Episode 148: Christos Lazaridis discusses brain death

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What is the main topic discussed in this episode?

Unknown 0:15

Yeah.

Matt Teichman 0:19

Hello and welcome to Elucidations, an unexpected philosophy podcast. I'm Matt Teichman, and with me today is Christos Lazaritis, a neurointensivist at the University of Chicago. And he is here to discuss brain death. Christos Lazaritis, welcome.

Christos Lazaridis 0:35

Thank you so much for having me, Matt.

Matt Teichman 0:38

Well, I was gonna ask you about what brain death is and we'll definitely get to that, but I think I have to start by asking, uh, what is a neuro intensivist?

Christos Lazaridis 0:45

Yeah, so I guess that there are two words in there, neurology and intensive care.

What is a neuro‑intensivist and what does their work involve?

Christos Lazaridis 0:51

Um the idea is that uh it's a specialized um critical care sub specialty that is designed basically to provide multi organ support and brain support for patients who have either um serious acute brain injuries or patients who are Post-neurosurgical procedures. And so it combines fields of knowledge from basic critical care, like for example, principles of mechanical ventilation, hemodynamic support, but it has a special focus on improving brain outcomes in patients with different types of acute brain injury.

Matt Teichman 1:31

So would like Um like the life support side of neurology, is that sort of approximately w the thing to have in mind or what? Aaron

Christos Lazaridis 1:38

Powell That that's a very n nice way to put it. Uh life and brain support. Aaron Powell

Matt Teichman 1:43

Okay. So speaking of life support, um maybe we could ease our way into the topic of brain death by just talking about life support technology. Um How did that come about? Like what are some of the things that our life support technologies can do?

How did modern life‑support technology develop and why did it create a need for a precise definition of death?

Matt Teichman 1:57

What are some different life support technologies we have available right now?

Christos Lazaridis 2:01

So if you look at the history of I guess critical care and you identify as a landmark point the 50s, for example, after the polio epidemics in Europe, particularly in Denmark, that's where you have a large number of people who require respiratory ventilatory assistance. And so that's where a primitive form form of mechanical ventilation comes about. Basically machines that provide oxygen, airway pressure and ventilation for the human body.

Matt Teichman 2:37

Would that be because the brain is no longer making the lungs automatically breathe or all could it also be because the lungs are sort of physically damaged?

Christos Lazaridis 2:44

In this specific scenario, polio had to do with the fact that the muscles and the nerves cannot support spontaneous regular breathing. Okay. And so you need artificial support. And so from there on you have a exponential increase of uh concomitant evolutions in technology and artificial support and machinery and medical knowledge. So you end up with a point um uh currently where you have actually technology that can take over or support to a very large extent the function of the heart and the circulation and the function of the respiratory system, the function of the kidneys. So take something like ECMO or extracorporeal membrane oxygenation, where you have a machine, you have a membrane. that oxygenates the blood, pumps through the body, and then is able to also um

Christos Lazaridis 3:42

deal with elimination of carbon dioxide. So you basically take over with the machine the function of the circulatory system and the function of the respiratory system.

What is the legal definition of brain death under the Uniform Determination of Death Act (UDDA)?

Matt Teichman 3:51

It's like you skip the breathing part. You just magically oxygenate the blood and uh take care of the carbon dioxide problem. Is that right? Is it I I'm that's what I'm visualizing here. Imagine instead of like lungs actually physically breathing in air, you're just skipping the i intake of air part and like doing the actual what what the lungs are there for.

Christos Lazaridis 4:09

So that's mostly right. You can have a patient who they have minimal uh pumping heart function and uh very, very sick lungs, for example, where there is heart and lung failure and you can take over the function of these organs in this artificial mechanical uh way. So, by replacing these vital functions in an artificial way, you're able to support patients and function of the organism for far longer than you could without this machinery. In fact, without this machinery, a lot of patients would just die, meaning their heart and lungs would stop working, oxygen nutrients would not uh circulate around, cells would

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Chapters

8 chapters

1 What is the main topic discussed in this episode? 0:15–0:51 2 What is a neuro‑intensivist and what does their work involve? 0:51–1:57 3 How did modern life‑support technology develop and why did it create a need for a precise definition of death? 1:57–3:51 4 What is the legal definition of brain death under the Uniform Determination of Death Act (UDDA)? 3:51–6:44 5 Why do some critics argue that brain death should not be considered true biological death? 6:44–11:50 6 How does the “dead donor rule” shape organ‑transplant practice and what are its ethical challenges? 11:50–16:22 7 What does the controversial Jahay McMath case reveal about the limits of brain‑death determinations? 16:22–23:46 8 Are clinicians consistently accurate in diagnosing brain death, and what efforts exist to improve reliability? 23:46–37:39

Speakers

1 identified

Matt Teichman 7 min

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Topics in this episode

California 1 Twitter 1 New Jersey 1 Denmark 1 University of Chicago 1 JAMA 1 Matt Teichman 2 Elucidations 1 polio 1 ECMO 1 American Academy of Neurology 1 World Brain Death Project 1

Source

Recorded20 Oct 2023

Publisherfeeds.acast.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20526255

Show notes

In this episode, Matt sits down with Christos Lazaridis (University of Chicago Medicine) to chat about what brain death is and whether brain death should count as, like, death death.Modern life support technology really hits its stride in the 1960s, allowing doctors to buy themselves more time to save their patients by connecting them to machines that can assist with breathing, blood oxygenation and/or heart pumping. But the flipside to that incredible technological breakthrough was that the medical community now needed to get more precise about the moment at which a person goes from being alive to being dead. After all, what had previously been a quick window between the two was now, due to life support technology, happening in extreme slow motion. In addition, organ transplanation was becoming more and more commonplace, meaning that it was no longer as simple as saying e.g. ‘I count someone as dead just in case their heart has stopped.’By the early 80s, the United States had settled on a standard definition for when someone counts as dead, which states that a person is dead if they have either permanently lost consciousness or permanently lost the ability to breathe and pump blood with their heart. That criterion makes certain life-saving practices possible; for example, it legally feasible for organ transplantation to begin once a patient has fallen into an irreversible coma, provided they agreed to donate their organs in advance.But should a person really count as dead just because they fell into an irreversible coma? We call that condition ‘brain death’, or sometimes the wordier ‘death by neurological criteria’, and we legally count it as a full death. Critics of the notion of brain death say that it should not count as death, because a person in this condition is still biologically alive. Their argument is that saying a person in this condition is dead is just a story we’re telling ourselves.In this episode, Christos Lazaridis—who is a practicing neurointensivist—argues that even if that is a story we’re telling ourselves, that’s fine, because this is a corner case in which it makes sense for the social/legal status of being dead to come apart from the biological status of being dead. Tune in to hear why he thinks this is the case! Hosted on Acast. See acast.com/privacy for more information.

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