The serious scientific and moral issues with the concept of brain death are coming to the fore with proposals to revise the Uniform Determination of Death Act (UDDA), writes Doyen Nguyen, M.D.,S.T.D., in the fall issue of the Journal of American Physicians and Surgeons.
The UDDA, established in 1981, defines brain death as “the irreversible cessation of all functions of the entire brain, including the brain stem.” Since late 2019, pro-brain death scholars have been insistently advocating for a radical revision of the UDDA standard that would agree with the diagnostic guidelines promoted by the American Academy of Neurology (AAN), Dr. Nguyen explains.
AAN guidelines permit the diagnosis of brain death to be established by bedside examination alone, without requiring an electroencephalogram (EEG) or cerebral blood flow studies. Physiological functions incompatible with death of the whole brain may persist, including regulation of blood pressure and secretion of anti-diuretic hormone (ADH).
These inconsistencies result in increasing public distrust of the determination of brain death, which permits the harvesting of vital organs.
Dr. Nguyen points out that biological death in humans, like the death of any other warm-blooded mammal, is not the same as irreversible coma. “One cannot say with semantic correctness that a cadaver or corpse is comatose.”
Modifying the definition of brain death to mean brain-stem death rather than whole brain death makes it a variation of the personhood-based or consciousness-based concept of death, she states. It has never been claimed to be biological death.
Physicians and the public need to be aware of these issues, Dr. Nguyen writes. She proposes that any amendments to the UDDA include the requirement of informed consent prior to brain death determination and an exemption from the diagnosis of brain death on the basis of personal convictions, not limited to religious beliefs or moral convictions, since there are people who reject brain death on scientific grounds.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.