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There have been various debates concerning the ascertainment of death. Death has been traditionally explained as the separation of the soul from the body. According to Ahronheim, Moreno and Zuckerman, the origin of this explanation was the understanding that the sign of life was the presence of breath (206). Old cultures such as the Egyptian and Hebraic cultures perceived life a spirit resident in a person's body. However, there were new discoveries in the sixteenth century that changed the perception of death. The discoveries were that blood circulated in the body and in death, the blood stopped circulating. The change in the perception of death distinguished the clinical death that there was no blood circulation and the real death where there the body was separated from the soul. According to Jan, the distinction of these two definitions rested on the lack of medical knowledge (352).

Many patients in a coma usually have their lives supported by machines. In many of such cases, the issue of brain death has raised a great deal of discussion. Another case of brain death has been that of organ transplantation. Byrne et al. note that the main question to ask is whether the personhood of a person is lost with brain death even if other body parts are still alive and are maintained by life supporting machines such as heart-lung machine (12). This debate is important especially in some special cases such as those of heart lung transplants where oxygenation of the organs should be maintained prior to the transplant. According to Eelco, Blacks dictionary defines life as the cessation of life; ceasing to exist and as defined by physicians, death is the total stoppage of blood circulation and the cessation of the cessation of animal and vital functions such as respiration and pulsation (2).

According to Byrne, there are some people that have brain injury that affects their brain leading to undergo permanent unconsciousness yet their other body parts function well (6). Such people have loss their brain reflexes though they are still alive and thy digest, metabolize food and excrete (Robert and Franklin 710). Many of these patients are supported by life supporting machines. Due to the permanent brain injury and unconsciousness, some people have argued that organ transplants can take place for such people since they are perceived to be dead. However, Peter notes that although it may be perfectly ethical to remove vital organs for transplantation from patients who satisfy the diagnostic criteria of brain death, the reason it is ethical cannot be that we are convinced they are really dead (315). Life supporting machines should continue supporting the patient until the time that the patient is very dead with the brain and all other body parts not functioning.

The issue of brain dead and life support is very contentious and has drawn a lot of debate. This study examines this issue of brain death, reasons why a brain dead person could still not be dead, life support and the application of life support machines to brain dead patients. Additionally, the study will also find out whether life-supporting machines should not be removed from brain dead people because of any reasons such as organ transplants. This study is qualitative in nature. Therefore, qualitative research methods will be used to conduct the survey. The researcher will conduct a survey on brain death and life support machines. The research will seek to fulfill the hypothesis that life support machines should not be withdrawn from a brain dead person until it is confirmed that the person is totally dead with his brain and body parts not functioning at all (Damien 13).

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The study will utilize secondary sources of data and primary sources. Secondary sources of data will be obtained from books and journal articles in addition to published and unpublished sources in the library of hospitals. Primary data will be collected from patients and doctors in various hospitals concerning the brain dead and life support. Primary data will be collected using questionnaires and interviews.

Annotated Bibliography

Ahronheim, Judith., Moreno, Jonathan and Zuckerman, Connie. Ethics in Clinical Practice, 2 Ed. MA: Massachusetts. Jones & Bartleft Learning Publishers. 2005. This book is about the various considerations to make while determining brain death of an individual. The book covers issues such as the declaration of death using the whole brain death standard, the religious objections and declaration of death and the protocol for obtaining organs for donation. There should be medical consideration, ethical and legal considerations while making declarations of brain death and organ transplants. Additionally, these considerations determine when to withdraw life support the person. The issues covered in the book are what the research is about. Therefore, the book will for a good source of literature to base the findings of my research.

Byrne, Paul. et al. Brain Death is not Death. 2005. Accessed on October 30, 2010 in this article, it is clear from the argument that the aim of medical practitioners is to protect and prolong life. The authors argue that brain death is not death and life-supporting machines should not be taken away from the brain dead patient unless patient has shown other proven signs of death (no any other parts of the body are still functioning). The article stipulates the signs of death that will guide people especially medical practitioners to tell when a person is completely dead in order to remove life support machines. Due to the vivid explanations by the authors of the signs of death and when to remove life support and carry out organ transplant. This article adds to the list of rich articles for this research.

