Controversies In The Determination Of Death

The question of how, by what standard, an individual should be declared dead is once more a matter of controversy. With this report, the President's Council on Bioethics takes up this controversy and seeks to illuminate the issues at the center of the renewed debate about the inherently perplexing problems of determining human death in an age of life-sustaining technologies. The President's Council examines the main lines of criticism and defense of the neurological standard, and also explores the ethical concerns engendered by the use of the traditional cardiopulmonary standard in the organ procurement practice known as "controlled donation after cardiac death." In so doing, the President's Council on Bioethics aims to apprise the American public of the contemporary state of the debate and to guide the public's reflections on matters that touch on some of society's deepest human questions.

In the 1980s, following the recommendation of a presidential commission, all fifty states replaced previous cardiopulmonary definitions of death with one that also included total and irreversible cessation of brain function. The Definition of Death: Contemporary Controversies is the first comprehensive review of the clinical, philosophical, and public policy implications of our effort to redefine the change in status from living person to corpse. Edited by Stuart J. Youngner, Robert M. Arnold, and Renie Schapiro, the book is the result of a collaboration among internationally recognized scholars from the fields of medicine, philosophy, social science, law, and religious studies. Throughout, the contributors struggle to reconcile inconsistencies and gaps in our traditional understanding of death and to respond to the public's concern that, in the determination of death under current policies, patients' interests may be compromised by the demand for organ retrieval. Their questions about the philosophical and scientific bases for determining death lead, inevitably, to more profound questions of social policy. Acknowledging that the definition of death is as much a social construct as a scientific one, the authors, in their analysis of these issues, provide a comprehensive and provocative source of information for students and scholars alike.

The question of how—by what standard—an individual should be declared dead is once more a matter of controversy. With this report, the President's Council on Bioethics takes up this controversy and seeks to illuminate the issues at the center of the renewed debate about the inherently perplexing problems of determining human death in an age of life-sustaining technologies. In the following pages, the President's Council examines the main lines of criticism and defense of the neurological standard, and also explores the ethical concerns engendered by the use of the traditional cardiopulmonary standard in the organ procurement practice known as “controlled donation after cardiac death.” In so doing, the President's Council on Bioethics aims to apprise the American public of the contemporary state of the debate and to guide the public's reflections on matters that touch on some of society's deepest human questions.

Report by the Pres. Council on Bioethics of an inquiry that was occasioned by another forthcoming Council report on ethical questions in organ transplantation. The two reports are linked ethically: most of the organs procured for transplantation in this country come from deceased donors who have been declared dead in accord with the neurological standard (NS). This report is primarily concerned with a careful analysis of the ethical questions raised by the NS, i.e., the clinical determination of ¿whole brain death.¿ Since then, the NS has been accepted as one of two valid standards for determining death and has been adopted in many countries throughout the world. The Council has concluded that the NS remains valid.

This book presents principal controversies over the determination of death by neurologic criteria (“brain death”). The editors and authors are exceedingly well-versed in this subject and are on the forefront of the current debates. The content is divided in the following disciplinary: philosophical (conceptual), medical, scientific, legal, religious, and ethical/social. Many of the topics feature pro-con debates, allowing readers to consider the merits of the arguments and decide their own position. The work is targeted to clinicians and nurses who treat critically ill and dying patients, organ donation personnel, ethicists and philosophers who write on end-of-life issues, and lawyers and legislative/public policy professionals who draft laws on death determination. It identifies and debates the essential controversies currently raging in academic and public policy circles over the medical adequacy, scientific validity, and conceptual coherence of death determination by neurologic criteria. Whether a professional or a student, the reader will be given a comprehensive course in the most pressing controversies and areas of consensus in the determination of death by neurologic criteria.

This book discusses the common principles of morality and ethics derived from divinely endowed intuitive reason through the creation of al-fitr' a (nature) and human intellect (al-‘aql). Biomedical topics are presented and ethical issues related to topics such as genetic testing, assisted reproduction and organ transplantation are discussed. Whereas these natural sources are God’s special gifts to human beings, God’s revelation as given to the prophets is the supernatural source of divine guidance through which human communities have been guided at all times through history. The second part of the book concentrates on the objectives of Islamic religious practice – the maqa' sid – which include: Preservation of Faith, Preservation of Life, Preservation of Mind (intellect and reason), Preservation of Progeny (al-nasl) and Preservation of Property. Lastly, the third part of the book discusses selected topical issues, including abortion, assisted reproduction devices, genetics, organ transplantation, brain death and end-of-life aspects. For each topic, the current medical evidence is followed by a detailed discussion of the ethical issues involved.

This Element considers current legal, ethical, metaphysical, and medical controversies concerning brain death. It examines the implicit metaphysical and moral commitments and dualism implied by neurological criteria for death. When these commitments and worldview are not shared by patients and surrogates, they give rise to distrust in healthcare providers and systems, and to injustice, particularly when medicolegal definitions of death are coercively imposed on those who reject them. Ethical obligations to respect persons and patient autonomy, promote patient-centered care, foster and maintain trust, and respond to the demands of justice provide compelling ethical reasons for recognizing reasonable objections. Each section illustrates how seemingly academic debates about brain death have real, on-the-ground implications for patients and their families.