Have the right to define his death?
Earlier this month, the Ontario Court of Appeal dismissed a petition filed by a family in the Toronto area who wanted his daughter,
Taquisha McKitty, to be kept alive artificially, even though the doctors had concluded that his brain death.
If the heart of Taquisha McKitty continued to beat, she would be defined as dead by the Ontario Court of Appeal.
Doctors could therefore unplug his artificial respirator even if the family is opposed.
The highest court in the province brings to the fore a debate that, in Quebec, must come out of universities.
Should we choose for ourselves the criteria according to which we will be declared dead?
According to the current state of the law, we have no choice: it is the doctors who decide. This leads to situations like that of Taquisha McKitty,
whose family believes she is still alive and fears that doctors will kill her by unplugging her. Fortunately,
his relatives will not have to endure this ordeal since McKitty died naturally last December, well before this judgment was rendered.
We must change the law to prevent a family from having to undergo such a test.
Two definitions of death
In September 2017, at the age of 27, Taquisha McKitty was declared a "brain dead". In other words, his brain activity has stopped irreversibly. She is then connected to an artificial respirator to be kept alive. In the eyes of the doctors, McKitty should be unplugged since she is dead.
The exact definition of brain death differs according to the approaches. Generally, it is considered essential that there is a permanent loss of consciousness as well as a cessation of activities of the brainstem. This results in an irreversible arrest of the respiratory functions, but other functions and organs can still operate alone, like the heart. This state must be distinguished from a permanent vegetative state, where the body remains autonomous, and coma, where the brain still shows signs of cerebral activity. In McKitty's case,
the artificial respirator allowed her body to continue living while she was brain dead.
McKitty's family is challenging the doctors' diagnosis. For them, death occurs only during the irreversible cessation of cardiac activity.
If the heart of Taquisha McKitty beats, she is still alive. It would be the disconnection by the doctors that would cause his death.
The family invokes in particular his faith and that of Taquisha in support of his definition of death.
Brain death and cardiac death
Choosing between brain death or cardiac death is difficult. Each position has advantages and disadvantages. On the one hand, brain death has the advantage of targeting what is generally perceived as the most important in humans: consciousness. Brain death is the medical translation of the loss of consciousness; faculties of being aware of oneself, interacting with one's environment, planning one's life, etc.
On a more practical level, brain death also facilitates organ transplantation. The body of the deceased continues to maintain their organs,
giving medical teams time to prepare and prepare the recipients.
On the other hand, brain death is reductive. The human being is more than his consciousness. The brain dead body maintains certain functions. His cells continue to grow. The body can fight infections and heal wounds. In addition, the heart is an important symbol of life and,
for some denominations, an essential element in distinguishing life and death.
In Quebec, the law does not impose a definition of death. Quebec Civil Status relies on the judgment of physicians. The legal problem that exists today in Ontario, where a family is challenging the medical definition of death, could therefore arise in Quebec. Should we, too, review our definition of death?
Give meaning to your life
In my opinion, every person should be free to define what criteria applies to their own death: brain death or permanent cessation of cardiac activity. An equally important stage in the life of our death should be consistent with our values.
The debate on medical aid in dying has made it clear that choosing the parameters of one's death is a way of giving meaning to one's life. In the same vein, many people provide advance medical directives to regulate the care they want or refuse to receive when death
is imminent. We desire, even in death, to remain masters of us.
If Taquisha McKitty wants to die in the same faith that has characterized her life, it would be to oppose her will
to force her to be unplugged while her heart is still beating.
Respecting the autonomy of Quebeckers would mean that the National Assembly gives us the right to choose the definition of our death. It's not impossible! Japan already allows it without this raising too many practical difficulties. In Quebec, it would be possible to adopt by default the criterion of brain death in order to facilitate posthumous organ donation while permitting derogations in writing.
Quebeckers could derogate from this default definition by specifying, for example, in their advance medical directives. This raises the question of who pays for life support, which should be the subject of another debate.
The National Assembly must look into the matter before another case like Quebec's Taquisha McKitty comes to our courts. A family should not have to endure a court battle while their daughter is on her death bed.
