Introduction

In decades past, the meaning and signs of death were clearer cut: respiratory failure and cardiac arrest would cause the body to lose its color, become cold and slowly turn into a corpse. However, the advent of mechanical ventilation has allowed intensive care units to keep the hearts and lungs of patients in comatose with severe brain trauma going indefinitely.

In 1968 an Ad Hoc committee formed at Harvard University developed a neurological criteria for death based on the cessation of brain function. This criteria drove significant developments because of the emergence of another technology, organ procuration, which allowed to surgically remove and reuse tissue from one body to another. Concerns arose including whether it was ethical to harvest organs from a comatose patient on mechanical ventilation, and whether the taking one off mechanical ventilation was comparable to stopping life sustaining treatment.

Assigned Readings

Miller, F. G., & Truog, R. D. (2009). The incoherence of determining death by neurological criteria: a commentary on “Controversies in the determination of death”, a White Paper by the President’s Council on Bioethics. Kennedy Institute of Ethics journal, 19(2), 185–193. https://doi.org/10.1353/ken.0.0282

Thesis: Miller and Truog explore the conflict between theory and practice with regards to the accepted standards of neurological death and the practice of vital organ procurement.

Miller, F. G., & Truog, R. D. (2008). Rethinking the ethics of vital organ donations. The Hastings Center report, 38(6), 38–46. https://doi.org/10.1353/hcr.0.0085

Thesis: Miller and Trug explore the inconsistency between current practices of vital organ harvesting, standards of brain death, and the dead donor rule. They argue for a change in norms towards a more coherent ethical approach.

Discussion Questions

  1. In what ways is the traditional criterion for death incoherent?
  2. What ethical elements/concepts must be evaluated to negotiate organ procuration in a comatose patient?

References and Additional Resources

Busl, K. M. (2020). What does the public need to know about brain death? AMA J Ethics. 22(12):E1047-1054. doi: 10.1001/amajethics.2020.1047.

Nair-Collins, M., & Miller, F. G. (2017). Do the ‘brain dead’ merely appear to be alive?. Journal of medical ethics, 43(11), 747–753. https://doi.org/10.1136/medethics-2016-103867

Lazaridis, C., & Blumenthal-Barby, J. S. (2015). Organ Donation Beyond Brain Death: Donors as Ends and Maximal Utility. The American journal of bioethics : AJOB, 15(8), 17–19. https://doi.org/10.1080/15265161.2015.1043407

Miller, F. G. & Truog, R. D. (2014) Bioethics and the Dogma of “Brain Death”. Hastings Center Bioethics Forum. https://www.thehastingscenter.org/bioethics-and-the-dogma-of-brain-death/