Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-01-11T22:49:29.810Z Has data issue: false hasContentIssue false
  • English
  • Français

Brain Death — Too Flawed to Endure, Too Ingrained to Abandon

Published online by Cambridge University Press:  01 January 2021

Robert D. Truog
Get access Rights & Permissions [Opens in a new window]

Extract

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.

By way of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 35 , Issue 2 , Summer 2007 , pp. 273 - 281
Copyright
Copyright © American Society of Law, Medicine and Ethics 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Capron, A. M., “Brain Death – Well Settled Yet Still Unresolved,” New England Journal of Medicine 344, no. 16 (2001): 1244–6.CrossRefGoogle Scholar
Kennedy Institute of Ethics Journal 14, no. 3 (2004); American Journal of Bioethics 3, no. 1 (2003).Google Scholar
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death: A Report on the Medical, Legal, and Ethical Issues in the Determination of Death (Washington, D.C.: Government Printing Office, 1981); “Guidelines for the Determination of Death,” JAMA 246, no. 19 (1981): 2184-6.Google Scholar
Wijdicks, E. F. M., “Brain Death Worldwide: Accepted Fact but No Global Consensus in Diagnostic Criteria,” Neurology 58, no. 1 (2002): 20–5CrossRefGoogle Scholar
Wijdicks, E. F. M., “The Diagnosis of Brain Death,” New England Journal of Medicine 344, no. 16 (2001): 1215–21.CrossRefGoogle Scholar
Willing, R., “Woman Is Kept Alive to Save Unborn Baby,” USA Today, June 16, 2005; Willing, R., “Brain-Dead Woman Dies After Baby Born,” USA Today, August 4, 2005.Google Scholar
Id., (June 16, 2005).Google Scholar
See Willing, (August 4, 2005), supra note 6.Google Scholar
King, L., “Interview with Jason, Justin Torres,” Larry King Live, CNN, June 30, 2005.Google Scholar
Youngner, S. J., Landefeld, C. S., Coulton, C. J., Juknialis, B. W. and Leary, M., “‘Brain Death’ and Organ Retrieval: A Cross-Sectional Survey of Knowledge and Concepts among Health Professionals,” JAMA 261, no. 15 (1989): 2205–10.CrossRefGoogle Scholar
Wikler, D. and Weisbard, A. J., “Appropriate Confusion over ‘Brain Death,’” JAMA 261, no. 15 (1989): 2246.CrossRefGoogle Scholar
Truog, R. D. and Fackler, J. C., “Rethinking Brain Death,” Critical Care Medicine 20, no. 12 (1992): 1705–13; Truog, R. D., “Is It Time to Abandon Brain Death?” Hastings Center Report 27, no. 1 (1997): 29-37; Truog, R. D., “Organ Transplantation without Brain Death,” Annals of the New York Academy of Science 913, no. 1 (2000): 229-39; Truog, R. D. and Robinson, W. M., “Role of Brain Death and the Dead-Donor Rule in the Ethics of Organ Transplantation,” Critical Care Medicine 31 (2003): 2391-6.CrossRefGoogle Scholar
Id., (Truog, and Robinson, ).Google Scholar
Crowley-Matoka, M. and Arnold, R. M., “The Dead Donor Rule: How Much Does the Public Care…And How Much Should We Care?” Kennedy Institute of Ethics Journal 14, no. 3 (2004): 319–332.CrossRefGoogle Scholar
Green, M. B. and Wikler, D., “Brain Death and Personal Identity,” Philosophy and Public Affairs 9 (1980): 105–33; Veatch, R. M., “The Whole-Brain-Oriented Concept of Death: An Outmoded Philosophical Formulation,” Journal of Thanatology 3, no. 1 (1975): 13–30; Veatch, R. M., “The Impending Collapse of the Whole-Brain Definition of Death,” Hastings Center Report 23, no. 4 (1993): 18-24; Youngner, S. J. and Bartlett, E. T., “Human Death and High Technology: The Failure of the Whole-Brain Formulations,” Annals of Internal Medicine 99, no. 2 (1983): 252-8.Google Scholar
Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (First of Two Parts),” New England Journal of Medicine 330, no. 21 (1994): 1499–508; Multi-Society Task Force on PVS, “Medical Aspects of the Persistent Vegetative State (Second of Two Parts),” New England Journal of Medicine 330, no. 22 (1994): 1572-9.Google Scholar
See Truog, (1997), supra note 12.Google Scholar
I have covered only an overview of the arguments here; please see my earlier work, cited supra note 12, for a more thorough review of the problems with the concept of brain death.Google Scholar
“A Definition of Irreversible Coma, Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” JAMA 205, no. 6 (1968): 337–40.CrossRefGoogle Scholar
Prendergast, T. J. and Luce, J. M., “Increasing Incidences of Withholding and Withdrawal of Life Support from the Critically Ill,” American Journal of Respiratory and Critical Care Medicine 155, no. 1 (1997): 15–20.Google Scholar
Truog, R. D., “Medical Futility in Intensive Care,” ICU Management 1 (2005): 12–4; Fine, R. L. and Mayo, T. W., “Resolution of Futility by Due Process: Early Experience with the Texas Advance Directives,” Annals of Internal Medicine 138, no. 9 (2003): 743-6; Halevy, A. and Brody, B. A., “Medical Futility in End-of-Life Care,” JAMA 282, no. 14 (1999): 1331.Google Scholar
