Health Administration/Organization; Death and Dying
For ten days after Motl Brody had been declared dead by physicians, the 12-year-old boy lay in an intensive-care unit of Children's National Medical Center, sustained by drugs and a ventilator. His Orthodox Jewish parents insisted that, according to religious law, Motl remained alive because his heart continued to beat. District of Columbia law said he did not.
Although statutes on the books of every U.S. state allow a determination of death when all functions of the brain, including the brain stem, have irreversibly ceased, there is continued debate, especially in religious, philosophical, and bioethics contexts, about how, or even if, brain death should be defined.
A new report by The George Washington University School of Public Health and Health Services (GW/SPHHS) offers an opportunity for health care providers, legislators and the general public to discuss the complexities of determining when death occurs. The report:
- Reviews the current legal definition(s) of death, based on either neurological or cardiovascular criteria, and how they evolved.
- Describes the distinction between a persistent vegetative state and brain death, explaining why a person whose body retains warmth, color, and some level of clinical functioning can nonetheless be considered dead.
- Considers arguments for a return to the exclusive use of a cardiovascular standard or a "higher-brain" standard built around the capacity for consciousness.
- Describes the debate over a statutory "conscience clause," which allows personal choice regarding the determination of one's death.
- Considers the uneasy relationship between the definition of death and the goal of increasing availability of organs for transplantation.
The lack of consensus on an ontological question as profound as when death occurs is no surprise. Nonetheless, broader discussions may be appropriate to deepen public understanding and to create mechanisms to resolve the conflicts that will inevitably continue to arise.
Goldstein, M. (2008). Diagnosing death: Why does it remain "well settled and persistently unresolved"? Washington, DC: George Washington University, School of Public Health and Health Services, Rapid Public Health Policy Response Project.