Clinical Death
Hospice care represents one of the greatest advances made in this direction. There has also been a liberalization of the use of narcotics and other drugs for symptomatic relief and improvement in the quality of life for the dying.
Clinically Dead? The Blurred Line Between Life and Death
One of the most difficult issues surrounding death in the era of technology is that there is now a choice, not of the event itself, but of its timing. When to die, and more often, when to let a loved one die, is coming within people's power to determine. This is both a blessing and a dilemma.
Insofar as the decision can be made ahead of time, a living will is an attempt to address this dilemma. By outlining the conditions under which one would rather be allowed to die, a person can contribute significantly to that final decision, even if not competent to do so at the time of actual death. The problem is that there are uncertainties surrounding every severely ill person. Each instance presents a greater or lesser chance of survival.
The chance is often greater than zero. The best living will follows an intimate discussion with decision makers covering the many possible scenarios surrounding the end of life. This discussion is difficult, for few people like to contemplate their own demise. However, the benefits of a living will are substantial, both to physicians and to loved ones who are faced with making final decisions. Most states have passed living will laws, honoring instructions on artificial life support that were made while a person was still mentally competent.
Another issue that has received much attention is assisted suicide euthanasia. In , the State of Oregon placed the issue on the ballot, amid much consternation and dispute. Perhaps the main reason euthanasia has become front page news is because Dr.
Clinical Death and Biological Death: They're Not Quite the Same
Jack Kevorkian, a pathologist from Michigan, is one of its most vocal advocates. The issue highlights the many new problems generated by increasing ability to intervene effectively in the final moments of life and unnaturally prolong the process of dying. The public appearance of euthanasia has also stimulated discussion about more compassionate care of the dying.
Autopsy after death is a way to precisely determine a cause of death. The word autopsy is derived from Greek meaning to see with one's own eyes. A pathologist extensively examines a body and submits a detailed report to an attending physician. Although an autopsy can do nothing for an individual after death, it can benefit the family and, in some cases, medical science.
Hereditary disorders and disease may be found. This knowledge could be used to prevent illness in other family members. Information culled from an autopsy can be used to further medical research. The link between smoking and lung cancer was confirmed from data gathered through autopsy. Early information about AIDS was also compiled through autopsy reports. What Happens to DeadBodies? Galen Press Ltd, Post Mortem Technique Handbook. A Population-based Autopsy Study.
Effect of AtemortemCardiovascular Disease.
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American Academy of Family Physicians. State Street, Chicago, IL American Society of Clinical Pathologists. College of American Pathologists. However, the injured cells do not actually die until hours after resuscitation. In , the laboratory of resuscitation pioneer Peter Safar discovered that reducing body temperature by three degrees Celsius after restarting blood circulation could double the time window of recovery from clinical death without brain damage from 5 minutes to 10 minutes. This induced hypothermia technique is beginning to be used in emergency medicine. Under laboratory conditions at normal body temperature, the longest period of clinical death of a cat after complete circulatory arrest survived with eventual return of brain function is one hour.
Reduced body temperature, or therapeutic hypothermia , during clinical death slows the rate of injury accumulation, and extends the time period during which clinical death can be survived. It is said in emergency medicine that "nobody is dead until they are warm and dead. The purpose of cardiopulmonary resuscitation CPR during cardiac arrest is ideally reversal of the clinically dead state by restoration of blood circulation and breathing.
However, there is great variation in the effectiveness of CPR for this purpose. Blood pressure is very low during manual CPR, [24] resulting in only a ten-minute average extension of survival. It is somewhere between the state of clinical death and a normal functioning state.
Clinical death
Patients supported by methods that certainly maintain enough blood circulation and oxygenation for sustaining life during stopped heartbeat and breathing, such as cardiopulmonary bypass , are not customarily considered clinically dead. All parts of the body except the heart and lungs continue to function normally. Clinical death occurs only if machines providing sole circulatory support are turned off, leaving the patient in a state of stopped blood circulation. Certain surgeries for cerebral aneurysms or aortic arch defects require that blood circulation be stopped while repairs are performed.
This deliberate temporary induction of clinical death is called circulatory arrest. This state is called deep hypothermic circulatory arrest. At such low temperatures most patients can tolerate the clinically dead state for up to 30 minutes without incurring significant brain injury. Controlled clinical death has also been proposed as a treatment for exsanguinating trauma to create time for surgical repair. Death was historically believed to be an event that coincided with the onset of clinical death.
It is now understood that death is a series of physical events, not a single one, and determination of permanent death is dependent on other factors beyond simple cessation of breathing and heartbeat. Clinical death that occurs unexpectedly is treated as a medical emergency. This effort continues until either the heart is restarted, or a physician determines that continued efforts are useless and recovery is impossible.
If this determination is made, the physician pronounces legal death and resuscitation efforts stop. If clinical death is expected due to terminal illness or withdrawal of supportive care, often a Do Not Resuscitate DNR or "no code" order is in place. This means that no resuscitation efforts are made, and a physician or nurse may pronounce legal death at the onset of clinical death.
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Whereas in the past the lack of a heart beat or spontaneous breathing was enough to lead to a declaration of death, that changed with the advent of resuscitation techniques like CPR cardiopulmonary resuscitation and defibrillation, organ transplants, and life support machines. Clinical death is treated as a medical emergency, with CPR and the like following. Only when a physician calls off the efforts and throws in the towel can brain or biological death, eventually followed by legal death, be declared.
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