course material

1. Discussion Essay
Unformatted Preview PHHE 435/535 Ethical Decision Making for Health Professionals
Module 6A Determining Life and Death Master of Public Health Program – Copyright ©
2017. Board of Trustees of Northern Illinois University. All Rights Reserved. Objectives •
Frameworks • When Does One of Us Begin? How Does One Determine Who is One of Us?
Shaped Who is one of us? Ethical Judgements 1 How Does One Determine Who is One of Us?
• Any one of the biological sciences helps us determine this? • Provides with facts • Society
has to interpret these facts Photo Credit: ctot_not‐def How Does One Determine Who is One
of Us? • We don’t know all the answers • Our biases reflect our framework of meaning and
value http://www.answersingenesis.org/assets/images/articles/wow/operating‐
system.jpg Stakes are High • Stakes are high if we are considering life and death issues,
especially so when society considered whether ‘someone is one of us’ Photo Credit: april 2
Interdisciplinary Study • Science – Provide facts • Philosophy – Interpret facts Photo Credit:
GoToVan Photo Credit: kakine kane Stages of Development • Fertilization, implantation,
primitive streak, fetal brain life, viability, birth, end infancy
http://www.orwelltoday.com/babyub2.jpg Proposed Markers Photo Credit: oatsy40 3
Stages of Deterioration • Permanent loss: Stages of Deterioration • Permanent loss: –
Cardiopulmonary function Photo Credit: The U.S. Army Stages of Deterioration • Permanent
loss: Photo Credit: Imagens Livres – Cardiopulmonary function – Brain function (brain
stem) 4 Stages of Deterioration • Permanent loss: – Cardiopulmonary function – Brain
function (brain stem) – Higher brain functions necessary for awareness and feeling Photo
Credit: GreenFlames09 Problems • Reductionist Are we more than biology? • Introduce
nonscientific ideas – Soul, mind Can’t verify Same terms may have Different meanings
Problems • Soul • Mind • Person Photo Credit: Karl‐Ludwig Poggemann 5 Concepts and
Criteria • Concepts – How we think and talk about variety of things • Criteria – Observable
facts – Indicates whether ‘someone is/is not one of us’ Classical Framework • Mystery
Religions (6th century B.C.E.) – belief that humans were more than their material bodies •
Doctrine of the ‘Soul’ Photo Credit: fiction of reality • Socrates, Plato – each person
composed of body and soul – Soul immaterial, eternal, animates body, enables one to think,
choose, abstract thought/concepts Photo Credit: fiction of reality 6 Body • Material •
Organic • Arises from seed mixing with bloody fluid in the uterus Photo Credit: Stew Dean •
Immaterial • Inorganic Photo Credit: Anders Sandberg • ‘Rational’ Soul arrives after body
achieves ability to feel Photo Credit: Fons Heijnsbroek Soul Body is a Receptacle for the Soul
7 Body is a Receptacle for the Soul • Socrates, Plato – each person composed of body and

2. soul Photo Credit: Ben Crowe Photo Credit: aaron wolpert – Beginning of life is when
immaterial rational soul enter body – Death permanent cessation of spontaneous
movement Body is a Receptacle for the Soul • Aristotle – Develop criteria for when soul
enters developing fetus • Vegetative soul • Animal Soul • Rational Soul Photo Credit: Karl‐
Ludwig Poggemann http://clendening.kumc.edu/dc/pc/Aristotle.jpg Feelings Animal Soul
Vegetative Soul Rational Soul 8 When Did I Begin? 90 days 40 days Photo Credit: Olivier Vax
When Did I Begin? • Important factor in moral evaluation of when abortion takes place
When Did I Begin? • Hebrew Bible Photo Credit: FirewallJC – Exodus 21:22 – considered
unborn not yet one of us/ not a crime of murder – Greek translation – developed fetus is one
of us 9 When Did I Begin? • Christianity – Aristotle had influence for 2000 years – Not killing
one of use until sufficient development occurred and God created a soul – Not before fetus
has sensation Photo Credit: Karl‐Ludwig Poggemann When Did I Begin? • Gratian Decretum
– a fetus did not become one of us until the human soul entered the fetal body some weeks
after conception When Did I Begin? Thomas Aquinas 1225 – 1274 The deliberate
destruction of a fetus before it is animated is morally wrong, but it is not murder 10
Breakdown of Seed Explanation • Attempt to move the time of soul infusion earlier in fetal
development • Technological advances in reproductive medicine When Did I Begin? • Two
components – Egg and Sperm • Discovery of DNA 1827 Photo Credit: Erin Campbell Smith
When Did I Begin? • Fertilized Human Egg Is this the moment when the rational soul
