BRAIN DEATH

Kelompok 7:
Antonia Hadiweijaya 07120110018
Debora Sarah Annetta 07120110019
Anita Pangestan 07120110026
Pratami Tanoto 07120110028
James Setyadi Handono 07120110044
Agatha Kartika 07120110045
Indra Gunawan Limadhy 07120110102
 CHAPTER I
Introduction

Topic :
Brain Stem Death
Background:
There are differences in perspective regarding the meaning of death
between Christian and secular point of view
There are controversies surrounding the death of the body and the
death of the person.
 Purpose
To understand how Christianity views brainstem death
To understand how Christianity views death in general
To know the righteous way of medical practice in accordance
to Christian world view in treating brainstem death patient

Subtopic explanation
Brainstem death from a medical point of view
Brainstem death from a Christian point of view
Comparison and analysis between the two
CHAPTER I
Introduction
 Background
Death is inevitable
Death concerns not only physical factors but also social, legal, moral,
philosophical, spiritual
Questions remain
Important as medical practitioners to understand and apply
 CHAPTER II
Brainstem death from a medical
point of view
BRAIN STEM FUNCTION
As the place for nucleus for cranial nerve 3-12.
As the place that the tractus pass it from the brain to entire body or vice versa. Example
corticospinal tractus.
The place that control breathing, sleep patterns, hunger, thirst, and etc
BRAIN DEATH
Absence of reflexes
Deeply comatose
Ventilator-dependent
 Why such definition is needed
Guidelines for medical practitioners
When to stop trying
Diverting resources to other patients in need
For the best interest family and relatives
Avoid unrealistic expectations
Make peace with reality
Financial
Moral, social, religious aspects
Transplantation
Justify
As shortly as possible, but confirmed dead
Legal implicationa
 Definition of Brain Death
According toThe US Uniform Determination of Death Act
Death can be defined as irreversible cessation of all functions
of the entire brain including the brainstem or the irreversible
loss of psychosocial integration, where psycho refers to a
capacity or potential for conscious experience of the world.
According to UU No. 36/ 2009 chapter 117 (Seseorang
dinyatakan mati apabila fungsi sistem jantung sirkulasi dan sistem
pernapasan terbukti telah berhenti secara permanen atau apabila
kematian batang otak telah dapat dibuktikan.)
 Diagnosis Criteria of Brain Death
Diagnosis
Exclusions
Where the patient may be under the effects of drugs.
Where the core temperature of the body is below 35c (eg
exposure).
Where the patient is suffering from severe metabolic or
endocrine disturbances which may lead to reversible coma (eg
diabetes)
Preconditions of diagnosis
The patient must be deeply comatose.
The patient must be maintained on a ventilator.
The cause of the coma must be known.
 Personnel
The brainstem death tests must be performed by
two medical practitioners.
The doctors involved should be experts in this
field and should not be connected in any way to
the transplantation team treating any organ
recipient(s).
At least one of the doctors should be of
consultant status. Junior doctors are not
permitted to perform these tests.
Each doctor should perform the tests twice.
 Test
The diagnosis of brainstem death is established by testing the
function of the cranial nerves that pass through the brainstem.
If there is no response to these tests the brainstem is considered to
be irreversibly dead.
The pupils are fixed and do not respond to changes in the
intensity of light.
There is no corneal reflex.
The vestibulo-ocular reflexes are absent (ie no eye movement
occurs after the instillation of cold water into the outer ears).
No motor responses within the cranial nerve distribution can
be elicited by painful or other sensory stimuli, (ie the patient
does not grimace in response to a painful stimulus applied to
the face or to the limb)
 Test
There is no gag reflex to bronchial stimulation
by a suction catheter passed down the trachea.
No respiratory movements occur when the
patient is disconnected from the ventilator for
long enough to ensure that the carbon dioxide
concentration in the blood rises above the
threshold for stimulating respiration, (ie after
giving the patient 100% oxygen for five minutes
the ventilator is disconnected for up to ten
minutes. If no spontaneous breathing of any
sort occurs within those ten minutes, the brain
stem is incapable of reacting to the presence of
the carbon dioxide and is thus dead).
 Critics
No universally accepted definition
If already dead, why not used as an educational cadaver or research
purposes right away?
Also, response (HR, BP) when dissected, also given anesthetic/
muscle relaxants for donor
Not all brain functions cease
Many are kept on life-support devices long after diagnosis
Pregnant mothers kept alive until delivery
CHAPTER III
Brainstem death from a
Christian point of view
DEATH CONCEPT BASED ON BIBLE
The Bible states that when a person dies, the breath of life departs from the
earthly body, and the soul no longer exists. The dust returns to the ground it
came from, and the spirit returns to God who gave it (Ecclesiastes 12:7, NIV).
At the resurrection, God reunites the body and the person lives again.
The death of body does not always mean the death of soul, but if the soul is
dead, the body must be dead.
 In Bibilical concept, when the spiritual soul
outliving our physical body, it does not mean the
moment of death.
In Genesis 9 : 4-5, But flesh with life thereof,
which is the blood thereof, shall ye not eat. And
surely your blood of your lives will I require; at the
hand of every beast will I require it, and at the hand
of man; at the hand of every mans brother will I
require the life of man.
Brain death cant be stated the true dead, because
the true dead should be in condition where the
blood stop circulating. But, in brain death, the body
is still depend on ventilator, so although the brain is
dead, the person is not dead yet.
BRAIN DEATH IN CHRISTIANITY PERSPECTIVE
From Christianity, there are two opinion about brain death. Catholic perspective receive
that brain death is physical death. The fact is from Pontifical Council for Pastoral
Assistance to Health Care Workers under Cardinal Fiorenzo Angelini issued its Charter for
Health Care Workers. The legitimacy of neurological criteria for ascertaining death was
accepted by this body as well. Because of that, the consequence for accepting legitimacy
of brain death, church continues to recognize the generous nature of freely chosen organ
donation, an act Pope John Paul II once called particularly praiseworthy and an act that
can offer a chance of health and even of life itself to the sick who sometimes have no
other hope.
The other opinion comes from John Frames, Professor of Apologetics and Systematic
Theology at Westminster Theological Seminary in Escondido, California, didnt agree the
opinion of Uniform Determination of Death Act, about brain death is death. He said that, It
is better to define death as the irreversible loss of heart, lung, and brain function -- to
make each a necessary criteria for declaring someone to be dead
CONCLUSION
The state of brain death is not the same as death itself because the Bible said that death
is the state of separation of the body and soul as written in Ecclesiast 12:7, not merely an
irreversible loss of brain function. As in Genesis chapter 9, the statement that our life is in
the blood can be used to assume that death is defined as when the functions of cardiac
and pulmonary cease to work. Thus, according to Christianity, brain death cannot be
taken as actual death.
 CHAPTER IV
Comparison and analysis
between medical and Christian
point of view
 Comparison and Analysis of Brain Death