Taquisha McKitty, to be kept alive artificially, even though the doctors had concluded that his brain death.
If the heart of Taquisha McKitty continued to beat, she would be defined as dead by the Ontario Court of Appeal.
Doctors could therefore unplug his artificial respirator even if the family is opposed.
The highest court in the province brings to the fore a debate that, in Quebec, must come out of universities.
Should we choose for ourselves the criteria according to which we will be declared dead?
According to the current state of the law, we have no choice: it is the doctors who decide. This leads to situations like that of Taquisha McKitty,
whose family believes she is still alive and fears that doctors will kill her by unplugging her. Fortunately,
his relatives will not have to endure this ordeal since McKitty died naturally last December, well before this judgment was rendered.
We must change the law to prevent a family from having to undergo such a test.
Two definitions of death
In September 2017, at the age of 27, Taquisha McKitty was declared a "brain dead". In other words, his brain activity has stopped irreversibly. She is then connected to an artificial respirator to be kept alive. In the eyes of the doctors, McKitty should be unplugged since she is dead.
The exact definition of brain death differs according to the approaches. Generally, it is considered essential that there is a permanent loss of consciousness as well as a cessation of activities of the brainstem. This results in an irreversible arrest of the respiratory functions, but other functions and organs can still operate alone, like the heart. This state must be distinguished from a permanent vegetative state, where the body remains autonomous, and coma, where the brain still shows signs of cerebral activity. In McKitty's case,
the artificial respirator allowed her body to continue living while she was brain dead.
McKitty's family is challenging the doctors' diagnosis. For them, death occurs only during the irreversible cessation of cardiac activity.
If the heart of Taquisha McKitty beats, she is still alive. It would be the disconnection by the doctors that would cause his death.
The family invokes in particular his faith and that of Taquisha in support of his definition of death.
Brain death and cardiac death
Choosing between brain death or cardiac death is difficult. Each position has advantages and disadvantages. On the one hand, brain death has the advantage of targeting what is generally perceived as the most important in humans: consciousness. Brain death is the medical translation of the loss of consciousness; faculties of being aware of oneself, interacting with one's environment, planning one's life, etc.
On a more practical level, brain death also facilitates organ transplantation. The body of the deceased continues to maintain their organs,
giving medical teams time to prepare and prepare the recipients.
On the other hand, brain death is reductive. The human being is more than his consciousness. The brain dead body maintains certain functions. His cells continue to grow. The body can fight infections and heal wounds. In addition, the heart is an important symbol of life and,
for some denominations, an essential element in distinguishing life and death.
In Quebec, the law does not impose a definition of death. Quebec Civil Status relies on the judgment of physicians. The legal problem that exists today in Ontario, where a family is challenging the medical definition of death, could therefore arise in Quebec. Should we, too, review our definition of death?
Give meaning to your life
In my opinion, every person should be free to define what criteria applies to their own death: brain death or permanent cessation of cardiac activity. An equally important stage in the life of our death should be consistent with our values.
The debate on medical aid in dying has made it clear that choosing the parameters of one's death is a way of giving meaning to one's life. In the same vein, many people provide advance medical directives to regulate the care they want or refuse to receive when death
is imminent. We desire, even in death, to remain masters of us.
If Taquisha McKitty wants to die in the same faith that has characterized her life, it would be to oppose her will
to force her to be unplugged while her heart is still beating.
Respecting the autonomy of Quebeckers would mean that the National Assembly gives us the right to choose the definition of our death. It's not impossible! Japan already allows it without this raising too many practical difficulties. In Quebec, it would be possible to adopt by default the criterion of brain death in order to facilitate posthumous organ donation while permitting derogations in writing.
Quebeckers could derogate from this default definition by specifying, for example, in their advance medical directives. This raises the question of who pays for life support, which should be the subject of another debate.
The National Assembly must look into the matter before another case like Quebec's Taquisha McKitty comes to our courts. A family should not have to endure a court battle while their daughter is on her death bed.
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