arrives? Photo Credit: Andrea Crisante Arbitrary interpretation 11 When Did I Begin? • Is
the destruction of a fertilized ovum the destruction of one of us? • Is the ‘Right to Life’ being
violated? • Arbitrary Interpretation Modern Concepts • Concept of Person/Personhood – So
widely defined, includes practically everyone – So narrow, only those with
selfconsciousness/rationality/moral agency/rights to be respected Conflict Modern
Concepts • Concept of Self – Consciousness that accompanies thinking – Also controversial
http://imagecache2.allposters.com/images/pic/130/009_575‐010~Norman‐Rockwell‐
Triple‐Self‐Portrait‐Posters.jpg 12 When Did I Begin? • No way to prove when human gains
or loses immaterial soul/mind • For a person who has permanently lost awareness, is there
a reason for saying the body has retained immaterial rational soul? No criteria New
Conceptual Framework: Two Extreme Positions • Body receptacle for soul • Humans are
nothing more than their bodies – Marxist ideology – Behaviorism New Conceptual
Framework • Living human body is – Biological – Psychological Human body is a perceiving
body 13 New Conceptual Framework • I experience myself as a psychic, a body that both
perceives, and is aware of perceiving • My body is me
http://www.internetbusinessdirectory.co.uk/cheshire/chester/ ibd230b.jpg New
Conceptual Framework • Body perceives and has the capacity to perceive
http://www.integrative‐breakthrough‐coaching‐solutions.com/images/perception.jpg
Three criteria to determine if a body is one of us: 1) Must have human DNA 2) Body exists
as an individual whole 3) Awareness/capacity for awareness Can verify if a body is one of
us 14 When Do We Begin? Photo Credit: AndreaLaurel Photo Credit: Duncan Hull Photo
Credit: woodleywonderworks When Do We Begin? • Moment of Implantation (Conception)?
• Zygote will not necessarily become one of us – Successfully implanted?
http://embryology.med.unsw.edu.au/Medicine/images/day8and9.jpg When Do We Begin?

3. • Bottom line about assessment – Not plausible within first two weeks after fertilization 15
When Do We Begin? • Not necessarily the beginning of a new individual body – Splitting and
Fusion http://content.answers.com/main/content/wp/en/6/6b/Embryo,_8_cells.jpg When
Do We Begin? • Individual body becomes psychic? • Development of neural pathways
(weeks 7 – 20) • Fetus becomes one of us when they can perceive When Do We Begin? • No
immaterial soul needs to arrive • Part of a natural development of the fetus itself Photo
Credit: Ray Fujloka 16 When Do We Begin? • Both biological and psychological aspects are
entwined in a mutual and complementary way Photo Credit: adrigu When Do We Begin? •
This area generates much controversy • Depends on how one conceives of themselves
Photo Credit: Adam Sporka Continue Photo Credit: Tracy Sorensen 17 PHHE 435/535
Ethical Decision Making for Health Professionals Module 6B Determining Life and Death
Master of Public Health Program – Copyright © 2017. Board of Trustees of Northern Illinois
University. All Rights Reserved. When Does One of Us Die?
http://www.millresort.com/images/pic_citizen.jpg When Does One of Us Die? • Concept of
‘Death’ • Criteria ‘Death’ – Allows us to verify that death has occurred (temperature, rigor
mortis) – Can be misleading with use of life-support machines 1 When Does One of Us Die? •
Why is this important in health care ethics? • We don’t want to make mistakes When Does
One of Us Die? • Use of new technologies further complicates the issue: Photo Credit: Social
Work 2012 When Does One of Us Die? • Use of new technologies further complicates the
issue: – Life support technology Photo Credit: Basic Life Support Certification 2 When Does
One of Us Die? • Use of new technologies further complicates the issue: – Life support
technology – Organ transplantations Photo Credit: Global Panorama When Does One of Us
Die? • Machines may delay the onset of indicators of death Photo Credit: reluctantMANGO
When Does One of Us Die? • Cardiopulmonary Criteria – functions have irreversibly ceased
• Provide oxygen to blood and distribute to body http://www.upstate.edu/chp/cp/ 3 When
Does One of Us Die? • When it happens, evidence death has occurred Photo Credit: Kris
Radder • Life-support technology, feeding tubes prolong life long after it would have ceased
naturally When Does One of Us Die? • Brain death – occurs even though body maintained on
life-support Photo Credit: Kris Radder – Evidence of necrosis When Does One of Us Die?
