Episode post here. Transcription by Prexie Miranda Abainza Magallanes.
Matt Teichman:
Hello and welcome to Elucidations, an
unexpected philosophy podcast. I’m Matt Teichman, and with me today
is Christos
Lazaridis,
a neurointensivist at the University of Chicago, and he’s here to
discuss brain death. Christos Lazaridis, welcome.
Christos Lazaridis:
Thank you so much for having me, Matt.
Matt Teichman:
Well, I was going to ask you about what brain
death is, and we’ll definitely get to that, but I think I have to
start by asking: what is a neurointensivist?
Christos Lazaridis:
I guess that there are two words in
there, neurology and intensive care. The idea is that it’s a
specialized critical care subspecialty that is designed to provide
multi-organ support and brain support for patients who have either
serious acute brain injuries, or patients who are post-neurosurgical
procedures. So it combines fields of knowledge from basic critical
care—for example, principles of mechanical ventilation, hemodynamic
support—but it has a special focus on improving brain outcomes in
patients with different types of acute brain injury.
Matt Teichman:
So: the life support side of neurology. Is
that approximately the thing to have in mind?
Christos Lazaridis:
That’s a very nice way to put it. Life
and brain support.
Matt Teichman:
Okay. Speaking of life support, maybe we
could ease our way into the topic of brain death by just talking about
life support technology. How did that come about? What are some of
the things that our life support technologies can do? What are some
different life support technologies we have available right now?
Christos Lazaridis:
If you look at the history of critical
care and you identify the ‘50s as a landmark point, after the polio
epidemics in Europe (particularly in Denmark), that’s where you have a
large number of people who require respiratory ventilatory assistance.
That’s where a primitive form of mechanical ventilation comes
about. Basically, machines that provide oxygen, airway pressure, and
ventilation for the human body.
Matt Teichman:
Would that be because the brain is no longer
making the lungs automatically breathe, or could it also be because
the lungs are physically damaged?
Christos Lazaridis:
In this specific scenario, polio had to
do with the fact that the muscles and the nerves cannot support
spontaneous, regular breathing, so you need artificial support. From
there on, you have an exponential increase of concomitant evolutions
in technology, and artificial support, and machinery, and medical
knowledge. So you end up with the point, currently, where you have
technology that can take over or support (to a very large extent) the
function of the heart, and the circulation, the function of the
respiratory system, and the function of the kidneys. Take something
like ECMO (Extracorporeal Membrane Oxygenation) where you have a
membrane that oxygenates the blood, pumps through the body, and then
is able to also deal with elimination of carbon dioxide. You basically
take over, with a machine, the function of the circulatory system and
the function of the respiratory system.
Matt Teichman:
It’s like you skipped the breathing part. You
just magically oxygenate the blood and take care of the carbon dioxide
problem. Is that right? That’s what I’m visualizing here: I’m
imagining that instead of lungs physically breathing in air, you’re
skipping the ‘intake of air’ part, and doing what the lungs are there
for.
Christos Lazaridis:
That’s mostly right. You can have a
patient who has minimal pumping heart function and very, very sick
lungs, where there is heart and lung failure. And you can take over
the function of these organs in this artificial, mechanical way. So by
replacing these vital functions in an artificial way, you’re able to
support patients and function of the organism for far longer than you
could, without this machinery. In fact, without this machinery, a lot
of patients would just die, meaning their heart and lungs would stop
working, oxygen nutrients would not circulate around, cells would not
be able to produce energy. Then you would have a gradual
disintegration of organ systems.
Matt Teichman:
Are these machines all outside the person,
plugged into them, or are there versions of them that you would
implant in the person? To have an artificial heart or artificial
lungs. Or is that a separate thing?
Christos Lazaridis:
There are implantable devices—something
like ventricular assist devices—where you actually put something
that can support pump function and enhance it. So there are different
versions of increasingly sophisticated mechanical circulatory
respiratory support.
Matt Teichman:
But I guess being exterior to the person is
connected up with it being temporary. We’re temporarily hooking them
up to this, because we want to heal them, so that they can do it on
their own, eventually. It seems like there’s a connection there.
Christos Lazaridis:
That is correct. And obviously, this can
happen in specialized places. It’s not only the machinery, obviously,
but a very sophisticated, complicated degree of knowledge and care. So
there are specialized nurses, specialized units, and specialized
physicians who provide this kind of support. The one thing you cannot
really support artificially is consciousness, but maybe we can get to
that a little bit later.
