Building a Fence Around Brain Death: The Shielded-Brain Formulation

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012641
Author(s):  
Douglas J Gelb
Keyword(s):  
Clinical Practice ◽  
Brain Death ◽  
Determination Of Death ◽  
Clinical Standards ◽  
History Of ◽  
Uniform Law ◽  
New Formulation ◽  
Law Commission ◽  
Current Practices

The concept of brain death was proposed more than 50 years ago and it has been incorporated in laws and clinical practice, but it remains a source of confusion, debate, and litigation. Because of persistent variability in clinical standards and ongoing controversies regarding policies, the Uniform Law Commission (ULC), which drafted the Uniform Determination of Death Act (UDDA) in 1980, has appointed a committee to study whether the act should be revised. This article reviews the history of the concept of brain death and its philosophical underpinnings, summarizes the objections that have been raised to the prevailing philosophical formulations, and proposes a new formulation that addresses those objections while preserving current practices.

Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act

2019 ◽  
Vol 47 (S4) ◽  
pp. 9-24 ◽  
Author(s):  
Ariane Lewis ◽  
Richard J. Bonnie ◽  
Thaddeus Pope ◽  
Leon G. Epstein ◽  
David M. Greer ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Brain Death ◽  
The United States ◽  
Determination Of Death ◽  
State Laws ◽  
Medical Standards ◽  
Key Issues ◽  
Death By Neurologic Criteria

Although death by neurologic criteria (brain death) is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: (1) the medical standards used to determine death by neurologic criteria, (2) management of family objections before determination of death by neurologic criteria, and (3) management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act (UDDA) and the rationale for these recommendations.

scholarly journals Pope John Paul II and the Neurological Standard for the Determination of Death: A Critical Analysis of his Address to the Transplantation Society

2017 ◽  
Vol 84 (2) ◽  
pp. 155-186 ◽  
Author(s):  
Doyen Nguyen
Keyword(s):  
Brain Death ◽  
Catholic Church ◽  
The Body ◽  
Human Organism ◽  
Determination Of Death ◽  
Pope John Paul Ii ◽  
John Paul Ii ◽  
The Brain ◽  
The Catholic Church

The introduction of the “brain death” criterion constitutes a significant paradigm shift in the determination of death. The perception of the public at large is that the Catholic Church has formally endorsed this neurological standard. However, a critical reading of the only magisterial document on this subject, Pope John Paul II's 2000 address, shows that the pope's acceptance of the neurological criterion is conditional in that it entails a twofold requirement. It requires that certain medical presuppositions of the neurological standard are fulfilled, and that its philosophical premise coheres with the Church's teaching on the body-soul union. This article demonstrates that the medical presuppositions are not fulfilled, and that the doctrine of the brain as the central somatic integrator of the body does not cohere either with the current holistic understanding of the human organism or with the Church's Thomistic doctrine of the soul as the form of the body. Summary The concept of “brain death” (the neurological basis for legally declaring a person dead) has caused much controversy since its inception. In this regard, it has been generally perceived that the Catholic Church has officially affirmed the “brain death” criterion. The address of Pope John Paul II in 2000 shows, however, that he only gave it a conditional acceptance, one which requires that several medical and philosophical presuppositions of the “brain death” standard be fulfilled. This article demonstrates, taking into consideration both the empirical evidence and the Church's Thomistic anthropology, that the presuppositions have not been fulfilled.

Brain Death

2017 ◽  
Author(s):  
Anupamaa Seshadri ◽  
Ali Salim
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Brainstem Reflex ◽  
Practice Parameters ◽  
Confirmatory Tests ◽  
History Of ◽  
Pediatric Populations ◽  
Definition Of

The concept of “brain death” is one that has been controversial over time, requiring the development of clear guidelines to diagnose and give prognoses for patients after devastating neurologic injury. This review discusses the history of the definition of brain death, as well as the most recent guidelines and practice parameters on the determination of brain death in both the adult and pediatric populations. We provide specific and detailed instructions on the various clinical tests required, including the brain death neurologic examination and the apnea test, and discuss pitfalls in the diagnosis of brain death. This review also considers the most recent literature and guidelines as to the role of confirmatory tests making this diagnosis.  Key Words: apnea test, brain death, brainstem reflex, death examination

Challenges to the Determination of Death by Neurological Criteria

2019 ◽  
Vol 19 (4) ◽  
pp. 583-599
Author(s):  
Tadeusz Pacholczyk ◽  
Stephen Hannan ◽  
Keyword(s):  
Brain Death ◽  
Determination Of Death ◽  
Ethical Concerns ◽  
Diagnostic Practices ◽  
Testing Potential ◽  
Brain Dead ◽  
Testing Protocols ◽  
The Brain ◽  
Apnea Testing

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed.

