept of death was that of "heart and respiration death", i.e. stoppage of spontaneous heart and breathing functions. Heart-lung bypass machines, mechanical respirators, and other devices, however have changed this medically in favor of a new concept "brain death", that is, irreversible loss of Cerebral function. Brain death is of three types: (1) Cortical or cerebral death with an intact brain stem. This produces a vegetative state in which respiration continues, but there is total loss of power of perception by the senses. This state of deep coma can be produced by cerebral hypoxia, toxic conditions or widespread brain injury. (2) Brain stem death, where the cerebrum may be intact, though cut off functionally by the stem lesion. The loss of the vital centers that control respiration, and of the ascending reticular activating system that sustains consciousness, cause the victim to be irreversibly comatose and incapable of spontaneous breathing. This can be produced by raised intracranial pressure, cerebral oedema, intracranial haemorrhage, etc.(3) Whole brain death (combination of 1 and 2).
    [Show full text]
  • Death & Decomposition Part II
    Death & Decomposition Part II Review: Why is TSD/PMI so important? Review: What happens in the Fresh (1st) Stage of Decomposition? STAGE 2: Bloat ⦿ 0-10 days ⦿ Putrefaction: bacterially-induced destruction of soft tissue and gas formation › Skin blisters and marbling › Build-up of fluids from ruptured cells and intestines Putrefaction – the gross stuff ➢ Decomposition that occurs as a result of bacteria and other microorganisms ➢ Results in gradual dissolution of solid tissue into gases and liquids, and salts Putrefaction ➢ Characteristics: ○ Greenish discoloration ○ Darkening of the face ○ Bloating and formation of liquid or gas-filled blisters ○ Skin slippage Putrefaction ➢ Begins about 36 hours after death ➢ Further destruction is caused by maggots and insects ➢ Above 40 F, insects will feed until the body is skeletonized Influences of Putrefaction ➢ Heavy clothing and other coverings speed up the process by holding in body heat ➢ Injuries to the body surface promote putrefaction ○ provide portals of entry for bacteria Marbling Stage 3: Active Decay ➢ 10-20 days after death ➢ Body begins to collapse and black surfaces are exposed ➢ Bloated body collapses and leaves a flattened body ➢ Body fluids drain from body Active Decay Active Decay: Destruction of Tissue • Severe decomp can result in complete destruction of soft tissue Active Decay: Advanced Decomposition Stage 4: Dry Decay ➢ 20-365 days after death ➢ Remaining flesh on body is removed and body dries out ➢ Body is dry and continues to decay very slowly due to lack of moisture ➢
    [Show full text]
  • Three End-Of-Life Cases: Resolving Their Moral Dilemmas
    Vol. 33:2 Summer 2017 Three End-of-Life Cases: Resolving Their Moral Dilemmas RENÉ E MIRKES, OSF, PHD An organization of Roman Catholic physicians presented a set of questions to guide moral assessment of three end-of-life cases. The questions for each scenario highlight a corresponding ethical dilemma: (Case #1) the determination of brain death by neurological criteria; (Case #2) the decision to withhold or withdraw artificial nutrition and hydration from an unresponsive wakefulness syndrome (UWS) (formerly referred to as persistent vegetative state, [PVS]) patient; and (Case #3) the administration of pain medication that hastens death. To adjudicate the moral concern raised in each of these clinical cases, the following moral analyses appeal to the natural law perspective summarized in the Ethical & Religious Directives for Catholic Health Care Services1 and in other philosophical resources, both Catholic and secular. CASE #1 An 18-year-old involved in a motorcycle accident was brought to the emergency room with massive head trauma and life support. A brain angiogram showed no blood flow, and a neurological examination revealed no brainstem reflexes as well as persistent apnea. Blood pressure medication was required for heart rate and blood pressure control. Since the patient was an organ donor, the organ recovery team was called in after he was declared brain dead. Discussion (1) When and how do we declare a person dead? What is the difference between theological and scientific definitions of death? (A) A living human being is a substantial union of a (mammalian) body and a rational soul. We are not spiritual beings who use or have bodies.
    [Show full text]
  • What You Lose When You Sign That Donor Card Giving Away Your Organs Sounds Noble, but Have Doctors Blurred the Line Between Life and Death?