Matt Teichman:
It’s a little hard to imagine what that would
be. A device that thinks for you. I don’t know.
Christos Lazaridis:
Maybe—
Matt Teichman:
—would it think what you would think? Or
maybe it would think what it wants to think. I don’t know.
Christos Lazaridis:
You’re the computer scientist, so some
kind of a chip that can replace—
Matt Teichman:
—I mean, even this would be very impressive,
but my first thought would be: maybe there could be a device to take
over homeostatic regulation of the bodily systems that the brain does.
That side of the brain, as opposed to the conscious thought side of
the brain.
Christos Lazaridis:
That’s very interesting. It gives me the
opportunity to actually make a comment about this. For a long time,
there has been this idea that the brain is the central
integrator. It’s the organ in the body that keeps everything
together. And you nicely used this term homeostatic integration,
where, if we want to define organismal life, we talk about how
organisms are not just a collection of different organs, but organs
that are speaking to each other. They are integrated, and they’re
working as a whole, for the organism as a whole. For a long time, this
idea that the brain was playing this very central function was one of
the justifications for the concept of death by neurologic criteria, or
brain death. It turns out the story is a little bit more complicated,
and in fact, this concept of the central integrator has been
challenged, and it’s probably false—meaning that for lack of a
deeper explanation, it seems like homeostatic integration is an
emergent property of the organism.
Matt Teichman:
So there is no one centralized thing
regulating everything.
Christos Lazaridis:
Correct.
Matt Teichman:
It’s like a distributed software application.
Blockchain!
Christos Lazaridis:
That is correct.
Matt Teichman:
Okay. So since brain death came up, maybe
this would be a good time to say: what is brain death, intuitively?
What’s the phenomenon? If I say, so and so is brain dead, what am I
saying?
Christos Lazaridis:
Right. Let me back up a little bit, and
talk about how brain death (and death by neurologic criteria) came
about. If you want just a brief historical overview, here are some
landmark events.
At least in the United States, the very first conceptualization of brain death is the so-called Harvard Ad Hoc Committee, and a paper they published in JAMA in 1968. Basically, that committee got together, and the goal of the committee was to pragmatically address two important issues that have come up. One is this idea, that we just talked about in the beginning, that technological artificial support was now able and was used to support patients who may have had devastating catastrophic brain injury. Who, without the support of mechanical ventilation would immediately die: their heart would stop, and they would die.
The second important event that triggered this conversation was advances in the science and practice of organ transplantation. So about a year before, in December of ‘67, was the first heart transplant, by Christiaan Barnard in South Africa. So the committee got together to say: how do we understand and conceptualize patients who have a heart beating, but they have catastrophic devastating brain injury?
The committee came up with a set of criteria which are not actually very different from what we use right now. Patients who were in total brain failure—they would be in a coma, in an irreversible coma—they would not have any brainstem reflexes, and (at the time) also have isoelectric EEG, or electroencephalogram. So the committee said: this is the concept of brain death, and these patients would count as legally, medically, and socially dead. But what’s interesting to note about this story is that the committee did not really offer a very sophisticated philosophical justification why that state of devastating brain injury should count as death. It was more of a pragmatic definition.
Then, fast forward from there to 1981, where the President’s Commission on bioethics comes together to actually suggest statutory language for states to have as laws on how to legally define death. That document, which is rather influential and still active (although it’s probably going to be revised soon) is the so-called UDDA, which is the Uniform Determination of Death Act.
It has two arms: it accepts death as being one thing, a univocal concept. It treats it as an event, not as a process, and it basically says a person—a human being—can get there in two ways. They can be determined dead in two ways. One is by the irreversible cessation of circulatory and respiratory function, or the irreversible cessation of all functions of the entire brain, including the brainstem. The last clause is that this determination should be made according to appropriate medical standards.
Matt Teichman:
So you need to have either of the two
conditions on this list to count as dead, according to the criterion
laid out in that law.
Christos Lazaridis:
Exactly, right.
Matt Teichman:
Isn’t it kind of funny how part one of the law
was: hey everybody, there’s just one thing that counts as death. It’s
not a grab bag category. That’s part A. And then part B is like:
there’s two totally different ways that somebody can count as dead. I
feel like those are two conflicting moves in the law.
Christos Lazaridis:
There’s debate about what is the
appropriate way to think about death. And here, we’re talking about
death as a scientific concept. It’s probably more appropriate to think
about it as a process. You have to draw a line somewhere, in order to
medicalize and operationalize the definition, the determination of
death.
