To the Editor.
—Both Bernat1 and Youngner2 presented compassionate summaries of our ongoing uneasiness with the concept of whole-brain death. Both point out that lay persons, physicians, and legislators all have problems distinguishing between wholebrain criteria and the popularized idea of "vegetating."3 For example, the North Carolina General Assembly (Bill 821, 1991) uniquely attempts to simplify the management of the persistent vegetative state by adding that such patients "... will succumb to death within a short period of time," without artificial nutrition or hydration. Further, any North Carolina citizen may now authorize, in advance, that artificial nutrition be withheld in the presence of terminal illness, permanent coma, persistent vegetative state or even "severe" dementia. This must be a prime example of conscientious lawmakers—even after intensive medical hearings, blending whole brain and higher brain (dementia) concepts of brain death. Depending on any local definition of artificial nutrition, patients in
Spudis EV. Brain Death. Arch Neurol. 1993;50(2):132. doi:10.1001/archneur.1993.00540020012007
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