[:en]Defining About Death by Syaefudin Ali Akhmad[:]

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This article was inspired when the author became a speaker at the poster presentation at the Annual Bioethics Conference at Harvard Medical School April 12-13 2018. The concept of death according to a biological view according to facts in humans is divided into two views, namely clinical death due to brain death (Brain Death) and clinical death due to circulation death (heart and respiration) (Circulatory Death). As a result of the death of the organ, it causes the appearance of a permanent condition that remains in a dead state and an irreversible condition or cannot be returned to its original state of life. The concepts of permanent and irreversible are the main characteristics for defining death so that it is said to be null and void if the function of the heart and brain is still reversible and continues to change in response to stimuli, aka it is no longer permanent. The medical definition of death does have a conflict between legal and biological views, especially in the case of brain death which can still be supported with assistive devices so that it is still possible to make it reversible and not permanent with physiological processes being maintained. Likewise with circulatory/cardiac death conditions which allow it to be maintained with the help of an Extra Corporeal Membrane Oxygenation (ECMO) machine as a heart replacement machine and a ventilator as a lung replacement. Instead of wanting to provide life saving and resuscitation to restore the basic functions of life as a human being, it turns out that there is another lesson in organ preservation for patients who have lost their consciousness. So in terms of quality of life it is not perfect because it is just a plant-style vegetative life that has no awareness to respond to external stimuli and cannot provide responses or choices. Meanwhile, quantitatively, its age is still ongoing, in the view of materialism empiricism, there are still signs of life, even though with the help of machines, in the form of heartbeats and circulation, which are still running. This is where the conflict lies between life saving and organ preservation. The idea is to use the good organs of people or patients who are no longer conscious and can no longer wake up due to brain death or circulatory death which can save the lives of others because one or two of their organs are damaged so they cannot live with dignity. For example, people with kidney failure will forever have dialysis and become dependent on the dialysis machine and cannot do activities that are more like strenuous and independent sports. The idea emerged to be able to use organs that were still good for people who were due to brain death and circular death by making death certificates after removing all the aids to achieve permanent and irreversible results. Technological advances in heart surgery allow a person to survive up to 30 minutes using a heart replacement pump machine and a heart that is released and removed from the body can survive for up to 60 minutes in cold temperature conditions to be transferred to another patient. In an operating situation, even though the patient is unconscious, he is still said to be alive with the help of a machine, because his condition can still be reversible and his condition is not permanent. This situation is also beneficial for the process of organ donation and organ transplantation so that the Donation after Brain Death (DHF) movement arises or after brain death and Donation after Cardiac Death (DCD) or organ donation after cardiac death. Pragmatically, several countries then agreed to euthanasia or mercy killing in patients who had confirmed brain death or cardiac death so that between possible or suspected brain death or cardiac death and clearly confirmed death after 8 tests of brain death and several tests of cardiac death it has been declared no longer functioning and it can be confirmed that the brain stem is dead or the heart and lungs are dead. In fact, several countries have dared to apply presumed consent for anyone who dies due to an accident, while certain organs are still good and can still be preserved, so they can automatically be donated to those who need them. The emergence of the case of Jahi McMath in America who was diagnosed with brain death due to complications of massive bleeding after tonsillectomy (tonsillectomy) at the age of 13 and became the world's spotlight because the court issued a death certificate but the family refused the certificate and demanded the hospital continue to care for him to this day. Even though he was legally declared dead 4 years ago, the person concerned is still able to grow and develop with the help of a ventilator and feeding tube that has been installed so far. The hospital also managed to persuade the Jahi family to donate their good organs to those in need.

Report from the Harvard Medical School team who followed and studied the case of a 13-year-old boy named Jahi McMath who fell into a coma after tonsillectomy surgery in Oakland California. On December 9, 2013 the operation was performed and bleeding occurred so that the patient fell into a coma due to whole brain death and the doctor declared him dead. The doctor will also stop life support assistance but the family refuses and fights the doctor's and court's decision to go to court. The family also sued doctors and hospitals for alleged malpractice. An argument ensued in court between the lawyer and the judge and a team of pediatric neurologists. In essence, on December 24, 2013, the court decided that Jahi McMath was declared dead, but the hospital must continue to provide life support until December 30, 2014. Then the family appealed to the second-class court on December 30, 2013. According to the family, the doctors and judges reasoned that it was not right to implementing the Uniform Determination of Death Act (UDDA) which determines death from only two aspects, namely the irreversible cessation of respiratory and circulatory functions and the cessation of all brain functions because in this case there was a violation of religious law or the constitution of the religion one adheres to and the right to privacy or individual autonomy. Moreover, Jahi's heart was still beating normally which he knew from the heart monitor and according to the witnesses sometimes Jahi was still moving and could move his limbs.

On January 5, 2014 the special children's hospital finally released Jahi to forensic medicine and a death certificate was issued on behalf of Jahi but the statement was still incomplete because an autopsy had not been carried out to determine the cause of death and manner of death and time of death. on 27 June 2017 Jahi was declared alive with evidence from various video recordings in which Jahi could follow orders to move. Six criteria for brain stem death consisting of respiratory failure with apnoea test, negative pupillary and corneal reflexes, no response to painful stimuli, cessation of heart rate without a ventilator, no recovery during treatment (different from coma and vegetative state which can still be recovered). , and a negative achilarry test can be proven to be reversible. Coma is a condition of losing consciousness, not awake, not aware, while vegetative state is a state of being awake, but not aware (not communicating with the outside world).[:]