Matt Teichman:
It seems like the goal here is to figure out
when you pronounce somebody dead. The act of legally pronouncing
somebody dead feels to me like that’s what’s driving this. Because
there are all these conditions we happen to be coming across people
in, and we want to know: how should we treat them? Should we treat
them as alive or dead? Is that right? Is the motivation for this to be
able to accurately pronounce someone dead?
Christos Lazaridis:
Absolutely. Obviously, not only for
medical reasons, but the determination and declaration of death has
very important consequences for public health, for social reasons, for
legal reasons. That point of transition from the living to the dead,
in order to be identified in a medical manner, reliably and
consistently in the same way, it has to be strictly demarcated. And
so, some of the problems may be related to exactly this, that we are
introducing, necessarily, some artificial divide between the living
and the dead.
Matt Teichman:
Is that what you were getting at, with your
event versus process terminology? If it’s an event, then it’s
instantaneous. It happens at this moment; they went from this state
to this different state. Versus a process, which would be more like a
continuously evolving pattern—like a gradient kind of a thing. Is
that what you’re getting at?
Christos Lazaridis:
Yes. Let me back up a little bit. We
talked about the Harvard Committee, we talked about 1981. But there’s
an important paper, actually, in 1972, in Penn Law Review, by
Alexander Capron and Leon
Kass, who
actually had to address the issue—
Matt Teichman:
University of Chicago Leon Kass?
Christos Lazaridis:
Yes, correct.
Matt Teichman:
Excellent.
Christos Lazaridis:
They had to address statutory language
and create something that did not really exist before. A conceptual
framework of: what are the different definitional levels and standards
in order to define death into law? And so, there are four levels that
are useful to situate a little bit more of the discussion and
understand the debate and some of the challenges.
The very first level is the concept of death, and this is really a philosophical question. I think the better way to understand it is: you have to know the ontology of the entity we are trying to determine the death of. In our situation, obviously, human ontology. What is the essential nature of a human being?
Matt Teichman:
Yeah, when do they turn from being a person to
being a corpse? Or something like that. It seems like a change of
what kind of entity it is.
Christos Lazaridis:
That’s correct. And there are several
starting points, but one starting point is to say: we are essentially
animals. We are essentially biological organisms. And so, death of a
human organism should follow the same principles as any other biologic
organism, up to a certain point of biological hierarchy. Another view
would be that we are essentially persons: embodied persons or
embrained persons. This could potentially generate a different kind
of standard. So that’s level one.
Then in the second level, you have to talk about physiological standards. If you take a certain concept, what kind of physiological standards would fit, going along with that concept? Take the biologic organism concept. The physiologic standards should be the irreversible cessation of homeostatic integration. That would be the corresponding standard. Then you have to talk about operational criteria. So in this case, the conversation is shifting from philosophical-conceptual to medico-technical. And so you have to—
Matt Teichman:
—how do you tell that’s happened? How do you
tell their brain is no longer regulating the body?
Christos Lazaridis:
For example, you have to say cessation of
cardiac function, loss of pulse, apnea, irreversible coma. And then
the very last stage, the fourth level, is testing. What kind of
medical testing can you use? What are the empirical signs and tests to
confirm that you are meeting the physiologic standard and the
operational criteria?
Matt Teichman:
I wonder if we could talk about some of the
background assumptions we’re making about why it matters that we get
it right determining when a person dies. I would think it would have
something to do with: look, we have a totally different relationship
to a dead body than we do to a living person. We’re not going to bury
a living person. We’re not going to hold out hope of having a
meaningful relationship and conversations with a dead body. Once the
person’s definitely dead, we’re good to do certain things that would
be horrible to do to a person who is still alive. That’s what’s
morally at stake, isn’t it? In figuring out how to get the time of
death about right.
Christos Lazaridis:
Absolutely, and that’s why this
demarcation is critical. One way this is very, very important is, you
said it: we treat differently—it’s two different categories—the
living and the dead. And there is a different set of duties,
responsibilities, and actions we can undertake with the living versus
the dead. One very important dimension of this is organ donation.
Matt Teichman:
Yeah.
