Charles M. Culver

On the definition and criterion of death.

The permanent cessation of functioning of the organism as a whole is the definition underlying the traditional understanding of death. We suggest the total and irreversible loss of functioning of the whole brain as the sole criterion of death; this has always been an implicit criterion of death. If artificial ventilation is present, only completely validated brain dysfunction tests should be used to show that this criterion of death is satisfied. In most cases without artificial ventilation, permanent loss of cardiopulmonary function is sufficient. We propose a statutory definition of death based on the criterion of total and irreversible cessation of whole brain functions but allowing physicians to declare death according to their customary practices in most cases.

Evoked Cortical Potentials: Relation to Hand Dominance and Eye Dominance

The amplitude and symmetry of right- and left-occipital lobe evoked potentials (EPs) to right and left visual-field stimulation were studied as a function of hand and eye dominance in female Ss. For all Ss, right-lobe EP amplitudes were greater than left-lobe during left visual-field, but not right visual-field, stimulation. Left-eyed Ss had significantly greater EP amplitudes than right-eyed Ss. Comparing this study with previous ones suggests a sex difference in the relationship of handedness to right lobe-left lobe asymmetry.

Family coercion and valid consent.

Coercion is commonly said to invalidate consent, and that is always true if the source of the coercion is the physician. However, if it is a family member who coerces the patient to consent, the resultant consent may be quite valid and treatment should proceed.

The Morality of Involuntary Hospitalization

There is a good deal of recent dispute both within and outside of psychiatry about the procedure of involuntary hospitalization. (We use ‘involuntary hospitalization’ to cover both 2–3 day ‘emergency’ detentions and longer civil commitments. We discuss mainly detention here but do refer to commitment when appropriate.) While writers such as Szasz [10] believe that involuntary hospitalization should be eliminated entirely, it is more common to find disagreement about how wide or narrow the grounds for detaining patients should be.

Beyond the Living Will: Making Advance Directives More Useful

Various forms of Advance Directives (Living Wills; Durable Powers of Attorney) are available that allow individuals to leave instructions about the conditions under which they would and would not want to be allowed to die. These Directives are often worded too vaguely to be helpful. A series of specific questions is described giving more precision to Advance Directives. All competent adults should consider and answer these questions; attending to this matter while one is able may prevent future suffering for both oneself and ones loved ones.

Community Service Workers and Recipients: A Combined Middle Class Lower Class Workshop

A one-week workshop, focusing on the nature of the helping relationship, was attended by 36 community service workers, subprofessionals, and lower class recipients. The workshop format included both T Groups and a variety of more structured activities. The workshop was apparently an effective learning experience, as judged by the staffs appraisal and by the results of questionnaires and interviews obtained from the participants. Social class differences, while visible during the workshop, seemed to carry neither more nor less impact than other demographic characteristics. The conclusion is that an open exploration of the helping relationship wherein helper and recipient directly confront each other may have great learning value for both.