Twenty-second World Medical Assembly

Gilder, S. S. B.

doi:10.1136/bmj.3.5616.493

Cited by 42 publications

(30 citation statements)

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“…It was founded on 17 September 1947, when physicians from 27 different countries met at the First General Assembly of the WMA in Paris. According the WMA, “the organization was created to ensure the independence of physicians, and to work for the highest possible standards of ethical behavior and care by physicians, at all times.”2 3 18 – 22 In 1968, from 5 to 9 August, delegates from 26 countries of 64 WMA member nations met in Sydney, Australia, to hold the WMA’s 22nd World Medical Assembly 2 3 22…”

Section: The 22nd World Medical Assemblymentioning

confidence: 99%

“…The Assembly issued an interim statement, known as the Declaration of Sydney. Stanley S B Gilder, the executive editor of the WMA’s journal from 1959 to 1973,2 3 19 – 23 published a résumé of the 22nd World Medical Assembly, with special emphasis on the Declaration of Sydney on human death (box 1) 3…”

Section: The 22nd World Medical Assemblymentioning

confidence: 99%

“…Moreover, there was public uneasiness about removing organs from living patients. Hence, the WMA Committee on Ethics and its Council had organised a study two years earlier, to formulate an account of death under the new circumstances 2 3…”

Section: The Declaration Of Sydneymentioning

confidence: 99%

“…On 5 August, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death published its report, “A definition of irreversible coma”, in the Journal of the American Medical Association 1—a milestone event. On the same day, the 22nd World Medical Assembly, meeting in Sydney, Australia, announced the Declaration of Sydney,2 3 a pronouncement on death that is less often quoted because it was overshadowed by the impact of the Harvard Report 1 4 – 17. The review here is advanced to preserve for current and future generations the pioneering contribution of the Declaration of Sydney.…”

mentioning

confidence: 99%

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The Declaration of Sydney on human death

Machado

Korein

Ferrer³

et al. 2007

J Med Ethics

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On 5 August 1968, publication of the Harvard Committee’s report on the subject of “irreversible coma” established a standard for diagnosing death on neurological grounds. On the same day, the 22nd World Medical Assembly met in Sydney, Australia, and announced the Declaration of Sydney, a pronouncement on death, which is less often quoted because it was overshadowed by the impact of the Harvard Report. To put those events into present-day perspective, the authors reviewed all papers published on this subject and the World Medical Association web page and documents, and corresponded with Dr A G Romualdez, the son of Dr A Z Romualdez. There was vast neurological expertise among some of the Harvard Committee members, leading to a comprehensible and practical clinical description of the brain death syndrome and the way to diagnose it. This landmark account had a global medical and social impact on the issue of human death, which simultaneously lessened reception of the Declaration of Sydney. Nonetheless, the Declaration of Sydney faced the main conceptual and philosophical issues on human death in a bold and forthright manner. This statement differentiated the meaning of death at the cellular and tissue levels from the death of the person. This was a pioneering view on the discussion of human death, published as early as in 1968, that should be recognised by current and future generations.

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Section: The 22nd World Medical Assemblymentioning

confidence: 99%

Section: The 22nd World Medical Assemblymentioning

confidence: 99%

Section: The Declaration Of Sydneymentioning

confidence: 99%

mentioning

confidence: 99%

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The Declaration of Sydney on human death

Machado

Korein

Ferrer³

et al. 2007

J Med Ethics

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“…During the Twenty Second World Medical Assembly, the Declaration of Sydney was announced regarding the pronouncement of death: "Death is an ongoing gradual process at the cellular level in which tissues vary in their ability to withstand the deprivation of oxygen. The moment of the death of particular cells and organs does not play as significant a role as confirming that the ongoing process is irreversible and no medical devices can restore life" [22]. The second milestone was publishing the Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death whose ad hoc definition initiated further discussion on the legitimacy of calling a coma, death [23].…”

Section: Death and Transplantologymentioning

confidence: 99%

Brain death criteria formulated for transplantation purposes: fact or myth?

Pabisiak

2016

Anaesthesiol Intensive Ther

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Medical progress has moved the boundaries of life that were set many centuries ago. The development of medical techniques has allowed us to witness cases that were unknown prior to the introduction of reanimation procedures and mechanical ventilation. Towards the end of the 1950s, the term "irreversible coma" was coined, and has evolved into what is currently known as the "brain death" concept. This latter concept, proposed in 1968, is very often referred to as the new definition of death, even in medical circles. What, up until this time, used to be the classic definition of death, namely cessation of circulation and respiration, should now be recognized as the classic criteria for death. Indeed, the new criteria for recognizing death has not resulted in changing the current criteria, but in complementing them. The first part of this paper presents brief descriptions of death in the humanities over the centuries and the impact of progress in medicine on changes in how death is defined today. The second part brings to light the complexity of creating the foundations of the neurological criteria for death. The integration of concepts from two complementary medical fields -neurology and transplantology -is described. Although for some period of time they have been linked together, they may grow independently in the future. The jargon phrase "brain death" is nowadays recognized as synonym of death, but in fact should be considered tantamount to declaring pronouncing a person's death.

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Determination of Brain Death/Death by Neurologic Criteria

Greer

Shemie

Lewis

et al. 2020

JAMA

440

533

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ImportanceThere are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.ObjectiveTo formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel.ProcessRelevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery.Evidence SynthesisBased on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed.RecommendationsPrior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability.Conclusions and RelevanceThis report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in...

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Twenty-second World Medical Assembly

Cited by 42 publications

References 0 publications

The Declaration of Sydney on human death

The Declaration of Sydney on human death

Brain death criteria formulated for transplantation purposes: fact or myth?

Determination of Brain Death/Death by Neurologic Criteria

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