Death is best viewed as a process during which the function of various organs deteriorates progressively; the precise sequence and time course of the organ failures depends on the nature of the underlying disease and treatment. Therefore a confident diagnosis of death is dependent on defining, with certainty, the point at which this process becomes irreversible. This decision is not always straightforward. The traditional signs of death (unconscious, not breathing, absent pulse) are easily detectable major events, following which the process of dying normally rapidly accelerates and passes the point of no return. However, the institution of cardiopulmonary resuscitation can interrupt, and sometimes reverse, this process so that cessation of heart beat and breathing do not necessarily indicate irreversibility. Therefore the context in which cardiorespiratory arrest occurs must be taken into account when deciding whether cessation of breathing and heart beat should be considered to represent death. Mechanical ventilation can prolong the process of dying in patients whose respiratory center has ceased to function as a result of irreversible brain injury. A person should not be pronounced dead unless the brain is dead; cardiorespiratory arrest is indicative of death only when it persists long enough for the brain to die.
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