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The Signs of Death

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PONTIFICIA PONTIFICIA ACADEMIA SCIENTIARVM ACADEMIA SCIENTIARVM The To Our Venerable Brother Msgr. Marcelo Sánchez Sorondo Signs Chancellor of the Pontifical Academy of Sciences Scripta Varia On 11-12 September of this year the Pontifical Academy Scripta Varia of of Sciences will organise a study seminar to further extend its 110 Death study of subjects and issues connected with the last stage of The Proceedings of the Working Group man’s life on earth. This significant meeting is to be located 110 11-12 September 2006 in the furrow of the centuries-old tradition of the Pontifical Academy of Sciences, whose task has been, and continues to be, that of offering the scientific community a valid and qual- ified contribution to the solution of those relevant scientific- technical problems that are at the basis of the development of mankind, taking into due consideration the moral, ethical The and spiritual aspects of every question as well. In performing its special service, the Pontifical Academy of Sciences always refers to the data of science and to the teachings of the Magisterium of the Church. In particular, as regards this study meeting, Christian Revelation also invites Signs the man of our time, who tries in so many ways to find the true and profound meaning of his existence, to address the subject of death by projecting his gaze beyond pure human reality and by opening his mind to the mystery of God. It is, indeed, in the light of God that the human creature better understands himself and his own definitive destiny, and the value and meaning of his life, which is the precious and irre- of placeable gift of the Almighty Creator. While cordially greeting those taking part in the working group, I hope and wish that the shared reflection will prove Death useful in producing opportune clarifications on aspects that concern such an important human question. And, assuring you of my spiritual nearness through prayer, I most willing- ly send to you, to the President of the Pontifical Academy of Sciences, and to all the distinguished scholars present, an Apostolic Blessing. From Castelgandolfo, 8 September 2006 EM AD IA C S Thus, when the functions of the brain which are, so to speak, at the A C I service of the soul, cease completely because of some defect or A E I N perturbation – since the messengers of the sensations and the C T I I F agents of movement no longer act –, it is as if the soul was no A I R T longer present and was not [in the body], and it has gone away. V N M O P Denique, dum haec eius tamquam ministeria vitio quolibet seu Front Cover: Leonardo Da Vinci, perturbatione omni modo deficiunt desistentibus nuntiis sentiendi et Profile of a Woman’s Head ‘Facing Death’, VATICAN CITY ministris movendi, tamquam non habens cur adsit abscedit [anima]. pen and bistre, with white traces, retouched, Florence, Uffizi. MMVII 2007 Saint Augustine, De Gen. ad lit., L. VII, chap. 19; PL 34, 365 THE SIGNS OF DEATH Address: The Pontifical Academy of Sciences Casina Pio IV, 00120 Vatican City Tel: +39 0669883195 / Fax: +39 0669885218 Email: [email protected] PONTIFICIAE ACADEMIAE SCIENTIARVM SCRIPTA VARIA 110 Working Group on THE SIGNS OF DEATH 11-12 September 2006 Edited by H.E. Msgr. Marcelo Sánchez Sorondo EM AD IA C S A C I A E I N C T I I F A I R T V N M O P EX AEDIBVS ACADEMICIS IN CIVITATE VATICANA MMVII The opinions expressed with absolute freedom during the presentation of the papers of this meeting, although published by the Academy, represent only the points of view of the participants and not those of the Academy. Acknowledgements I would like to thank the following people for their valuable work on this vol- ume: Dott. Lorenzo Rumori (layout, graphic design, conference photographs and index structure), Gabriella C. Marino (language revision, transcripts, proofreading and index structure), Dott.ssa Barbara Pelinka (German tran- scripts and translations), Dott.ssa Alessandra Petrillo (proofreading), Prof. Matthew Fforde (revision), Archiv. Aldo Cicinelli and Dott.ssa Simonetta Ulisse (Secretariat). M.S.S. ISBN 978-88-7761-090-4 © Copyright 2007 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means, electronic, mechanical, recording, photocopying or otherwise without the expressed written permission of the publisher. PONTIFICIA ACADEMIA SCIENTIARVM VATICAN CITY His Holiness Pope Benedict XVI The Participants of the Working Group of 11-12 September 2006 The Participants of the Working Group of 11-12 September 2006 The Participants of the Working Group of 11-12 September 2006 CONTENTS Preface................................................................................................. XIII Lettera di Sua Santità Benedetto XVI al Venerato Fratello S.E. Mons. Marcelo Sánchez Sorondo Cancelliere della Pontificia Accademia delle Scienze a motivo del seminario ..................................................... XIV Letter of His Holiness Benedict XVI to Our Venerable Brother Msgr. Marcelo Sánchez Sorondo Chancellor of the Pontifical Academy of Sciences on the Occasion of the Working Group............................... XV The Purpose of the Meeting Bishop Chancellor Marcelo Sánchez Sorondo ................................ XVI Why the Concept of Brain Death is Valid as a Definition of Death. Statement by Neurologists and Others A. Battro, J.L. Bernat, M.-G. Bousser, N. Cabibbo, Card. G. Cottier, R.B. Daroff, S. Davis, L. Deecke, C.J. Estol, W. Hacke, M.G. Hennerici, J.C. Huber, Card. A. López Trujillo, Card. C.M. Martini, J.C. Masdeu, H. Mattle, J.B. Posner, L. Puybasset, M.E. Raichle, A.H. Ropper, P.M. Rossini, M. Sánchez Sorondo, H. Schambeck, E. Sgreccia, P.N. Tandon, R. Vicuña, E.F.M. Wijdicks, A. Zichichi ....... XXI Questions for Neurologists and Others about Brain Death as the Criterion for Death.................................................................................. XXX Programme.......................................................................................... LXXXVIII List of Participants ............................................................................. XCI SCIENTIFIC PAPERS AND DISCUSSIONS What is not Brain Death: the Vegetative State and Movements in Brain Death Conrado J. Estol................................................................................. 3 Discussion on Dr. Estol’s paper......................................................... 18 X CONTENTS The Minimally Conscious State: Neuroimaging and Regeneration Stephen Davis..................................................................................... 24 Discussion on Dr. Davis’s paper ........................................................ 33 The Clinical Criteria of Brain Death Throughout the World Eelco F.M. Wijdicks ........................................................................... 41 Discussion on Dr. Wijdicks’s paper ................................................... 47 Neurophysiological Signs of Brain Death (EEG & Evoked Potentials): Are They Safe & Reliable? Paolo M. Rossini ................................................................................ 56 Discussion on Dr. Rossini’s paper..................................................... 65 Human Brain, Functional Organisation, Altered States of Conscious- ness and the Assessment of Brain Death Marcus E. Raichle.............................................................................. 70 Discussion on Dr. Raichle’s paper..................................................... 79 Brain Death – An Artifact Created by Critical Care Medicine or the Death of the Brain Has Always Been the Death of the Individuum Werner Hacke..................................................................................... 84 Discussion on Dr. Hacke’s paper....................................................... 91 Surviving Areas of Brain Tissue in Brain Death: Is the Whole More Than the Sum of its Parts? Michael G. Hennerici......................................................................... 101 Discussion on Dr. Hennerici’s paper................................................. 114 Alleged Awakenings from Prolonged Coma and Brain Death and Delivery of Live Babies from Brain-Dead Mothers do not Negate Brain Death Jerome B. Posner ............................................................................... 116 Discussion on Dr. Posner’s paper...................................................... 123 Is Brain Death the Death of the Human Being? On the Current State of the Debate Robert Spaemann .............................................................................. 130 Discussion on Dr. Spaemann’s paper................................................ 142 CONTENTS XI How do Physicians Prove Irreversibility in the Determination of Death? James L. Bernat ................................................................................. 159 Discussion on Dr. Bernat’s paper ...................................................... 177 The Neurologist’s View on the Determination of Brain Death Lüder Deecke...................................................................................... 183 Discussion on Dr. Deecke’s paper ..................................................... 194 The Assessment of Coma Outcome by the Use of Multimodal MR and Proportionality of Care in Neuro-Injured Patients Louis Puybasset ................................................................................. 195 Discussion on Dr. Puybasset’s paper................................................
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