Revising Brain Death: Cultural Imperialism?

Veatch Robert M. , “The Impending Collapse of the Whole Brain Death Definition of Death”, Hastings Centre Report, July-August 1993, pp. 18–24.

JAMA, Aug. 5, Vol. 205, No. 6, pp. 337–340.

JAMA, Aug. 5, Vol. 205, No. 6, pp. 337–340.

Journal of the Canadian Medical Association, Dec. 28, 1968, vol, pp. 1266–7.

British Medical Journal, 13 November 1976, 2, pp. 1187–1188.

British Medical Journal, 13 November 1976, 2, pp. 1187–1188.

British Medical Journal, 3 February 1979, 1, p. 332.

See the appended list of publications.

Hermeren-G “The New Debate on Brain Death is a Storm in a Cup of Water”, Lakartidningen, 1993 May 26; 90(21): 2067–8.

Veatch, Op Cit.

Veatch is mistaken in this. There has been no change to the law. It still refers to the cessation of all function of the brain. What has happened is a de facto departure from the legal definition by those in the medical profession who still depend on the Harvard or Royal Colleges criteria alone.

President's Commission for the Study of Ethical Problems in Medicine, Defining Death: A Report on the Medical, Legal and Ethical Issues in the Determination of Death, US Government Printing Office, Washington, DC, 1981.

Singer Peter , “How Death Was Re-defined”, Rethinking Life and Death, (The Text Publishing Company, 1994) Chapter 2, pp. 20–35.

The view that functions of the various organs in a comatose patient are morally significant only if they are coordinated and thus functionally related to one another as functioning parts of a living whole. The integration of the body parts into one functioning, living body is thought to depend on the integrating functions of the brain.

Wilder Daniel , “Brain Death: A Durable Consensus?”, Journal of Bioethics, Vol. 7, number 2/3, 1993, p. 239–246.

Catherwood John F. , “Rosencrantz and Guilderstern are ‘Dead’ “, Journal of Medical Ethics, 1992 18, 34–39.

Veatch, Op Cit.

The legal status quo, as distinct from the clinical status quo, is that death is defined as having occurred when there is irreversible cessation of a function of the brain.

Discussion of the various ancillary tests now available is the subject of the references collected in the Appendix.

“Universal Declaration of Human Rights” (1948) Article 3, in United Nations, A Compilation of International Instruments, Vol. 1 (Part 1) Universal Instruments, United Nations, New York and Geneva, 1994, p. 1, and the “International Covenant on Civil and Political Rights” (1966) Article 6, Ibid. p. 22.

A utilitarian might have no moral difficulty with this in principle but, even for a utilitarian, to accept the practice as a rule would raise serious social doubts about the security of one's own person once admitted to hospital in a brain damaged state.

Veatch, Op. Cit.

Younger SJ ; Arnold RM , “Ethical, Psychosocial, and Public Policy Implications of Procuring Organs from Non-Heart-Beating Cadaver Donors”, JAMA, 1993 Jun 2; 269(21): 2769–74; JC Fackler; RD Truog, “Life, Death, and Solid Organ Transplantation Without Brain Death”, Crt-Care-Med, 1993 Sep 21 (9 Suppl): S356–7.

Advice given to me in a personal communication by a senior neurologist, Byrne E. Dr. , St. Vincent's Hospital, Melbourne, and published in Nicholas Tonti-Filippini, “Determining When Death Has Occurred”, Linacre Quarterly, 58 February 1991, pp. 25–49.

Rix B.A. , “Danish Ethics Council Rejects Brain Death as the Criterion of Death”, Journal of Medical Ethics, 1990, 16, 5–7.

Cerney , “Solving the Donor Shortage by Meeting the Bereaved Family's Needs”, Crit-Care-Nurse, 1993 Feb; 13(1): 32–6; T. Pottecher; F. Jacob; L. Pain; S. Simon; M.L. Pivirotto, “Information to Relatives of Organ Donors, Factors of Consent or Refusal, Results of a Multi-Center Study” Ann-Fr-Anesth-Reanim. 1993; 12(5): 478–82. Recently there have been reports of a change of approach in Spain in which patients, whose conditions are likely to proceed to brain death, and their relatives, are approached well before death, and consent to donation in the event brain death is obtained. In Australia and Britain and the United States I suspect such patients are seldom ever ventilated and so they do not survive in a brain dead state required for most organ procurement. Reportedly, the Spanish approach would seem to have a high rate of acceptance in the regions where it has been tried. (The experiment is limited to those areas which have a relatively high compliance rate with organ donation. Anecdotally, the wealthier, more educated communities in Spain have a relatively low compliance rate with organ donation.) The problem with implementing the new approach in most other Western countries would be the economics of ventilating a category of patients who would not ordinarily be ventilated. That raises resource allocation questions.

Travelling, I have been a patient of fourteen different hemodialysis units

Renee C. Fox , & Swazey Judith P. , Spare Parts: Organ Replacement in American Society, (New York: Oxford University Press, 1992), pp. 34–38.

Gillon Raanon , “Editorial: Death”, Journal of Medical Ethics, 1990, 16, pp. 3–4.

Veatch , Op Cit.

A similar concern has been expressed in a thorough treatment of the medical issues by Peter McCullagh, Brain Dead, Brain Absent, and Brain Donors: Human Subjects or Human Objects?, (John Wiley and Sons Ltd., Chichester, 1993), pp. 7–56.

The Concise Oxford Dictionary (Ninth Edition) (Oxford: Clarendon Press, 1995).

Singer Peter , Op Cit, p. 22.

Singer , Op Cit.

Thomson Judith Jarvis , “A Defense of Abortion”, Philosophy and Public Affairs, No. 1, Winter 1975, pp. 47–66.

Veatch , Op Cit.

Council of Vienne (1312) cf. Catechism of the Catholic Church (Vatican City: Libreria Editrice Vaticana, 1994) n. 365.

Gillon , Op Cit.

Catechism of the Catholic Church, (Vatican City: Libreria Editrice Vaticana, 1994) n. 364.

Second Vatican Council, Gaudium et Spes (Pastoral Constitution of the Church in the Modern World) 1965, n 14, cf. Catechism of the Catholic Church (Vatican City: Libreria Editrice Vaticana, 1994), n.36.

Singer , Op Cit, pp. 28–9.

Grisez Germain , and Boyle Joseph , Life and Death with Liberty and Justice (University of Notre Dame Press, 1979) pp. 59–85.

Singer , Op Cit p 29.

Pope Pius X.I.I. , “The Prolongation of Life”, The Pope Speaks, Vol. 4, 1957, pp. 395–398.

Pope Pius X.I.I. , “The Prolongation of Life”, The Pope Speaks, Vol. 4, 1957 p. 396–7.

Pope John Paul I.I. , Encyclical Letter: Evangelium Vitae (Libreria Editrice Vaticana, 1995) n. 15.