To the Editor: The 1968 JAMA article1 presenting criteria for brain death justly deserves to be considered a classic. However, while the article provided criteria for the diagnosis of irreversible coma, it did not offer a rationale for why these criteria should be diagnostic of the death of a human being.
The commentary by Dr Rosenberg2 did not mention the controversy over the status of patients diagnosed as brain dead, which has intensified over the last 20 years. Reflecting this controversy, the President's Council on Bioethics recently issued a white paper, “Controversies in the Determination of Death.”3 Patients with brain death maintained on mechanical ventilation retain an array of vital functioning that makes it very difficult to give a coherent account of why they are dead.4
Miller FG, Truog RD. Controversies About Brain Death. JAMA. 2009;302(4):380-382. doi:10.1001/jama.2009.1037