Christos Lazaridis:
There is this principle of medical
ethics, a foundational principle of organ donation, the so-called
dead donor rule. The idea that the donor should not die as a result
of organ donation. The donor should already be determined and declared
to be deceased, dead, and then organ donation proceeds. Of course,
there are scholars who have suggested that the dead donor rule could
be abandoned on the basis of principles like autonomy and
non-maleficence. Someone, if they choose to end their life that way,
they should be allowed. For example, if you’re withdrawing
life-sustaining treatments, and you want to be an organ donor, then
that should be allowed. This has also been called organ donation
euthanasia. But let’s bracket this for a little bit.
We still have to say that the donor rule is a foundational principle, and so it’s extremely important for the enterprise of organ transplantation that we have accurate, reliable determination of death and the exact time and point of death.
Matt Teichman:
This is obviously morally problematic, but you
could see how somebody who was hyped up to get some functioning organs
for an organ transplant surgery might feel pressure to draw the line
earlier rather than later, because the organs are only going to be
useful for that purpose for a limited amount of time. By the way, how
much time is that? Like, if I were to tragically die right here how,
long would we have to harvest my organs?
Christos Lazaridis:
Well, it depends. There’s different
ischemic time according to different organs, for example, the heart
and liver. It also depends on, if one of us has a cardiac arrest now,
what kind of advanced cardiac life support we receive. If you very
quickly achieve what we call return of spontaneous circulation,
paramedics come in here, and they do the right things, and then you’re
placed on mechanical support, several organs can be well
preserved. Also in this, since we are talking about brain death, we
call this heart beating donation, after death by neurologic
criteria, versus non-heart beating donation.
Matt Teichman:
So we talked about two criteria for whether
somebody counts as brain dead. One was the loss of this integrative
function that the brain performs, and the other one was the loss of a
heart beat and breathing. How do you figure out whether a person is in
either of these conditions and can’t come back?
Christos Lazaridis:
Let me answer this in two ways, because
you mentioned indirectly the idea of irreversibility. And this is a
subtle, tricky point that I want to separately—
Matt Teichman:
—it’s intuitive, right? Why would you take
somebody’s organs when they’re going to be better in a week? That’s
crazy.
Christos Lazaridis:
Oh, absolutely. By definition, death is
an irreversible event. And by the way, the word irreversible is in
the law. In the UDDA, both disjuncts talk about irreversibility, which
creates a little bit of a problem. Let’s introduce another term:
permanence. What’s the difference between irreversibility and
permanence? The difference is that irreversibility has to do with
immutability—something that it’s practically and theoretically
impossible to change, or return, or be reversible, regardless of human
action or not.
Permanence has to do with the idea that a condition may not be physiologically or theoretically irreversible. But for example, let’s take a patient who has a do not resuscitate order. Someone like this, if they go into cardiac arrest, you would not provide ACLS (Advanced Cardiac Life Support), which includes chest compressions, or electrical therapy, or pharmacologic support to restart the heart. There, you determine and declare death according to a standard of permanence, which does not mean that this is a heart that would not stop if the effort was made. So in practice, in the hospital, we use this permanence standard very often, not the biological and legal concept of irreversibility.
Matt Teichman:
It also seems like it’s a matter of the
patient’s preference that makes it permanent. Whereas, in another
case, it might be just because the person is damaged and they can’t
heal.
Christos Lazaridis:
That plays a huge role. If there are
limits of what kind of support and how advanced the support is going
to be, then you could potentially have two identical patients, in
terms of their physiology and their organ failures. One is declared
dead, versus the other is placed on ECMO, which we talked about in the
beginning.
Matt Teichman:
So one way a person might not be able to come
back is because they’ve told you they don’t want to come back in the
way that you can bring them back.
Christos Lazaridis:
Correct.
Matt Teichman:
Another way that somebody might not be able to
come back is they have serious brain damage. But if somebody is just
unconscious, how can you tell whether they’re just in a temporary coma
and they could come back, versus their brain is never going to make
them conscious again?
Christos Lazaridis:
This is a good and rather complicated
question. Let me answer it this way. How do we determine death by
neurologic criteria, or brain death? There are specific rules that a
clinician has to follow in order to make that determination. We talked
a little bit about the very basic criteria, that the 1968 Harvard
Committee brought about, and then you have recommended guidelines on
what needs to be done to come up with this determination. This is from
the 2010 American Academy of Neurology.