Young, P. J. and Matta, B. F., “Anaesthesia for Organ Donation in the Brainstem Dead – Why Bother?” Anaesthesia 55, no. 2 (2000): 105–6; Dalgleish, D., Letter, “Brain Stem Death: Healthcare Workers have Difficulty Accepting Current Management,” British Medical Journal 321, no. 7261 (2000): 635; Keep, P. J., Letter, “Anaesthesia for Organ Donation in the Brainstem Dead,” Anaesthesia 55, no. 6 (2000): 590; Poulton, B. and Garfield, M., Letter, “The Implications of Anaesthetising the Brainstem Dead,” Anaesthesia 55, no. 7 (2000): 695.CrossRefGoogle Scholar
Olick, R. S., “Brain Death, Religious Freedom, and Public Policy: New Jersey's Landmark Legislative Initiative,” Kennedy Institute of Ethics Journal 1, no. 4 (1991): 275–88.CrossRefGoogle Scholar
Associated Press, “Organ Donations Barred by Judge: Vital Organs of Doomed Girl Can't Be Given to Others, a Florida Judge Rules,” New York Times, March 28, 1992.Google Scholar
Schmidt, T. C., “The Ohio Study in Light of National Data and Clinical Experience,” Kennedy Institute of Ethics Journal 14, no. 3 (2004): 235–40, at 236–7.CrossRefGoogle Scholar
Id., at 238.Google Scholar
Id.Google Scholar
Veatch, R. M., “The Dead Donor Rule: True by Definition,” American Journal of Bioethics 3 (2003): 10–1; Veatch, R. M., “Abandon the Dead Donor Rule or Change the Definition of Death?” Kennedy Institute of Ethics Journal 14, no. 3 (2004): 261–76.Google Scholar
See Truog, and Robinson, supra note 12.Google Scholar
See Veatch, (2004), supra note 28, at 268.CrossRefGoogle Scholar
Id., at 267.Google Scholar
Id., at 268.Google Scholar
Id.Google Scholar
See Veatch, (2003), supra note 28, at 11.Google Scholar
See Veatch, (2004), supra note 28, at 273.CrossRefGoogle Scholar
See Truog, and Robinson, supra note 12.Google Scholar
Parker, I., “The Gift: Zell Kravinsky Gave Away Millions. But Somehow It Wasn't Enough,” The New Yorker, August 2, 2004, at 54–63.Google Scholar
Abecassis, M., Adams, M., Adams, P., Arnold, R. M., Atkins, C. R., Barr, M. L., Bennett, W. M., Bia, M., Briscoe, D. M., Burdick, J., Corry, R. J., Davis, J., Delmonico, F. L., Gaston, R. S., Harmon, W., Jacobs, C. L., Kahn, J., Leichtman, A., Miller, C., Moss, D., Newmann, J. M., Rosen, L. S., Siminoff, L., Spital, A. and Starnes, V. A. et al., “Consensus Statement on the Live Organ Donor,” JAMA 284, no. 22 (2000): 2919–26.Google Scholar
See Prendergast, and Luce, supra note 20.Google Scholar
See Truog, and Robinson, supra note 12; Potts, M. and Evans, D. W., “Does It Matter That Organ Donors Are Not Dead? Ethical and Policy Implications,” Journal of Medical Ethics 31, no. 7 (2005): 406–9.Google Scholar
Ebbert, S. and Mullin, R., “Police Pursuit Claims a Life,” Boston Globe, December 14, 1999.Google Scholar
Krieger, L. M., “A Life-and-Death Proposal,” New York Times, June 5, 1996.Google Scholar
I responded to the article at note 42 with a letter explaining the facts of brain death, but there were no responses to the issue of doctors taking organs from living patients: Truog, R. D., Letter to the Editor, “Let Organ-Donor Family Make Dignified Choice, Not Before Death,” New York Times, June 8, 1996.Google Scholar
“Not Quite Dead,” 60 Minutes, CBS, April 13, 1997.Google Scholar
DeVita, M. A., Webb, S. A., Hurford, W. E., Truog, R. D., Wlody, G. S., Hayden, C. T., Sprung, C. L., Brilli, R. J., Beals, D. A., Rothenberg, D. M., Friedman, A. L., Silverstein, D. S., Kaufman, D. C., Perkin, R. M., Rosenbaum, S. H., Cist, A. F. M., Samotowka, M., Teres, D., Unkle, D. W., Burns, J. P., T. E. Wallace, and the Ethics Committee of the American College of Critical Care Medicine, “Recommendations for Nonheartbeating Organ Donation,” Critical Care Medicine 29, no. 9 (2001): 1826–31.Google Scholar
Fost, N., “Reconsidering the Dead Donor Rule: Is It Important That Organ Donors Be Dead?” Kennedy Institute of Ethics Journal 14, no. 3 (2004): 249–60.CrossRefGoogle Scholar
Siminoff, L. A., Burant, C. and Youngner, S. J., “Death and Organ Procurement: Public Beliefs and Attitudes,” Kennedy Institute of Ethics Journal 14, no. 3 (2004): 217–34.CrossRefGoogle Scholar
See Veatch, (2003), supra note 28, at 10.Google Scholar
Gianelli, D. M., “AMA Organ Donor Opinion Sparks Ethics Debate,” American Medical News (Chicago), July 25, 1994.Google Scholar
Gianelli, D. M., “Ethics Council Reverses Stand on Anencephalic Organ Donors,” American Medical News (Chicago), December 25, 1995.Google Scholar
Charo, R. A., “Realbioethik,” Hastings Center Report 35, no. 4 (2005): 13–14, at 14.CrossRefGoogle Scholar
Deschamps, J. Y., Roux, F. A., Sai, P. and Gouin, E., “History of Xenotransplantation,” Xenotransplantation 12, no. 2 (2005): 91–109.CrossRefGoogle Scholar