    What You Lose When You Sign That Organ-Donor Card - WSJ.com http://online.wsj.com/article/SB10001424052970204603004577269910... Dow Jones Reprints: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues, clients or customers, use the Order Reprints tool at the bottom of any article or visit www.djreprints.com See a sample reprint in PDF format. Order a reprint of this article now LIFE & CULTURE Updated March 13, 2012, 10:11 a.m. ET What You Lose When You Sign That Donor Card Giving away your organs sounds noble, but have doctors blurred the line between life and death? By DICK TERESI The last time I renewed my driver's license, the clerk at the DMV asked if she should check me off as an organ donor. I said no. She looked at me and asked again. I said, "No. Just check the box that says, 'I am a heartless, selfish bastard.'" Becoming an organ donor seems like a win-win situation. Some 3.3 people on the transplant waiting list will have their lives extended by your gift (3.3 is the average yield of solid organs per donor). You're a hero, and at no real cost, apparently. But what are you giving up when you check the donor box on your license? Your organs, of course—but much more. You're also giving up your right to informed consent. Doctors don't have to tell you or your relatives what they will do to your body during an organ harvest operation because you'll be dead, with no legal rights.
    [Show full text]
  • How to Know If You're Dead
    How to Know If You're Dead Beating-heart cadavers, live burial, and the scientific search for the soul A patient on the way to surgery travels at twice the speed of a patient on the way to the morgue. Gurneys that ferry the living through hospital corridors move forward in an aura of purpose and push, flanked by caregivers with long strides and set faces, steadying IVs, pumping ambu bags, barreling into double doors. A gurney with a cadaver commands no urgency. It is wheeled by a single person, calmly and with little notice, like a shopping cart. For this reason, I thought I would be able to tell when the dead woman was wheeled past. I have been standing around at the nurses' station on one of the surgery floors of the University of California at San Francisco Medical Center, watching gurneys go by and waiting for Von Peterson, public affairs manager of the California Transplant Donor Network, and a cadaver I will call H. "There's your patient," says the charge nurse. A commotion of turquoise legs passes with unexpected forward-leaning urgency. H is unique in that she is both a dead person and a patient on the way to surgery. She is what's known as a "beating-heart cadaver," alive and well everywhere but her brain. Up until artificial respiration was developed, there was no such entity; without a functioning brain, a body will not breathe on its own. But hook it up to a respirator and its heart will beat, and the rest of its organs will, for a matter of days, continue to thrive.
    [Show full text]
  • From Modern to Postmodern Medicine: the Case of Organ Transplants
    FROM MODERN TO POSTMODERN MEDICINE: THE CASE OF ORGAN TRANSPLANTS A THESIS SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES OF MIDDLE EAST TECHNICAL UNIVERSITY BY NİHAN BOZOK IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE DEPARTMENT OF SOCIOLOGY FEBRUARY 2015 Approval of the Graduate School of Social Sciences Prof. Dr. Meliha Altunışık Director I certify that this thesis satisfies all the requirements as a thesis for the degree of Doctor of Philosophy. Prof. Dr. Ayşe Saktanber Head of Department This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Doctor of Philosophy. Assoc. Prof. Dr. Erdoğan Yıldırım Supervisor Examining Committee Members Prof. Dr. Ş. Halil Turan (METU, PHIL) Assoc. Prof. Dr. Mustafa Şen (METU, SOC) Assoc. Prof. Dr. Erdoğan Yıldırım (METU, SOC) Assoc. Prof. Dr. Nedim Karakayalı (Bilkent U, POL. SCI) Asst. Prof. Dr. Çağatay Topal (METU, SOC) PLAGIARISM I hereby declare that all information in this document has been obtained and presented in accordance with academic rules and ethical conduct. I also declare that, as required by these rules and conduct, I have fully cited and referenced all material and results that are not original to this work. Name, Last name: Nihan Bozok Signature : iii ABSTRACT FROM MODERN TO POSTMODERN MEDICINE: THE CASE OF ORGAN TRANSPLANTS Bozok, Nihan Ph.D., Department of Sociology Supervisor: Assoc. Prof. Dr. Erdoğan Yıldırım February, 2015, 240 pages This thesis investigates the constituent tendencies of postmodern medicine, concentrating upon the organ transplantation therapy.
