Withholding and Withdrawal of Life Support from Critically Ill Patients: CNSThis concept was appealing, because it recognized the integrative function of the central nervous system (CNS), without which there can be no breathing or heartbeat. The legal propriety of brain death was upheld in the case of Tucker v Lower (1972), in which a Virginia court found that physicians who removed Bruce Tucker from a ventilator in order to transplant his heart were not guilty of a wrongful determination of death. Since then, the Presidents Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research has recommended a uniform determination of death statute; 37 states plus the District of Columbia have passed brain death statutes, and several of the nonstatute states have acknowledged the propriety of withholding or withdrawing life support from the brain dead. Furthermore, policies of “required request” were enacted in 1986 in California, Oregon, and New York requiring that physicians bring up the issue of organ donation with the families of patients with brain death. eye drops for pink eye

Clearly, society has moved from a concept of death centering on heart and lung function to one centering on function of the CNS. And at the same time, it seems to be regarding human life less as a biologic process than as a process of self-awareness and social interaction. As this occurs, ethicists such as Jonsen are asking “What does life support support?” and advocating the preservation not of specific organs or even the entire organism but of “personhood.” As Veatch has written, “the real question today is not the choice between heart and brain, but rather which part or parts of the nervous system are so essential to human function that their irreversible loss would constitute death of the person as a whole.” This question is especially relevant in withholding or withdrawing life support from patients who are not brain dead by conventional criteria but who are anence-phalic, are comatose or in a persistent vegetative state, or prefer death to a life with suffering and pain.