As a neurologist who specializes in critical care, I believe we need a clearer, more consistent legal definition of death. The Uniform Determination of Death Act (UDDA), the legal standard for death throughout the U.S., has deficiencies, particularly with respect to the description of death by neurologic criteria, aka brain death. This causes confusion and moral distress for both families and health care teams and can lead to protracted lawsuits about whether a person is alive or dead.
Historically, doctors declared death when a person was not breathing and had no heartbeat or palpable pulse. This occasionally caused controversy because they declared death prematurely. Declaring death became even more complicated as the 20th century progressed. Cardiopulmonary resuscitation (CPR) and ventilators allowed vital functions to continue in people who previously would have died. Some of these people were comatose as a result of catastrophic brain injuries and would never be able to breathe on their own because of damage to the lowest part of the brain stem.
In 1968 a group chaired by anesthesiologist Henry Beecher and composed of experts in neurology, physiology, biochemistry, law and social ethics convened at Harvard University to examine the definition of “irreversible coma,” which subsequently became known as “brain death/death by neurologic criteria.” They noted that the characteristics of irreversible coma—a permanently nonfunctioning brain—included unreceptivity and unresponsiveness, no movements or spontaneous breathing (apnea) and no brain stem reflexes.
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The group believed that this definition of death would not require statutory changes because the law treated the question of death…
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