Byrne, Paul. et al. Brain Death: The Patient, the Physician and Society. n.d.  Accessed on October 30, 2010. The authors of this article present an argument about the changes in the medical practice. The changes are about the manner in which the determination of the death of a person is conducted. The article addresses new modes of declaring a person dead. A complexity of medical practices arises that are discussed in the article. Since one of the issues addressed in this article are reacted to the study topic, the article will be relevant to the study and will be incorporated together with the other articles and books used during the research.

Damien, Keown. Buddhism, Brain Death, and Organ Transplantation. Journal of Budhist Ethics, 17. (2010): 1-25. The author explains the concept of organ transplant based on the Buddhist religion. He compares the modern concept of brain death (the loss of cerebral functions) and the traditional Buddhist understanding of death as the loss of the organic integrity of the body. Basing on this judgment, he expresses serious reservations about the modern day organ transplantation. The inconsistency between these two views is due to the adoption of contemporary medicine where the concept of death is scientifically and philosophically flawed and not because of the conflict between traditional beliefs and science. The article defines death based on Buddhism and establishes the criteria and tests for death that are in accordance with the teachings of Buddhism and the modern medicine. The article is relevant to the study since it highlights the concept of brain death and organ transplants in relation to when to remove life support machines from a dead person.

Eelco, Wlidicks. The Diagnosis of Brain Death. The New England Journal of Medicine, 344.16 (2001). In this article, Eelco notes that physicians, workers in the health care and the clergy people worldwide have fully accepted that when the brain is dead, a person is dead. However, the uniform determination act in the U.S was formulated based on the principle that death can be diagnosed by neurologic criteria. The author continues by arguing that there is a difference between severe brain damage and brain death. Brain death means that the here is no need for life support and is the principle behind organ transplant. It is important that physicians understand the difference between these two terms. He further notes that brain death in adults is caused by traumatic injury to the brain and subarachnoid hemorrhage while in children; brain death is caused by abuse, motor vehicle accidents and asphyxia. The issues of brain death, its causes in adults and children and how it can be determined clinically are very relevant to this research making this article vital for this study.

Jan, Mohammed. Brain Death Criteria. The Neurological determination of death. Neurosciences. 13.4 (2008) 350-355. This article examines the neurological process of determining brain death. Jan defines brain death as the permanent absence of all cerebral and brainstem functions. Brain death is usually diagnosed clinically with the process requiring the occurrence of acute and irreversible CNS insult. To evaluate correctly the brain death, drug intoxication, poisoning, metabolic derangements, and hypothermia should be corrected.  The article is very relevant to my study because it examines the clinical process of brain death. Such a process is required to determine whether the person is dead on not and therefore ascertain when to remove life support machines.

Peter, Jeffery. Brain Death: A Survey of the Debate and the Position in 1991. Heythrop Journal, 33.3 (1992): 307-323. This article distinguishes the traditional view of brain death and the modern views of brain death. Traditionally, brain death was explained as the separation of the soul from the body due to lack of medical knowledge. However, in modern society, brain death is a controversial issue since one can be brain dead with the other body parts still functioning. The author asks whether the human personhood is lost with brain death even though other pars are still functioning and supported by machines such as the heart-lung life-supporting machine. Despite this, the issue is whether to remove the life supporting machines while the person is brain dead and conduct organ transplants or not. The relevance of these issues to this study is real making the article a supplement to my primary source for the research.

Robert, Truog and Franklin, Miller. The Dead Donor Rule and Organ Transplantation. The New England Journal of Medicine. 359.7 (2008): 709-714. These two authors in this article argue about the dead donor rule and its applications to donor transplants. They argue that brain injury can lead to permanent unconsciousness with patients unable to think or do anything else. However, despite their condition, the other body parts of the patients can still perform other per functions such as digestion, metabolism and excretion. They point out that though the patients could be unconscious, it is not ethical to remove life-supporting machines and conduct organ transplant to such patients because the patients are still alive and not dead. The dead donor rule is significant in relation to organ transplants of the dead. This article is significant to this study because it highlights dead donor rule in relation to organ transplant and removal of life support machines.

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