Brain death: Can it be resuscitated?

Hastings Center Report

Volumn 39, Issue 2, 2009, Pages 18-24

  Shewmon, D Alan ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTIFICIAL VENTILATION; ASSISTED CIRCULATION; ASYSTOLE; BRAIN DEATH; BRAIN DYSFUNCTION; BRAIN FUNCTION; CONSENSUS; CONSULTATION; HUMAN; INTENSIVE CARE UNIT; MEDICAL PROFESSION; ORGAN TRANSPLANTATION; PERSISTENT VEGETATIVE STATE; RESUSCITATION; REVIEW; ARTICLE; ATTITUDE TO DEATH; DECISION MAKING; DEFENSE MECHANISM; FAMILY; MASS MEDIUM; MEDICAL ETHICS; POLITICS; TRANSPLANTATION;

ATTITUDE TO DEATH; BRAIN DEATH; DECISION MAKING; ETHICS, MEDICAL; FAMILY; HUMANS; MASS MEDIA; POLITICS; RATIONALIZATION; RESUSCITATION; TISSUE AND ORGAN PROCUREMENT;

EID: 65549091494     PISSN: 00930334     EISSN: 1552146X     Source Type: Journal    
DOI: 10.1353/hcr.0.0122     Document Type: Review

References (31)

1. President's Council on Bioethics, Controversies in the Determination of Death (Washington, D.C.: President's Council on Bioethics, 2008).
2. H.K. Beecher et al., "A Definition of Irreversible Coma," Journal of the American Medical Association 205 (1968): 337-340
3. M.A. DeVita, J.V. Snyder, and A. Grenvik, "History of Organ Donation by Patients with Cardiac Death," Kennedy Institute of Ethics Journal 3 (1993): 113-129
4. P.M. Black, "Brain Death (Second of Two Parts)," New England Journal of Medicine 299 (1978): 393-401, at 395-396
5. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death (Washington, D.C.: U.S. Government Printing Office, 1981).
6. J.L. Bernat, C.M. Culver, and B. Gert, "On the Definition and Criterion of Death," Annals of Internal Medicine 94 (1981): 389-394
7. S.J. Youngner et al., "'Brain Death' and Organ Retrieval: A Cross- Sectional Survey of Knowledge and Concepts among Health Professionals," Journal of the American Medical Association 261 (1989): 2205-2210;
8. L.A. Siminoff, C. Burant, and S.J. Youngner, "Death and Organ Procurement: Public Beliefs and Attitudes," Kennedy Institute of Ethics Journal 14 (2004): 217-234
9. American Academy of Neurology, Quality Standards Subcommittee, "Practice Parameters for Determining Brain Death in Adults (Summary Statement)," Neurology 45 (1995): 1012-14;
10. E.F. Wijdicks, "Determining Brain Death in Adults," Neurology 45 (1995): 1003-1011.
11. A.H. Ropper and R.H. Brown, Adams and Victor's Principles of Neurology (New York: McGraw-Hill, 2005), 962, emphasis added.
12. F. Plum, "Clinical Standards and Technological Confirmatory Tests in Diagnosing Brain Death," in The Definition of Death: Contemporary Controversies, ed. S.J. Youngner, R.M. Arnold, and R. Schapiro (Baltimore, Md.: Johns Hopkins University Press, 1999), 34-65, at 53, emphasis added.
13. R.E. Cranford and D.R. Smith, "Consciousness: The Most Critical Moral (Constitutional) Standard for Human Personhood," American Journal of Law and Medicine 13 (1987): 233-248, at 243, emphasis added.
14. For criticisms of organismic unity, see Journal of Medicine and Philosophy 26, no.5 (2001), entire issue. On the personhood rationale, see
15. J.P. Lizza, Persons, Humanity, and the Definition of Death (Baltimore, Md.: Johns Hopkins University Press, 2006);
16. R.M. Veatch, "The Impending Collapse of the Whole-Brain Definition of Death," Hastings Center Report 23, no. 4 (1993): 18-24;
17. R.M. Veatch, "The Death of Whole-Brain Death: The Plague of the Disaggregators, Somaticists, and Mentalists," Journal of Medicine and Philosophy 30 (2005): 353-78;
18. M.B. Green and D. Wikler, "Brain Death and Personal Identity," Philosophy and Public Affairs 9 (1980): 105-33;
19. R.M. Zaner, ed., Death: Beyond Whole-Brain Criteria (Dordrecht, the Netherlands: Kluwer Academic Publishers, 1988);
20. R.J. Devettere, "Neocortical Death and Human Death," Law, Medicine and Health Care 18 (1990): 96-104.
21. F. Plum and J.B. Posner, The Diagnosis of Stupor and Coma (Philadelphia, Penn.: F.A. Davis Company, 1983), at 325;
22. C. Machado, "A New Definition of Death Based on the Basic Mechanisms of Consciousness Generation in Human Beings," in Brain Death. Proceedings of the Second International Conference on Brain Death, ed. C. Machado (Amsterdam, the Netherlands: Elsevier, 1995), 57-66.
23. S.J. Youngner and R.M. Arnold, "Philosophical Debates about the Definition of Death: Who Cares?" Journal of Medicine and Philosophy 26 (2001): 527-37;
24. R.D. Truog and W.M. Robinson, "Role of Brain Death and the Dead-Donor Rule in the Ethics of Organ Transplantation," Critical Care Medicine 31 (2003): 2391-96;
25. N. Fost, "Reconsidering the Dead Donor Rule: Is It Important That Organ Donors Be Dead?" Kennedy Institute of Ethics Journal 14 (2004): 249-60;
26. F.G. Miller and R.D. Truog, "Rethinking the Ethics of Vital Organ Donations," Hastings Center Report 38, no.6 (2008): 38-46.
27. E.F.M. Wijdicks, "Brain Death Worldwide: Accepted Fact but No Global Consensus in Diagnostic Criteria," Neurology 58 (2002): 20-25. (Pubitemid 34041932)
28. All parenthetical references are to the white paper; President's Council on Bioethics, "Controversies in the Determination of Death: A White Paper by the President's Council on Bioethics" (Washington, D.C.: President's Council on Bioethics, 2009); http://www.bioethics. gov/reports/death/index.html.
29. The council acknowledges this reasoning when it explains that breathing is not a necessary sign of life: "Even if the animal has lost that capacity, other vital capacities might still be present" (p. 64). But it fails to use the same logic as applied jointly to breathing and consciousness.
30. Emphasis added. Curiously, this statement is contradicted later in the white paper by another claim: "This drive [to breathe] is the organism's own impulse, exercised on its own behalf, and indispensable to its continued existence" (p. 62). The claim that the drive to breathe is indispensable is patently false.
31. The footnote states: "Shewmon fails to convey the essential character of breathing. . . . [He] misses the critical element: the drive exhibited by the whole organism to bring in air, a drive that is fundamental to the constant, vital working of the whole organism" (p. 63, emphasis in original).