The Incoherence of Determining Death by Neurological Criteria: A Commentary on "Controversies in the Determination of Death", a White Paper by the President's Council on Bioethics
Determination of Death
History of Health Ethics / Bioethics
Bioethics Commissions / Councils
Neurosciences and Mental Health Therapies
Definition of Death
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AbstractTraditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment? In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation.
Kennedy Institute of Ethics Journal 2009 June; 19(2): 185-193
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Trends in Maternal Mortality : 1990 to 2013UNICEF; United Nations Population Division; World Bank; WHO; UNFPA (Geneva: World Health Organization, 2014)A number of initiatives that commenced in recent years are geared towards achievement of the fifth millennium development goal (MDG 5: improving maternal health), most notably the launch of the global strategy for women's and children's health in 2010 by the United Nations (UN) Secretary-General. Measuring the MDG 5 target of reducing the maternal mortality ratio (MMR) by three quarters between 1990 and 2015 remains a challenge. Accordingly, the maternal mortality estimation inter-agency group (MMEIG), comprising the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), the United Nations Population Division (UNPD), and the World Bank, together with a team at the National University of Singapore and University of California at Berkeley, United States of America, have been working together to generate internationally comparable MMR estimates. The estimates for 2013 presented in this report are the seventh in a series of analyses by the MMEIG to examine the global extent of maternal mortality. Consultations with countries were carried out following the development of the MMR estimates. The purposes of the consultations were: to give countries the opportunity to review the country estimates, data sources, and methods; to obtain additional primary data sources that may not have been previously reported or used in the analyses; and to build mutual understanding of the strengths and weaknesses of available data and ensure broad ownership of the results. This report presents global, regional, and country estimates of maternal mortality in 2013, as well as trends from 1990 to 2013. The report is organized as follows: chapter one gives introduction; chapter two provides an overview of the definitions and approaches for measuring maternal mortality. Chapter three is a detailed description of the methodology employed in generating the estimates. Chapter four presents the estimates and interpretation of the findings. Chapter five assesses the progress towards MDG 5. The annexes and appendices presents the sources of data for the country estimates, as well as MMR estimates for the different regional groupings for UNFPA, UNICEF, the UNPD, WHO, and the World Bank.
Tajikistan - Improving Statistics for Children's Births and DeathsWorld Bank (World Bank, 2012-03-19)The Government of Tajikistan has
identified improving maternal and child health (MCH) as key
priorities in its new Health Sector Strategy for 2010-2020.
The Government recognizes that improving MCH outcomes is
critical to achieve the Millennium Development Goals (MDG)
for maternal and child health over the next four years.
Tajikistan's data on most of the MDG indicators for
maternal and child health can be improved significantly. The
Government's ability to track its progress and to take
action to ensure the achievement of its MDGs will be
considerably bolstered by access to reliable data on
childbirths, child mortality and others factors that affect
these outcomes. To improve data reporting, data collection
needs to be consistent in its methods and sources, which is
currently not the case. As a result, health facilities and
national agencies' reports diverge significantly from
the results of nationally representative surveys. With this
in mind, the study therefore set out to identify the main
factors affecting two specific areas of Tajikistan's
Health Information System-namely the child birth and death
registration system as well as the possible steps to address
them. The analysis reveals a number of issues that are key
constraints to the further development of the vital
statistics system in Tajikistan, particularly in the
specific area of registration of births and deaths. Most of
these go well beyond the health sector's span and call
for broader action by the Government in order to be
effectively and comprehensively addressed. The most
important is the absence of clear leadership and ownership
among the Government agencies for the issues related to
accurate vital statistics. In view of this, there are
several priority actions that have to be taken over the
short to medium term by the Government and its key agencies
to improve this situation. The most critical action is to
clearly establish one Government agency to undertake the
overall coordination, responsibility and ownership on the
issue of vital statistics.
Miniatlas of Millennium Development Goals : Building a Better WorldWorld Bank (Washington, DC, 2013-01-30)The Millennium Development Goals (MDGs) are a challenge the global community has set for itself. They are a challenge to poor countries to demonstrate good governance and a commitment to poverty reduction. And they are a challenge to wealthy countries to make good on their promise to support economic and social development. The MDGs have captured the world's attention, in part because they can be measured, as this little book demonstrates. More important, the goals address our most human concerns for the welfare of everyone with whom we share this planet. The authors are now one third of the way to the target date of 2015, and there are 100 million fewer people living in extreme poverty than in 1990. By 2015, 500 million more will have achieved at least a minimally acceptable standard of living- the greatest decrease in poverty since the beginning of the industrial revolution. But progress has been uneven, and many of the poorest countries, especially in Africa, lag behind. Extreme poverty means having less than $1 to meet your daily needs. But poverty is not measured in money alone. Poor people lack education, they lack health care, and they often live on wasted lands or in city slums. Solving these problems will require a substantial investment in people as well as in physical assets. Wealthy countries can help, not only through their aid programs- which are important but also by opening their markets and by sharing knowledge. Most important of all, developing countries must unleash the potential of their citizens, empowering them to create a place for themselves and their children in the world.