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Comment & Response
February 2, 2021

Determination of Brain Death

Author Affiliations
  • 1Neurocritical Care, University of Chicago Medical Center, Chicago, Illinois
  • 2Center for Bioethics and Humanities, Upstate Medical University, Syracuse, New York
JAMA. 2021;325(5):492. doi:10.1001/jama.2020.23228

To the Editor In their article “Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project,” Dr Greer and colleagues1 addressed the minimum standards for brain death/death by neurologic criteria (BD/DNC) with the intention of alleviating inconsistencies in clinical practice. The authors followed the 1981 US President’s Commission in determining that death must be defined by and carry the force of law, both to ensure public acceptance and to protect practitioners.2 Indeed, the expert consensus recommended that all countries recognize BD/DNC as legal death. Greer and colleagues further suggested that consent is not needed for the clinical evaluation, apnea testing, or ancillary testing, nor, when criteria are met, for discontinuation of somatic support. These recommendations were made without inclusion of patient or family advocates and without direct input from diverse social, cultural, and religious groups who may disagree. A law defining death is different from a scientific fact or a medical diagnosis. Alexander Capron, the executive director of the 1981 US President’s Commission, cautioned that defining human death as a medical matter misapprehends the undertaking: At issue is not a biological understanding of cells and organ systems, but rather a social formulation of humanhood. Through a formal declaration of the points at which life begins and ends society determines who is a full human being with rights and responsibilities.3 This is an issue about which people may disagree.

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