chapter  35
12 Pages

Brain Death

WithWINSTON CHIONG

In the history of medicine, debates and demands for greater precision regarding the determination of death have reflected technological advances in medical care as well as broader social concerns. Prior to the mid-1700s, physicians did not play a central role in pronouncing death; as Hippocratic tradition advised physicians to withdraw when death could not be delayed, this role was left largely to family, undertakers, and lay practitioners. The development of resuscitative techniques such as ventilation (advocated by the Amsterdam Society for the Recovery of Drowned Persons in 1767) and electrical resuscitation (first documented in 1774) raised public awareness that some people who had been presumed dead could be revived. Sensational press reports of people buried alive stoked widespread fears of premature burial, vividly represented by Poe and other Gothic writers, and uncertainty over the timing of death prompted laws requiring longer and longer observation periods prior to burial. Physicians of the period responded to demands for greater certainty in the determination of death by critically evaluating a variety of physical signs of death (often used in combination), such as rigor mortis, mottling of skin, pulseless arteries, absence of blood flow from transected blood vessels, hypothermia, pupillary dilation, and putrefaction (Powner et al. 1996). Laennec’s invention of the stethoscope in 1819 eventually led to greater confidence in physicians’ ability to discern even minimal heart and lung function, and thereby to consensus on the application of circulatory and respiratory tests for death.