Medical Point of View Biblical Point of View

Brain death is a death Brain death is not a death

Explain death from material only Explain death from material and
immaterial
 Summary

Brain death from medical point of view is different from the biblical
point of view.
From medical point of view, brain death means true death. But, from
biblical, brain death hasnt always mean true death because only the
body is dead, but the soul has not been dead. The Bible states that
when we die, our body returns to the ground it came from, and the
soul returns to God who gave it.
 Conclusion:
Application as a Christian doctor

As doctor, we should explain to the family about the medical

condition of the patient that the patient has been dead according
to medical aspect, and only depend on the life support
equipment.
The decision to put off the life support equipment or not, is
depend on the family. If the family still want the equipment to be
put on, we will put on. But if they dont, we will put off the life
support equipment because the unconsciousness is ireversible.
 CHAPTER V
Bibiliography

Bacchiocchi, Ph. D S, Chapter IV: The Biblical view of Death. In editor.

mmortality or Resurrection? England: Paperback; 1997.
Frame JM, Medical Ethics: Principles, Persons, and Problems. Journal
of Biblical Ethics in Medicine 1988; 3(3):25.
Pacholczyk FT, Science, Religion, and Brain Death. Issue of Lay
Witness Magazine 2012 Jan 01;
Stammer T, Brain Death. Christian Medical Fellowship Files 2012 Jun 6;
48.