Photo Credit: Kris Radder • Are patients with dead brains and living bodies alive or dead? 4
When Does One of Us Die? https://www.theguardian.com/sport/2015/sep/15/sydney‐
boxer‐davey‐browne‐jr‐dies‐in‐hospital‐after‐title‐fight When Does One of Us Die? •
‘Harvard Criteria’ – Irreversible coma – EEG electrical activity
http://drx.typepad.com/psychotherapyblog/images/2007/07/21/brain.jpg When Does
One of Us Die? • Second criteria – irreversible cessation of all brain functions • Patients in
irreversible coma, sustained on life-support were in fact dead 5 When Does One of Us Die? •
State laws recognizing brain-death criterion Photo Credit: lanbirdart • Not the same in all
states When Does One of Us Die? • Uniformed Determination of Death Act: – Irreversible
cessation of circulatory and respiratory functions – Irreversible cessation of all functions of
the entire brain, brain stem Brain-Death • Whole brain – means person is truly dead Photo
Credit: Marcy Gilbert Medical Center • Brain stem – control of respiration and BP – if dies,
then need to be on ventilator 6 Brain-Death – Definitive Criterion • If diagnosed as brain
dead, when life-support removed from corpse • Life support is not keeping patients alive

4. Brain-Death • Not definitive tool
http://www.cnsforum.com/content/pictures/imagebank/hirespng/placement_EEG_leads.p
ng • EEG only used in secondary role to confirm clinical diagnosis Brain-Death • Hard to
diagnose in children in first year of life • Neurological development incomplete
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/9854.jpg 7 Brain-Death
• Problems with criterion still exist – Not all states have passed laws, MDs uncomfortable
using – Right to life groups fearful of slippery slope – lead to accepting euthanasia and
abortion http://placebojournal.com/gazettes/j0314371.jpg Cerebral Death • Neocortical –
Support functions of awareness • Not currently recognized as criterion Coma PVS Both
Unconscious • Coma • Looks like in a deep sleep • Can’t be aroused 8 Both Unconscious •
PVS • Alternating sleep and arousal (not aware) • Eyes open • Facial expressions • Can
make sounds
http://images.google.com/imgres?imgurl=http://www.ejumpcut.org/archive/jc48.2006/S
chaivoStaiger/balloonfolder/Picture‐
9.jpg&imgrefurl=http://www.ejumpcut.org/archive/jc48.2006/SchaivoStaiger/index.html
&h=167&w=220&sz=7&hl=en&start=21&tbnid=LCj36k‐
TBrWT5M:&tbnh=81&tbnw=107&prev=/images%3Fq%3DTerry%2BShaivo%26start%3D
20%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN Permanent Loss of Capability
for Awareness • If we accept the idea of the psychic body (awareness), perhaps neocortical
death does mean death has occurred • No longer one of us Confusion and Grey Areas
http://ccforum.com/content/figures/cc105‐2.jpg • Continues to be confusion over concept
of brain death 9 Confusion and Grey Areas
http://a.abcnews.com/images/Nightline/ntl_life_death_070917_ms.jpg • Grey areas over
life and death raise ethical concerns Moral Well-being
http://www1.istockphoto.com/file_thumbview_approve/1401729/2/istockphoto_140172
9_virtuous_woman_kjv.jpg • Morally virtuous person treats all life with respect, and a high
degree of dignity and care Matter of Interpretation? • Is the manner in which we designate
transitions in embryonic and fetal development an arbitrary exercise? • If we choose the
definition of death as no brain function, how do we separate/distinguish developing fetus
and brain dead adult when human existence is over? Absence of brain life/ (Brain death) 10
What’s Wrong with Analogy that says Human Existence is Over with Brain Death? • Fetus is
alive (just not yet developed awareness) • Brain-dead patient is dead
http://www.ccmep.org/2003_articles/Palestine/tom3.jpg
http://content.answers.com/main/content/wp/en/thumb/f/f3/250px‐Fetus.jpg When
Does One of Us Die? • Concept of death • Criteria death – Allows us to verify that death has
occurred (temperature, rigor mortis) – Can be misleading with use of life-support machines
Conclusion Photo Credit: Ben Seldelman 11