The Determination of Death

1977 ◽  
Vol 7 (4) ◽  
pp. 277-296 ◽  
Author(s):  
Gerald M. Devins ◽  
Robert T. Diamond
Keyword(s):  
Brain Death ◽  
Science And Technology ◽  
Medical Science ◽  
Determination Of Death ◽  
Recent Developments ◽  
The Brain

Recent developments in medical science and technology have rendered obsolete the traditional medical criteria for determining death in a small but growing number of terminal patients. Philosophical problems encountered in attempts to develop a more sophisticated set of operational procedures are discussed. Both the traditional conditions indicating death as well as more recent reformulations required to pronounce a state of brain death in those moribund individuals in whom the traditional signs have been obscured are reported. Finally, some of the medical, legal, and social considerations which arise from recognition of the brain death definition are discussed briefly.

Definition of Brain Death

1983 ◽  
Vol 40 (1) ◽  
pp. 5-14
Author(s):  
John J. Paris ◽  
Ronald E. Cranford
Keyword(s):  
Public Policy ◽  
Brain Death ◽  
Policy Position ◽  
Determination Of Death ◽  
Definition Of

“It is important to be clear on what determination of death statutes involve…. It is equally important to understand the objections to such legislation, analyze and evaluate them, and devise a coherent public policy position on the issue. That policy must be medically sound, ethically appropriate, and theologically acceptable.”

scholarly journals Brain Blood Flow in the Neurological Determination of Death: Canadian Expert Report

2008 ◽  
Vol 35 (2) ◽  
pp. 140-145 ◽  
Author(s):  
Sam D. Shemie ◽  
Donald Lee ◽  
Michael Sharpe ◽  
Donatella Tampieri ◽  
Bryan Young
Keyword(s):  
Blood Flow ◽  
Brain Death ◽  
Imaging Techniques ◽  
Radionuclide Angiography ◽  
Brain Blood Flow ◽  
Determination Of Death ◽  
Xenon Ct ◽  
Clinical Criteria ◽  
Canadian Council

The neurological determination of death (NDD, brain death) is principally a clinical evaluation. However, ancillary testing is required when there are factors confounding the clinical determination or when it is impossible to complete the minimum clinical criteria. At the time of the 2003 Canadian Forum clarifying the criteria for brain death, 4-vessel cerebral angiography or radionuclide angiography were the recommended tests and the electroencephalogram was no longer supported. At the request of practitioners in the field, the Canadian Council for Donation and Transplantation sponsored the assembly of neuroradiology and neurocritical care experts to make further recommendations regarding the use of ancillary testing. At minimum, patients referred for ancillary testing should be in a deep unresponsive coma with an established etiology, in the absence of reversible conditions accounting for the unresponsiveness and the clinical examination should be performed to the fullest extent possible. For newborns, children and adults, demonstration of the absence of brain blood flow by following recommended imaging techniques fulfill the criteria for ancillary testing: 1. radionuclide angiography or CT angiography 2. traditional 4-vessel angiography 3. Magnetic resonance angiography or Xenon CT. In the absence of neuroimaging, an established cardiac arrest, as defined by the permanent loss of circulation, fulfills the ancillary criteria for the absence of brain blood flow. Acknowledging the existing limitations in this field, further research validating current or evolving techniques of brain blood flow imaging are recommended.

scholarly journals An interdisciplinary response to contemporary concerns about brain death determination

Neurology ◽  
2018 ◽  
Vol 90 (9) ◽  
pp. 423-426 ◽  
Author(s):  
Ariane Lewis ◽  
James L. Bernat ◽  
Sandralee Blosser ◽  
Richard J. Bonnie ◽  
Leon G. Epstein ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Brain Death ◽  
American Academy ◽  
Determination Of Death ◽  
Brain Death Determination ◽  
Death By Neurologic Criteria ◽  
Law And Humanities ◽  
American Academy Of Neurology ◽  
Death Determination

In response to a number of recent lawsuits related to brain death determination, the American Academy of Neurology Ethics, Law, and Humanities Committee convened a multisociety quality improvement summit in October 2016 to address, and potentially correct, aspects of brain death determination within the purview of medical practice that may have contributed to these lawsuits. This article, which has been endorsed by multiple societies that are stakeholders in brain death determination, summarizes the discussion at this summit, wherein we (1) reaffirmed the validity of determination of death by neurologic criteria and the use of the American Academy of Neurology practice guideline to determine brain death in adults; (2) discussed the development of systems to ensure that brain death determination is consistent and accurate; (3) reviewed strategies to respond to objections to determination of death by neurologic criteria; and (4) outlined goals to improve public trust in brain death determination.

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