Tag: determination of death

Bioethics Blogs

“Organ Sustaining Treatment” – Better Language for Medicine after Death

Nevada is close to being the first U.S. state to amend the Uniform Determination of Death Act to more clearly specify the medical standards by which cessation of brain function must be measured.

The bill already passed the Assembly and is scheduled fo…

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

“Organ Sustaining Treatment” – Better Language for Medicine after Death

Nevada is close to being the first U.S. state to amend the Uniform Determination of Death Act to more clearly specify the medical standards by which cessation of brain function must be measured.


The bill already passed the Assembly and is scheduled for a second Senate Health Committee hearing today, May 15.


One notable part of A.B. 424 is unique use of the term “organ-sustaining treatment.”  “Organ-sustaining treatment means a medical procedure or intervention that, after a person has been determined to be dead serves only to prolong the patient for survivability of a fetus or an anatomical gift.


While a patient might remain on mechanical ventilation after declaration of death, it would be wrong to describe that as “life-sustaining treatment,” since there is no “life.” In short, the same ICU medical intervention is best described as “LST” for a PVS patient but as “OST” after death.  

Nevada is close to being the first U.S. state to amend the Uniform Determination of Death Act to more clearly specify the medical standards by which cessation of brain function must be measured.


The bill already passed the Assembly and is scheduled for a second Senate Health Committee hearing today, May 15.


One notable part of A.B. 424 is unique use of the term “organ-sustaining treatment.”  “Organ-sustaining treatment means a medical procedure or intervention that, after a person has been determined to be dead serves only to prolong the patient for survivability of a fetus or an anatomical gift.


While a patient might remain on mechanical ventilation after declaration of death, it would be wrong to describe that as “life-sustaining treatment,” since there is no “life.”

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

Shouldn’t Dead Be Dead?: The Search for a Uniform Definition of Death

Check out “Shouldn’t Dead Be Dead?: The Search for a Uniform Definition of Death” in the latest Journal of Law Medicine & Ethics 45(1). 


NYU authors Ariane Lewis, Katherine Cahn-Fuller, and Arthur Caplan conclude:


“It is clear that variation in the definitions of death throughout the United States persists. The Hailu case introduced a medical, ethical, and legal quandary by questioning the medical determination of death and setting a legal precedent that the Harvard criteria for brain death should be treated as the only accepted medical standard for brain death determination, despite the fact that these criteria have been replaced by the AAN guidelines.  Variations in the definition of death yields uncertainty and confusion and can undermine public trust in both medicine and the law.”


“The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research recognized that it was imperative that the definition of death be identical throughout the United States. While they felt that individual states should have laws about the definition of death, they noted the role of the federal government in defining death was to ‘usefully bring together experts and representatives of different streams of thought on the matter [to] clarify support,’ such as was the case in both the Hailu and McMath cases, so that practices in such situations are uniform and thus understood by families, the media and the public.”


“The Commission hoped that the UDDA would prompt homogeneous medical and legal  management of all decedents, but it is clear that this goal has not been achieved.”

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 Is Changing Law on Determination of Death

In November 2015, the Nevada Supreme Court decision in Aden Hailu cast serious doubt on the legitimacy of prevailing measures for determining and declaring death on the basis of neurological criteria.

To eliminate this uncertainty, a new bill (A.B. 424) seeks to clarify:

1.  Consent is not required to administer tests to determine brain death.

2.  After brain death is determined, treatment must be withdrawn within 24 hours.  

3.  Brain death must be assessed in accord with the 2010 American Academy of Neurology  guidelines.

Clarifying that consent is not required is a good idea.  While many clinicians already proceed as if that were true, some do not.  Moreover, families have sought and obtained injunctions (temporary and sometimes permanent) in Virginia, Montana, California, and Kansas preventing administration of the apnea test without surrogate consent.

Requiring that treatment be withdrawn within 24 hours eliminates the possibility of a longer period of accommodation.  While accommodation is legally required in only IL, CA, NJ, and NY, facilities elsewhere often provide that.  That accommodation sometimes exceeds 24 hours.

