The classification of preserved hypothalamic activity in brain death and brainstem death as functional or non-functional has become a subject of debate. While proponents of the neurological criterion claim that these activities lack functional significance (Shemie et al. 2014), Nair-Collins and Joffe (2023) argue for their functional physiological role. However, the interpretation of the term "function" within the medico-legal framework, where death is characterized by the irreversible cessation of all brain functions, remains unclear. -/- My intention here is not to (...) engage in a debate over the validity of different viewpoints regarding the functional significance of preserved activities in the hypothalamus or the heart. Rather, I aim to highlight the critical importance of exploring and defining the concept of function in medicine, which currently lacks clarity. My point is that, whatever our position in the brain death debate, reaching a consensus on this conceptual matter would minimize misunderstandings and establish a robust foundation for further insightful analysis. (shrink)

Nair-Collins and Joffe (2023) highlight the complexities inherent to the clinical diagnosis of death by neurologic criteria and inconsistencies between legal, scientific, and clinical standards for...

As Nair-Collins and Joffe note, the concern that our tests for brain death do not successfully show that all brain functions have stopped is not new (Nair-Collins and Joffe 2023). As our abilities...

Ariane Lewis reviewed medicolegal challenges to Death by Neurologic Criteria (DNC) in the United Kingdom in order to identify and discuss the ethical issues raised (Lewis 2024). Here I briefly clar...

Nair-Collins and Joffe (2023) rightly call attention to an incompatibility between brain-based criteria for death, as defined by the Uniform Determination of Death Act (UDDA), and what the current...

The definition of death as “irreversible coma” was introduced in 1968 by the Harvard University Medical School. It was developed largely in diagnostic terms as the “irreversible cessation of all functions of the entire brain, including the brainstem.” In its review of brain death in 1981, The President’s Commission for the Study of Ethical Problems in Medicine argued that brain death is consonant with circulatory death because the loss of certain brain functions results in the “loss of integrative unity of (...) the organism,” leading to cardiac arrest. This picture of a unified conception of death was challenged by subsequent clinical evidence suggesting that, with proper treatment, circulatory death is not the inevitable result of brain death. Here, it is argued that, if death, in the morally relevant sense, is defined as irreversible loss of consciousness, a unitary conception of death can be maintained. However, significant theoretical and methodological obstacles remain in diagnosing irreversible loss of consciousness. (shrink)

Efforts to revise the Uniform Determination of Death Act in order to align law with medical practice have failed. Medical practice must now align with the law. People who are not dead under the law that defines death should not be declared dead. There is no compelling reason to continue the practice of declaring legally living persons to be dead.

Ariane Lewis provided an insightful review of several controversial cases of death by neurologic criteria (“brain death”) in the UK, focusing on Archie Battersbee, a boy whose tragic illness provok...

The Case of Archie Battersbee in the United Kingdom (UK) is a tragic one: a 12-year-old otherwise healthy boy who suffered a cardiac arrest at home on April 7, 2022, and was subsequently diagnosed...

Several facts about organ donation and transplantation are not in dispute: (1) there is a shortage of available organs; (2) many potential organ donors die after authorized withdrawal of life-susta...

We thank the authors of commentaries for their thoughtful discussion of our target article. Here we briefly summarize the points made in the target article (Nair-Collins and Joffe 2023). Then we em...

Although medicolegal challenges to the use of neurologic criteria to declare death in the USA have been well-described, the management of court cases in the United Kingdom about objections to the use of neurologic criteria to declare death has not been explored in the bioethics or medical literature. This article (1) reviews conceptual, medical and legal differences between death by neurologic criteria (DNC) in the United Kingdom and the rest of the world to contextualize medicolegal challenges to DNC; (2) summarizes (...) highly publicized legal cases related to DNC in the United Kingdom, including the nuanced 2022 case of Archie Battersbee, who was transiently considered dead by neurologic criteria, but ultimately determined to be in a vegetative state/unresponsive-wakeful state; and (3) provides an overview of ethical issues raised by medicolegal challenges to DNC in the United Kingdom and a comparison to the management of these challenges in the USA. (shrink)

Since the introduction of a new criterion for determining death (i.e., the brain death criterion) in 1968, the research community has been embroiled in debates about whether this criterion should b...

We share Nair-Collins and Joffe's (2023) concern with the accuracy of the “whole brain-death” diagnosis, which fails to take into account current understandings of residual brain function (neurohor...

Brain death, or death by neurological criteria (BD/DNC) is the permanent loss of brain function as defined by an unresponsive coma, loss of brainstem reflexes, and the ability to breathe without me...