Art Caplan has a new piece, co-authored with David C. Magnus, Ph.D. and Benjamin S. Wilfond, M.D., in the NEJM, addressing the legal and medical reasons for accepting brain death as death. From the article:
Over the past several decades, brain death has become well entrenched as a legal and medical definition of death. It is clearly defined by the neurologic community […], standards for diagnosis are in place, and it is established in law. It has become the primary basis of organ-procurement policy for transplantation. Ironically, the other standard for defining death, irreversible cessation of circulation, lacks consensus about diagnosis.
The concept of brain death has periodically come under criticism.4 The primary objections focus on inadequacies in the philosophical rationale for the concept that the unifying functioning of the body has been lost with loss of brain functioning, combined with a concern that biologically, there is still a sense that the body is alive, often long after brain death occurs. Wound healing can continue to occur, most organs continue to function for some period, hormonal and body-temperature regulation may be maintained. It has been reported that a child’s growth can continue. And as the Muñoz case demonstrates, a pregnancy can be maintained even after the pregnant woman has met the neurologic criteria for death.
Even many of the most vocal critics of brain death agree that there is no obligation to continue providing mechanical support after brain death. Although they do not consider brain death to be death, many of them agree that the person has ceased to exist and has no interests at stake in the discontinuation of ventilator support. Although some physicians accommodate a family’s grief by allowing a brief delay either before completing brain-death examinations or before discontinuing mechanical support after a brain-death determination, these actions are for the family, not the patient. In addition, many believe that it is appropriate to procure organs after such declarations.
Read the full article here.