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The five major world religions
For customers in the United States and Canada Phone: 1. Individuals are urged to order through a local Bookseller. The Forum on Religion and Ecology at Yale. Email Sign-Up. He pronounces death to be the cessation of all cardiac and respiratory activity and all movement. To make these rulings he draws on the same commentaries the opposition uses, but points to a section they do not use [ 22 ] and comes to a different conclusion.
Bleich considers the rhythmic and continuing beating of the heart to be movement that is not comparable to the spasms occurring after decapitation.
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The opposition between these two views has endured for more than fifty years; each side produces volumes of materials, Responsa and arguments to bolster its view. It remains contentious.
In January of , The Rabbinic Council of American, a union of Modern Orthodox Rabbis declared that it would not lend its support to either position but encouraged its members to make their own decisions on which definitions fulfill the requirements of Jewish law. Around the same time, one rabbinate in the United Kingdom reversed earlier rulings and rejected brain death criteria [ 21 ].
Withdrawing mechanical support at any point is at least as controversial in the orthodox community as the criteria used to define death. Even those who favor using neurological criteria find it difficult to discontinue mechanical support, especially the ventilator, even though the patient has met the criteria for brain death. Thus it is forbidden to cause the dying person to die more quickly. For example if one is a goses moribund person for a long time and is unable to expire, it is forbidden to remove the pillows or mattress from underneath him,.
The argument is paradoxical, on the one hand, the patient has been determined dead by brain criteria but on the other, the presence of artificially applied respiration clearly trumps brain death. Feinstein, who accepts neurological criteria, sends a mixed signal when he specifically states that respirator should not be turned off even if the person meets the criteria for brain death.
There are occasional voices in the orthodox rabbinic community who believe that the respirator and other interventions may be discontinued.
Most in the Orthodox community, however, see these interventions as medical treatment and argue that they are obligatory and must be continued despite the fact that death has been determined using neurological criteria. Most of orthodoxy agrees, however, that there is a point at which treatment may be suspended, but they disagree on when that point is.
He does not believe treatment should stop under other circumstances regardless of the reason. He notes that even the best intention does not matter; the act of discontinuing treatment for anyone other than a gose s is still homicide [ 28 ], p.
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Moshe Feinstein, in basic agreement with Bleich on this issue, extends the period of time during which it is appropriate to withdraw treament to a few weeks. The Conservative tradition shares the perspective that medical care is obligatory up to a point, but extends the period of time in which treatment may be withheld or withdrawn—up to a year or more. Permission to withhold or withdraw medicines is applied more broadly. Rabbi Elliott N. Dorff has successfully introduced the category of terefah , which applies as soon as someone receives a diagnosis of terminal, incurable illness.
While in Orthodox and Conservative Judaism, the debate centers on when treatment may be terminated, Reform Judaism focuses on the therapeutic effectiveness of treatment. The decisions in this branch of Judaism are left to the patient and family in consultation with their pysician [ 29 ], p. Christianity developed from the first century Jewish reform movement centered on Jesus.
From these roots Christianity inherits respect for scripture and authoritative interpretation and brings both to the examination of contemporary moral issues. As it moved throughout the Roman Empire, Christianity borrowed key ideas from Greek philosophy, especially Plato and Aristotle. Two aspects of Greek influence are important here: the Platonic view that the human is comprised of two separate components, body and soul, and the idea that the mind of the individual is superior to the body.
A schism that began in the early eleventh century separated Christianity into two forms, now called Western Christianity and Eastern Orthodoxy. Western Christianity includes Roman Catholicism and the Protestant reform movements that developed from it beginning in the early sixteenth century.
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As the church grew in its first several centuries, it quickly developed a hierarchical structure that differentiates it from Judaism. Pronouncements on moral issues come from the top of the church structure, the Papacy, and though individuals might disagree, the pronouncements have a key impact on what the Catholic laity thinks. These pronouncements rely more on biblically based moral theory rather than on analysis of past statements of authoritative individuals. A full decade before the Harvard Committee convened, Pius XII, leader of the Church from —, addressed the International Congress of Anesthesiologists to answer questions raised by one of their members.
Included in his response were the moral issues of defining death and withdrawing mechanical support. Pius XII makes two key statements. He distinguished between the death of the whole person and the death of organs. But considerations of a general nature allow us to believe that human life continues for as long as its vital functions—distinguished from the simple life of organs—manifest themselves spontaneously or even with help of artificial processes [ 31 ].
It remains for the doctor, especially the anesthesiologist, to. These statements were later used to affirm the Catholic position that neurological criteria, determined by the medical community, were appropriate definitions of death. The authors of the Harvard criteria drew on this statement in their report. In his writings and talks, he developed a clear and consistent understanding of determining death that followed from the statements of his predecessors. In , the Pontifical Academy of Sciences revisited the issues. Brain death has been a highly important and useful concept for clinical Medicine, but it continues to meet with resistance in certain circles.
The reasons for this resistance pose questions for medical neurologists, who are perhaps in the best position to clarify the pitfalls of this controversial issue. In this report the Academy noted that cardio-pulmonary criteria had long been the standard for determining that death had occurred, but with the advent of the ventilator and need for organs, medicine developed new criteria.
In discussing the Academy findings, John Paul II delineates the Harvard Criteria and subsequent emendations to it in an argument that affirms his acceptance of these criteria when strictly applied. He clearly states that it is appropriate to turn to medical authorities in order to assess the criteria and notes that Harvard Brain Death Criteria and that the Uniform Determination of Death Act are accepted by all 50 American States, the American Medical Academy and the American Bar Association.
Because Papal authority carries significant weight, the roughly Catholic hospitals in the American medical system all adhere to neurological determination of death. They uniformly oppose the use of neurological criteria and argue instead that cessation of the cardio-pulmonary system is the only licit determination of death. It results from the separation of the life-principle or soul from the corporal reality of the person. Because the official position of the Roman Catholic Church firmly asserts that brain death is death, there is no difficulty in ending the mechanical means that was used to support the patient prior to the determination of death.
The Church uses guidelines to assist in deciding when withdrawing support prior to determining death is a morally fitting decision. To assess the appropriateness of an action in a complex moral situation such as withholding or stopping treatment, Roman Catholicism draws on an ethical system developed by thirteenth century theologian, Thomas Aquinas, and a 16th century lecture on stopping treatment by Francisco diVittoria.
Both men provide a method for ethical analysis. Four criteria must be met for an action to be considered moral. First, the action must arise from a good will, second, there must be a proportion of good over evil arising from the action, third, the evil may not be directly intended, and finally the evil must not be the means of producing the good. Administering a drug that will provide pain relief to a terminally ill patient the good but will also depress the respiratory system and hasten death the evil exemplifies double effect.
Giving the drug can be considered acceptable if the action is intended to benefit the patient, the lessening of suffering is sufficient to outweigh the shortening of life, the death is not directly intended and the patient is not killed in order to end suffering. In addition to Natural Law, Roman Catholic medical ethics make use of several principles Francisco DiVittoria set out in his discussion of end of life issues.