Tag: determination of death

Bioethics Blogs

Premortem Cryopreservation Does Not Cause Death

In 1990, Thomas K. Donaldson sued the California Attorney General for the right to an elective premortem cryopreservation. Most cryopreservation is postmorterm. But Donaldson wanted to act before a malignant tumor destroyed his brain.

Unfortunately for Donaldson, the Santa Barbara trial court and an appellate court rejected Donaldson’s claims. The courts construed his request as one for assisted suicide. That was a crime in California and the courts found (like state appellate courts everywhere in the USA) that there was no constitutional violation in applying that law to Donaldson’s situation.


But why was the case framed as a right to assisted suicide?  The whole point of cryogenic preservation is that sometime in the future, when a cure for Donaldson’s disease is found, then his body may be “reanimated.” If true, then he would not be brought back from the dead.  Legally, he would have never been dead.  


Since the Uniform Determination of Death Act requires irreversibility, it seems that premortem  cryopreservation does not cause death. Yes. Donaldson’s cardiopulmonary functions and brain functions may cease. But that cessation would not be irreversible. Of course, cryopreservation may not work. But it seems that factual predicate was not carefully examined.  


The case was dramatized in a 1990 episode of LA LAW.


[embedded content]

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

New Legal Guidelines for Determination of Brain Death

My analysis of Nevada’s recent amendment to the Uniform Determination of Death Act (UDDA) is now Online First at the  Journal of Bioethical Inquiry: “New Legal Guidelines for Determination of Brain Death.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Brain Death: Legal Fiction Used to Justify Ending Lives Prematurely – Another California Lawsuit

Brain death is a legal fiction used to justify ending lives prematurely. That is how the family of Israel Stinson frames its argument in a new brief filed in a California federal court, last week.


Israel Stinson’s family is challenging the constitutionality of the California Uniform Determination of Death Act (CUDDA). Contrast the claims made by the family of Jahi McMath. They contend only that Jahi does not (as a matter of fact) satisfy the CUDDA standards. They do not attack the (legal) validity of the standards themselves.


The Stinson family argues that “the biological basis for brain death is hotly disputed and central to this case.”  They allege that Israel remained alive AFTER an official death certificate was issued. They describe brain death as a “haphazard, uneven, and utilitarian-driven rush to declare patients dead, ignoring that possibility they might be alive.”


The State of California filed a motion to dismiss the family’s Third Amended Complaint on jurisdictional grounds. The hearing is scheduled for August 11.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

California Uniform Determination of Death Act – Constitutional Challenge

The family of Israel Stinson continues its lawsuit asking a federal court to declare that the California Uniform Determination of Death Act is unconstitutional.

In late May, the State of California filed a motion to dismiss the family’s third ame…

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Brain death: experts divided on how death is defined

Pdf logoSome authors, as Bernat reports in his article, have come to classify brain death unscientifically, illogically, even treating it as a legal fiction

In the November 2014 issue of the American Journal of Bioethics, see HERE (1), Professor James L. Bernat reflects on where the concept of brain death is headed. The reason for this is the fact that there is still reticence as regards this concept in the public and academic spheres. Professor Bernat refers to two recent cases in which the diagnosis of brain death led to clinical-ethical-care problems that emerged in the media and public opinion.   One of these is the case of Jahi McMath, a child who suffered severe anoxic encephalopathy, as a result of which she developed symptoms consistent with a diagnosis of brain death. Jahi’s parents refused to accept the diagnosis of death and requested that the patient’s treatment is maintained, as they did not consider her dead. The second case is that of Marlise Muñoz, a pregnant patient, also declared brain dead and whose physicians decided to maintain life support measures (connection to a respirator, and maintenance of other treatments), based on the fact that the survival of the foetus was at stake. Marlise’s family asked that these support measures be withdrawn since Marlise was considered clinically and legally dead.

Persistence of controversy in brain death criterion

The persistence of controversies in relation to the concept of brain death is striking, although it is over 40 years since the birth of this concept of death of the person, published in the Journal of the American Medical Association (JAMA) in 1968 (2).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Nevada Amends Uniform Determination of Death Act

In a sign of things to come, Nevada has

Justice Pickering

amended the Uniform Determination of Death Act (UDDA).  Expect other states to make similar amendments soon.  On Friday, June 2, Governor Sandoval signed A.B. 424.  