    [Show full text]
  • Fermentation of Non-Digestible Oligosaccharides by Human Colonic Bacteria
    Proceedings of the Nutrition Society ( 1996), 55,899-9 12 899 Symposium 2 Fermentation of non-digestible oligosaccharides by human colonic bacteria BY GLENN R. GIBSON, ANNE WILLEMS, SALLY READING AND M. DAVID COLLINS Department of Microbiology, Institute of Food Research, Earley Gate, Reading RG6 6BZ The principal substrates for colonic bacterial growth are dietary carbohydrates which have escaped digestion in the upper gastrointestinal tract. These may be starches, dietary fibres, other non-absorbable sugars, sugar alcohols and oligosaccharides. In the large intestine, saccharolytic bacteria are able to metabolize carbohydrates for increased energy and growth with short-chain fatty acids (SCFA) and a variety of other metabolites, such as the electron-sink products lactate, pyruvate, ethanol, H, and succinate, being produced. The majority of human large intestinal micro-organisms, have a strictly anaerobic metabolism, whilst numbers of facultative anaerobes are many orders of magnitude lower than those of the obligate anaerobes. Of the culturable flora, numerically predominant anaerobes are Gram-negative rods belonging to the genus Bacteroides. Other groups which have hitherto been identified as quantitatively significant include bifidobacteria, clostridia, eubacteria, lactobacilli, Gram-positive cocci, coliforms, methanogens and dissimilatory sulphate- reducing bacteria. Generally, the various components of the large intestinal microbiota may be considered as exerting either pathogenic effects or they may have potential health- promoting values. Bifidobacteria and lactobacilli are considered to belong to the latter group. Bacteria in the colon respond largely to the available fermentable substrate, and there is currently some interest in the use of diet to specifically increase groups perceived as health promoting. Non-digestible oligosaccharides seem to have this (prebiotic) potential.
    [Show full text]
  • Brain Death S34 (1)
    BRAIN DEATH S34 (1) Brain Death Last updated: December 19, 2020 CRITERIA FOR BRAIN DEATH .................................................................................................................. 1 APNEA TEST (S. APNEA CHALLENGE) ...................................................................................................... 5 ANCILLARY STUDIES ............................................................................................................................... 6 CARE OF ORGAN DONOR .......................................................................................................................... 9 ORGAN DONATION AFTER CARDIAC DEATH .......................................................................................... 11 PEDIATRIC ASPECTS ............................................................................................................................... 12 Diagnosing brain death must never be rushed or take priority over the needs of the patient or the family BRAIN DEATH (BD) or DEATH BY NEUROLOGICAL CRITERIA (DNC) – permanent loss of brain function* (cerebrum nor brain stem nor cerebellum) (i.e. no clinical detection at bedside).** *vs. brain activity (such as laboratory detection of cellular-level neuronal and neuroendocrine activity) is compatible with brain death, e.g. osmolar control - some patients develop diabetes insipidus only after clinical signs of brain death (i.e. diabetes insipidus is not required for BD diagnosis). **vs. VEGETATIVE STATE - brain stem is intact. It is suggested
    [Show full text]
  • Part 3 Metabolism of Proteins and Nucleic Acids Частина 3 Обмін Білків І Нуклеїнових Кислот
    МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ'Я УКРАЇНИ Харківський національний медичний університет PART 3 METABOLISM OF PROTEINS AND NUCLEIC ACIDS Self-Study Guide for Students of General Medicine Faculty in Biochemistry ЧАСТИНА 3 ОБМІН БІЛКІВ І НУКЛЕЇНОВИХ КИСЛОТ Методичні вказівки для підготовки до практичних занять з біологічної хімії (для студентів медичних факультетів) Затверджено вченою радою ХНМУ Протокол № 1 від 26.01.2017 р. Approved by the Scientific Council of KhNMU. Protocol 1 (January 26, 2017) Харків ХНМУ 2017 Metabolism of proteins and nucleic acids : self-study guide for students of general medicine faculty in biochemistry. Part 3: / Comp. : O. Nakonechna, S. Stetsenko, L. Popova, A. Tkachenko. – Kharkiv : KhNMU, 2017. – 56 p. Compilers Nakonechna O. Stetsenko S. Popova L. Tkachenko A. Обмін білків та нуклеїнових кислот : метод. вказ. для підготовки до практ. занять з біологічної хімії (для студ. мед. ф-тів). Ч 3. / упоряд. О.А. Наконечна, С.О. Стеценко, Л.Д. Попова, А.С. Ткаченко. – Харків : ХНМУ, 2017. – 56 с. Упорядники О.А. Наконечна С.О. Стеценко Л.Д. Попова А.С. Ткаченко - 2 - SOURCES For preparing to practical classes in "Biological Chemistry" Basic Sources 1. Біологічна і біоорганічна хімія: у 2 кн.: підруч. Біологічна хімія / Ю.І. Губ- ський, І.В. Ніженковська, М.М. Корда, В.І. Жуков та ін. ; за ред. Ю.І. Губського, І.В. Ніженковської. – Кн. 2. – Київ : ВСВ «Медицина», 2016. – 544 с. 2. Губський Ю.І. Біологічна хімія : підруч. / Ю.І. Губський – Київ– Вінниця: Нова книга, 2007. – 656 с. 3. Губський Ю.І. Біологічна хімія / Губський Ю.І. – Київ–Тернопіль : Укр- медкнига, 2000. – 508 с. 4. Гонський Я.І.
