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In Reply. —
These somewhat contradictory letters demonstrate the difficulty of achieving clarity in discussing the definition of death. Rabbi Tendler and Dr Rosner misread our editorial as proposing a rejection of whole-brain criteria and a return to the old, heart-lung definition of death, while Dr Oro takes us to task for endorsing a new, "higher brain" definition. In fact, the editorial explicitly endorses current laws based on the irreversible loss of all functions of the entire brain as the best approach for the present. Our aim was to question the too-little examined assumption that the whole-brain definition has a solid conceptual foundation, above and beyond its evident practical utility.The debate over defining death has focused on three rival definitions: the traditional version, based on permanent cessation of heart and lung function; the recently accepted whole-brain revision, involving irreversible cessation of all brain functions; and the so-called higher brain
Wikler D, Weisbard AJ. 'Brain Death'-Reply. JAMA. 1989;262(20):2835. doi:10.1001/jama.1989.03430200078022