The basic pillar there is that you have a patient who is in a coma, and the definition of coma is: you have someone who is laying in a bed. They are motionless, they have eyes closed, and they have no responses to internal or external stimuli. Then you do a careful examination of what we call brainstem reflexes, which includes things like pupillary reaction to light, or corneal reflexes, gag and cough, and then, finally, you do something we call an apnea test, which is a way to test the very lower part of the brainstem—the medulla—where respiratory centers are. If all of these testing criteria are met, then you can determine someone as dead by neurologic criteria. There are important prerequisites that one has to take into account. Patients have to be normothermic. You shouldn’t have any confounders like intoxications or different—
Matt Teichman:
—it sounds stupid, but what if they’re in a
deep sleep? I assume there’s big differences there. Obviously, if
they’re asleep, you can wake them up. But apart from that, just in the
state itself, I assume there are big differences.
Christos Lazaridis:
You’re bringing up a good point, that for
a non-medical layperson, looking at someone who may meet these
criteria may not look very different than someone who is under
sedation. They are in the intensive care unit, is a warm body
supported by machinery. You wouldn’t be able to tell the difference,
without having this specialized knowledge. This is important, because
the way one communicates the state and what it means to family members
requires a certain degree of nuance. Sometimes, it ends up leading to
some resistance by family members, who may say: well, you know, this
is a warm body; I’m not sure why this would count as death. But just
to complete the prior segment, there are very specific prerequisites,
confounders that have to be excluded, and a testing process that has
to be reliably and consistently followed in order to determine death
by neurologic criteria.
Matt Teichman:
Are we good at doing that? How often does it
seem like a person is never going to come back, according to our best
guess, and yet, oh my god, it’s a Robin Williams movie moment: they
come back against all odds. Are we good at predicting that?
Christos Lazaridis:
There are several things one can say
about this. There are scientific medical papers out there that suggest
that we are not very consistent in how we do these determinations. And
so, there is an important effort from the American Academy of
Neurology to create consistency. A recent document that’s been very
influential is a so-called World Brain Death
Project. It
was published in JAMA, and it’s basically a large consortium of
experts. The whole effort of this paper (and this literature) is to
say: we need to be consistent about how we come up with this
determination. University of Chicago should not be doing it different
than, let’s say, a hospital in Connecticut, or a hospital in
Boston. It turns out that there is this inconsistency. So this is one
thing to say about your question. Then you asked about how good are we
in terms of being correct about these determinations.
Matt Teichman:
Yeah. It’s like you’re predicting the future,
in a way. Making the irreversibility determination is: I predict that
no matter how much time we give it, this person is going to be in this
state forever.
Christos Lazaridis:
Right. Here is one way that one can
introduce an important caveat in this conversation. What follows the
determination of death by neurologic criteria, at least in the United
States, and in other countries that have this enshrined in law, is
that one of two things happen. One is if the person is an organ donor,
then donation practices take over. Otherwise, artificial support is
removed. And so, what follows is cardiorespiratory cessation.
Critics of the brain death concept have talked about a potential fallacy that is introduced here. It has to do with a self-fulfilling prophecy. Now, having said that, if you look at the literature, there are the occasional cases that sometimes even make the news that a certain person was determined dead, and then something happened that reversed this determination. These are rather rare reports. A lot of them are contested, in the sense that potentially something was not appropriately done in the determination. However, there is this one case—I don’t know if you would want us to go there now—this recent case of Jahi McMath—
Matt Teichman:
—let’s do it.
Christos Lazaridis:
It is an important and in many ways
fascinating case. Jahi was a young woman, a teenager, who had what was
expected to be an uncomplicated oropharyngeal surgery. Unfortunately
and tragically, she had a very significant hemorrhagic complication
after surgery, so she ended up having a rather prolonged cardiac
arrest, and suffering what we call very severe anoxic ischemic brain
injury. The heart stops, there is no blood flow going to the brain,
there is no oxygen, brain cells die.
And so, Jahi was determined to meet neurologic criteria for death in a hospital in California. This was contested by her family, who did not accept the diagnosis. The case ended up reaching the courts. There was an independent neurologist sent by the court to examine Jahi. There were multiple electroencephalograms. There was also what we call a nuclear or SPECT blood flow study. Basically, it shows you if there is blood going into the brain.
Long story short, all of this testing suggested that, indeed, Jahi was meeting death by neurologic criteria. So what ends up happening is that the family does not accept this diagnosis, as I said. They moved Jahi to New Jersey, which is the only state in the United States that has a religious exemption clause, meaning that a family or a person can object to the diagnosis of death by neurologic criteria, because of religious beliefs. And so, Jahi ends up being dead in California yet alive in New Jersey. She survives (I guess, in quotation marks) for another about four and a half years, up to the point where she now meets circulatory criteria. She’s maybe the only person that has two different death certificates in two different time points.