    [Show full text]
  • Pediatric Forensic Pathology: Limits and Controversies
    Pediatric Forensic Pathology: Limits and Controversies Commissioned by The Inquiry into Pediatric Forensic Pathology Ontario, Canada (As amended, 15 February 2008) Authors: Stephen Cordner Jonathon Ehsani Lyndal Bugeja Joseph Ibrahim Victorian Institute of Forensic Medicine November 2007 Paediatric Forensic Pathology: Limits and Controversies i Title Page This paper was written by Stephen Cordner (1), Jonathon Ehsani (2), Lyndal Bugeja (3), and Joseph Ibrahim (4) from the Victorian Institute of Forensic Medicine in Australia for the Inquiry into Pediatric Forensic Pathology in Ontario, Canada. The authors thank Dr Jeffrey Hubbard, Albany, New York for his comments on this paper. Any faults are ours, however. Editorial decisions and the opinions expressed are the responsibility of the first author and do not represent those of the Victorian Institute of Forensic Medicine or Monash University or of the Inquiry into Pediatric Forensic Pathology or the Commissioner. 1—Stephen Cordner AM MA MB BS BMedSc DipCrim DMJ FRCPA FRCPath Professor of Forensic Medicine, Monash University. Director, Victorian Institute of Forensic Medicine, Australia. 2—Jonathon Ehsani BMedSci, MPH (International), MH.Sci (Public Health) PhD Candidate, Monash University Accident Research Centre, Victoria, Australia. Senior Research Officer, Victorian Institute of Forensic Medicine, Victoria, Australia. 3—Lyndal Bugeja BA (Hons - Criminology) PhD Candidate, Monash University Accident Research Centre, Victoria, Australia. Senior Research Officer, Victorian Institute of Forensic Medicine, Victoria, Australia. 4—Joseph Ibrahim MB BS Grad Cert HE PhD MRACMA FAFPHM FRACP Consultant Physician, Victorian Institute of Forensic Medicine, Victoria, Australia. The authors acknowledge with thanks the assistance of Ms Kerry Johannes, Library Manager at the Victorian Institute of Forensic Medicine.
    [Show full text]
  • Bea2017.Pdf (3.251Mb)
    This thesis has been submitted in fulfilment of the requirements for a postgraduate degree (e.g. PhD, MPhil, DClinPsychol) at the University of Edinburgh. Please note the following terms and conditions of use: This work is protected by copyright and other intellectual property rights, which are retained by the thesis author, unless otherwise stated. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given. No Heroics, Please Mapping Deceased Donation Practices in a Catalan Hospital Sara Bea PhD in Science Technology and Innovation Studies The University of Edinburgh 2016 Declaration I declare that the thesis has been composed by myself and that the work presented is my own, except where explicitly indicated otherwise in the text. (Sara Bea) ii iii Abstract This thesis presents an in-depth ethnographic mapping of deceased donation in a Catalan hospital. A unique site in terms of leading edge technoscientific practices, high rates of donation and its consolidated specialised team of transplant coordinators (TCs). The thesis situates donation as an embedded medical practice and traces the practicalities and specificities of making donation a possibility at the hospital. The empirical accounts offer a distinctive contribution that complements and challenges existing social sciences literature about donation.
    [Show full text]
  • Interpretation of Measured Alcohol Levels in Fatal Aviation Accident Victims
    INTERPRETATION OF MEASURED ALCOHOL LEVELS IN FATAL AVIATION ACCIDENT VICTIMS Overview By Dr Shelley Robertson MBBS, LLB, FRCPA, DMJ, FACLM, DAvMed, MHealSc (AvMed). CONTENTS SUMMARY............................................................................................................................... 3 INTRODUCTION.................................................................................................................... 4 BACKGROUND....................................................................................................................... 5 Chemistry of Ethanol ........................................................................................................ 5 Metabolism of Ethanol...................................................................................................... 5 Putrefaction....................................................................................................................... 6 Micro-organism Production of Alcohol............................................................................ 7 Methods of Analysis ......................................................................................................... 7 Specimens ......................................................................................................................... 8 DIFFICULTIES ASSOCIATED WITH THE ASSESSMENT OF POST-MORTEM ALCOHOL LEVELS.................................................................................................... 11 Post-accident Survival ...................................................................................................
    [Show full text]