The bill was a direct response to the problems identified by the Nevada Supreme Court in the Aden Hailu case.  I discussed that case here and posted case materials here.

The UDDA requires that clinicians determine brain death in accordance with guidelines set forth by either the American Academy of Neurology or the Pediatric Section of the Society of Critical Care Medicine. The statute identifies the guidelines by name: “Evidence-based Guideline Update: Determining Brain Death in Adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology” and “Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations.” 

Furthermore, recognizing that the guidelines might be updated, the statute preserves flexibility. It requires that clinicians determine brain death in accordance with the “subsequent revisions approved” by the guidelines authors.

Explicitly referencing specific guidelines eliminates the need to determine whether these guidelines qualify as “accepted medical standards.” This has been a significant problem. Since adoption of the UDDA in the early 1980s, there has been significant variability in the brain death determination guidelines followed by hospitals across the United States.

At least in Nevada, that variability should be eliminated by the new statute. By unambiguously identifying which guidelines are authoritative, the statute eliminates uncertainty over which medical standards are “accepted.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

International Conference to Better Define Brain Death

Today is the start of Euroanaesthesia 2017: The European Aneasthesiology Conference.


One notable talk by Giuseppe Citerio is “Brain death definition: is brain dead…dead enough?” Outside this one talk. the INDEPENDENT reports that “the concept of ‘brain death’ or death by neurological criteria, known as DNC, was introduced 40 years ago, but doctors have different ideas of what this means. Now they are gathering for the Euroanaesthesia congress in Geneva in the hope of coming up with a once-and-for-all answer.”


Professor Citerio said: “Many of the controversies that surround the determination of death by DNC have not been settled and this [meeting] presents an opportunity for future research and education to clarify outstanding issues in order to reduce professional and public disquiet.”


At the Geneva meeting on 3 to 5 June, Professor Citerio will call for the international community to establish a universal definition of DNC and a universal way to diagnose it.
issues.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Nevada Senate Passes Bill to Amend Uniform Determination of Death Act

On May 23, 2017, the Nevada Senate passed A.B. 424 which amends the Uniform Determination of Death Act (UDDA) in response to the Aden Hailu case and other recent challenges to brain death. The bill already passed the Assembly last month.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Nevada Senate Passes Bill to Amend Uniform Determination of Death Act

On May 23, 2017, the Nevada Senate passed A.B. 424 which amends the Uniform Determination of Death Act (UDDA) in response to the Aden Hailu case and other recent challenges to brain death. The bill already passed the Assembly last month.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Very Early Embryo & Its Moral Signifiance

by Andrew J. Prunty

As technology and biological research continue to develop in the twenty-first century, it is necessary to address and further define the ethical considerations of embryonic research and the appropriate rights that may limit the extent of human research on zygotes, blastocysts, and fetal scientific advancement. Because the area of harvesting embryonic stem cells remains significantly undefined, both legally and morally, there are vastly different opinions between researchers and bioethicists, mainly because of ethical limitations, on the rights that should be granted to cells with the potential to develop into human beings and the consequences of neglecting significant scientific research or advancement.

Current laws in the United States differ at the federal and state level, but there is no consistency in recognizing human embryos as humans, or affording them the same legal rights granted to a child; in fact, legal precedent actually detracts certain rights from developing embryos, favoring a human’s ability to destroy a potential human being (i.e. Roe v. Wade[i]) or the categorization of embryos as property (i.e. Davis v. Davis[ii], A.Z. v. B.Z.[iii], Marriage of Dahl[iv], or Reber v. Reiss[v]). These case law samples suggest the courts’ inability to reach a conclusion as to what is the status of an embryo.

The debate is not only circumscribed to matters of research, but to fundamental controversial and intertwined issues of bioethics such as: when life begins, embryonic stem cells, fetal rights, abortion, et cetera. All these topics are contentious and when one topic arises, they begin to comingle.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.