Matt Teichman:
That’s pretty weird.
Christos Lazaridis:
Yes, it is. And it identifies that there
is a lot to be said about this case. For example, you wouldn’t expect
that state borders would make a difference in the status of alive
or—
Matt Teichman:
—they’re just moving somebody; it’s
amazing. It resurrects them.
Christos Lazaridis:
Exactly.
Matt Teichman:
I wouldn’t have thought that was possible.
Christos Lazaridis:
And just to complete why this case
becomes even more interesting is that at least her family and Alan
Schumann—who is a very well-known neurologist and has been a critic
of brain death for a long time—they have claimed that Jahi ended up
transitioning from the state of dead by neurologic criteria (brain
dead) to what we call minimally conscious. Meaning that she was able
to exhibit a certain amount of basic purposeful behavior. Again, this
is contested, and unfortunately, beyond Alan Schumann, I don’t think
there has been any other independent validation of this
claim. However, just—
Matt Teichman:
—and probably people don’t want to get
involved legally after the person’s been pronounced dead. So it could
be hard to gather a lot of evidence on it.
Christos Lazaridis:
It was certainly hard to even be able to
provide care for Jahi. So her family had to go into a significant
struggle to get care for her. And for the most part of four years, she
ended up living at their apartment with support—with a mechanical
ventilator. So the question arises, after the central integrator of
the brain has died, you would expect the body to fall apart, right?
That doesn’t seem to be the case, at least for Jahi.
Matt Teichman:
Now that we’ve laid out the motivation for
brain death, I’m kind of not buying it, because it seems like it’s a
bit of a cheat. Legally, we have this dead donor rule, which says
somebody has to be dead for you to be able to harvest their organs for
an organ transplant. And then it expedites that process to be able to
do it with somebody who’s irreversibly lost consciousness.
So what are we going to do? Well, we’re going to round the loss of consciousness up to being death so that it expedites that process. It seems like some sort of legal trick where the more honest thing to do would be: don’t call it death. If the person’s cells are still alive, they’re metabolizing energy, they can go through puberty, they can carry a pregnancy to term, why would you call it death? Just call it loss of consciousness. And then, if need be, change the law so that the law now has an expanded window during which it’s considered okay to harvest somebody’s organs. It seems like that terminology would be more transparent than bringing in this notion of death, just because it’s legally convenient.
Christos Lazaridis:
Right. What you just explained is exactly
the position of a number of scholars and critics about the notion of
death by neurologic criteria. Another way to put it is that it may be
what we call a legal fiction, kind of the same way we talk about
treating in the law a corporation as a person. So there’s one school
of thought that says: well, this is a non-transparent fiction. It
seems that we now understand biological death a little bit
better. There’s no central integrator. And so, death of the brain is
not sufficient for death of the organism. So it’s not biological
death.
One route would be to abandon death by neurologic criteria, and then think about how one would go about continuing the important project of organ transplantation. And one way to do it is to abandon the dead donor rule. There is a lot of heated debate on this. Obviously, other complicated things would have to happen: for example, changing homicide laws in a situation like this.
However, there is this other camp—and I think I side more on this other side—that even if death by neurologic criteria is not equivalent to biological death, it is a very useful, appropriate social policy. So to some degree, yes, it is a social convention. We are drawing a line. People have called it—if you don’t like the term legal fiction, you can use the term legal status. The idea that you create a category in law that can be treated in a certain way. What is the justification there? It’s really the idea (going back to the irreversibility/permanence debate) that death by neurologic criteria, with a good, high degree of accuracy, they can get us this idea of permanent loss of consciousness.
And so, one way to redefine brain death (or death by neurologic criteria) is to say that it’s the permanent loss of consciousness, apnea, permanent loss of the ability to spontaneously breathe, and loss of brain stem reflexes. Which is a surrogate to assure that you do indeed have this permanent loss of consciousness, because consciousness is mediated—generated—by structures in the brainstem.
Matt Teichman:
Christos Lazaridis, thank you so much for
participating in what has to be the most heavy metal Elucidations
episode ever. I mean, come on, we covered death. I should have gotten
Ozzy Osbourne to co-host this. Thank you.
Christos Lazaridis:
Matt, you’ve been very kind inviting
me. Thank you so much.