▻ Final cessation of activity in the central nervous system especially as indicated by a flat electroencephalogram for a predetermined length of time
Before the advancement we have now, a body with missing internal organs was often proclaimed dead. Now, we have organ transplants and blood transfusions which allows the patient to survive when they are about to die.
This ethical issue has to do with the idea of either saving someone or letting them die in the name of the religion. As certain religions object to the use of blood transfusions due to the idea of impurity.
"A 46-year-old Muslim female patient with IgA nephropathy was seen for an annual review on the renal transplant waiting list. She had started peritoneal dialysis in 2007, and we had listed her for a renal transplant in 2008. When seen now in spring 2010, she was very well indeed, and there were no new issues regarding transplant listing. At the end of the consultation, we asked for potential donors, as per our unit policy. She mentioned that she was born in Pakistan. It then transpired that several young and healthy relatives from her large family were available. All of them, however, were of the Muslim faith and believed that organ donation was not in keeping with Islam. They had therefore decided not to see the live donor team in the first place. The patient herself was not sure what to do and asked us for help, saying ‘Does Islam forbid organ donation?’ The doctor in our clinic (AW) had to admit total ignorance but promised to investigate."
The right to refuse medical treatment is well established in medicine and in law. The legal tradition of the right to be left alone has deep roots. When cases arose asserting that a patient has a right to be free of unwanted medical intervention, the right was readily recognized and clearly affirmed.
◘ These legal cases can be categorized into four classifications:
▫ patient with decision-making capacity
▫ patient without capacity but who had earlier expressed treatment preferences for end-of-life care either verbally or in a written advance directive document
▫ patient without capacity who had made no prior expression of treatment preferences
▫ patient who never had the capacity to make treatment decisions.
In cases of patients with intact decision-making capacity, courts have ruled that such patients have the right to refuse medical interventions even when those interventions are life-sustaining.
"Abraham and his parents refused the additional chemotherapy recommended by his physicians at a children's hospital because of the adverse effects he had suffered previously."
There is an ethical issue over discontinuing medical interventions when, a patient correctly diagnosed as having lost brain functions permanently and will never regain consciousness. He or she will experience no pleasure or pain, enjoy no social interaction, and be unable to pursue or complete his or her life's projects.
Part of the public concern over employing a brain-based standard to determine death seems to arise from fear that this may cause medical treatment to be withdrawn from some patients who might have regained consciousness. This fear is expressed in patients who have resumed normal lives after long periods of coma or even after having been pronounced dead. The ethical question is whether a new, brain-oriented definition of death would lead to abandonment of patients who might have responded to continued medical care. Those who press this objection to "redefinition" of death insist that death should not be pronounced until it is certain that recovery is impossible.