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May 1992

Defining DeathA Superficial and Fragile Consensus

Author Affiliations

From the Division of General Internal Medicine, Department of Medicine and the Clinical Ethics Program, University Hospitals of Cleveland (Ohio) and the Center for Biomedical Ethics, Case Western Reserve University, School of Medicine, Cleveland.

Arch Neurol. 1992;49(5):570-572. doi:10.1001/archneur.1992.00530290162028

Beauchamp and Childress, in their Principles of Biomedical Ethics, describe how an African tribe, the Nuer, used a conceptual ploy to circumvent a moral prohibition against killing unwanted newborns.1

... the Nuer tribe viewed defective newborns as nonhuman "hippopotamuses" who were mistakenly born to human parents and who would be put in the river, which was viewed as their natural habitat.

Does our own society's rapid and widespread embrace of so-called brain death represent a similar form of conceptual gerrymandering? A review of the social, medical, and public policy developments of the last two decades leaves the answer to this question in doubt.

In 1968, an ad hoc committee at the Harvard Medical School, Boston, Mass, proposed "a new criterion for death": total and irreversible loss of functioning of the whole brain.2 The motivation was clearly stated as follows: (1) to relieve the "burden" imposed by severely brain-damaged patients;

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