La muerte cl赤nica: un diagn車stico y un testimonio Clinical death: A diagnosis and a testimony

作者：J L Trueba

来源：Anales del Sistema Sanitario de Navarra, 2007.

• Muerte encefalica
• Muerte clinica
• Diagnostico
• etica
• Brain death
• Clinical death
• Diagnosis
• Ethics

La muerte cl赤nica de una persona es la muerte del enc谷falo. Hay un consenso bastante generalizado en nuestra medicina occidental sobre los criterios necesarios y el modo de proceder para un correcto diagn車stico de %26quot;muerte encef芍lica%26quot;. En un caso concreto, cuando existen antecedentes razonables de da o cerebral catastr車fico y determinados signos cl赤nicos en la exploraci車n neurol車gica, un m谷dico con suficiente experiencia puede llegar a emitir un diagn車stico de muerte cl赤nica. Aceptando que el diagn車stico de muerte es un ejercicio de puro juicio pr芍ctico, y que como tal nunca puede dar certidumbre absoluta, debemos asumir que a pesar de la incertidumbre debemos tomar decisiones razonables y prudentes. Sin embargo, existen opiniones discrepantes que consideran ser赤a necesario un m芍s alto grado de certeza antes de tomar decisiones. Para tomar decisiones responsables se requiere intentar comprender el concepto de la muerte cerebral como un aut谷ntico constructo cultural en el que son necesarios conocimientos a cerca de %26quot;qu谷%26quot; es lo que se define cient赤ficamente como muerte; el %26quot;c車mo%26quot; se puede diagnosticar en la pr芍ctica; el %26quot;cu芍ndo%26quot; se dice que un hombre est芍 cl赤nicamente muerto, y de %26quot;cual%26quot; es el grado de evidencia que conlleva el diagn車stico. The clinical death of a person is the death of the brain. There is a fairly general consensus in western medicine on the necessary criteria and the mode of proceeding for a correct diagnosis of %26quot;brain death%26quot;. In a specific case, with a reasonable previous record of catastrophic brain damage and certain neurological exploratory signs, an expert practitioner is able to diagnose clinical death. Accepting that the diagnosis of death is an exercise of diagnostic judgement, in practical application, which cannot as such provide absolute certainty; we have to accept that, in spite of this uncertainty, we have to take sensible and prudent decisions. However, there are dissenting opinions that believe in the need for a higher degree of certainty before taking decisions. It is necessary to try to understand the concept of %26quot;brain death%26quot; in order to be able to take responsible decisions. This concept is a real %26quot;cultural construction%26quot;, in which it is necessary to have knowledge about the scientific definition of death, how death can be diagnosed in practice, when it is possible to say that someone is clinically dead, and what is the degree of evidence carried by the diagnosis.