It is important to be precise in identifying the clinical standards by which brain death must be measured.  A reference to “generally accepted standards” is not sufficient in light of significant variability.  On the other hand, the bill seems to require use of the AAN standards for determining brain death “in adults” even when the patient is a child.  

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

Federal Court Dismisses Constitutional Attack on Uniform Determination of Death Act

The U.S. District Court for the Eastern District of California has dismissed the second amended complaint by the family of Israel Stinson against the California Department of Public Health.

The path that Israel took — through five hospitals in two co…

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 end is not what it seems – feasibility of conducting prospective research in critically ill, dying patients.

Guest Post: Amanda Van Beinum

Paper: Feasibility of conducting prospective observational research on critically ill, dying patients in the intensive care unit

Collecting information about how people die in the intensive care unit is important. Observations about what happens during the processes of withdrawal of life sustaining therapies (removal of breathing machines and drugs used to maintain blood pressure) can be used to improve the care of dying patients. This information can also be used to improve processes of organ donation. But when the Determination of Death Practices in Intensive Care Units (DDePICT) research group first proposed to start collecting prospective data on dying and recently dead patients, a common response from other clinical researchers was, “You’re going to do what?” The research community did not believe that prospective research using an informed consent model would be possible in patients dying after withdrawal of life sustaining therapies in the intensive care unit.

While the clinical research community supported the “big picture” idea behind conducting this research, they were skeptical about our prospective research design and our intent to obtain full informed consent from all families prior to the patient’s death. Some also felt that we would have a hard time obtaining institutional ethics board approval or would encounter barriers from research coordinators uncomfortable with approaching families for consent at a difficult and emotional time in the patient’s care. However, the DDePICt group was persistent, and succeeded in their efforts to design the first prospective, observational pilot study in Canada of patients dying in the intensive care unit after withdrawal of life sustaining therapies.

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

A eulogy for the UK Donation Ethics Committee

Guest Post: David Shaw

Paper: The Untimely Death of the UK Donation Ethics Committee

Most people I know want to donate their organs after they die. Why wouldn’t they? If you have to die, you might as well do your best to save several other lives once you’re gone. But organ donation is a more ethically complex topic than many people realise. From Spring 2014 until April this year I was a member of the UK Donation Ethics Committee (UKDEC), which advised NHS Blood and Transplant and the various UK health departments on the ethics of organ donation and transplantation. The committee included doctors, lawyers, nurses, ethicists like me, and ‘lay’ members – ordinary members of the public. In my JME article, I discuss the committee’s work and why it came to an end.

UKDEC dealt with a wide variety of topics. We advised the Welsh Government on the ethical implications of a switch to ‘deemed consent’ to organ donation in Wales, undertook an analysis of the role of the family in donation, and engaged with ethnic minorities and religious groups to facilitate discourse about donation. Most of all, our work was important because we provided practical ethical guidance to healthcare professionals who were often unsure about the ethics and sometimes the legality of new developments in organ donation. Every year new technologies emerge that can enable donation where it was previously impossible, or which can improve the viability of donated organs. Sometimes doctors would approach UKDEC for our advice on their protocols that wished to make use of these new innovations.

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

Rethinking Irreversibility and Its Implications on Determining Death

By Alex Lin
Alex Lin is an undergraduate student at Rutgers University pursuing a dual degree in Biological Sciences and Philosophy. As an aspiring physician, he is interested in medical ethics and runs the Rutgers Bioethics Society alongside a diverse team of student thinkers. Alex is from Paramus, New Jersey, and volunteers as an emergency medical technician for his community.
Death, by definition, is irreversible. The notion of irreversibility is a central component of the current standards of death, cardiopulmonary and neurological alike. Given that the neurological criteria−the irreversible cessation of whole brain function−is the legally recognized criterion of death in many countries, including the United States [1], forthcoming advancements in neurotechnology under the BRAIN Initiative will be crucial to the accurate determination of death. With the development of technologies that allow scientists to study how individual neurons interact in significantly greater detail, questions emerge concerning the particular moment of truly irreversible total brain failure.
Consider the relatively new discovery of human adult neurogenesis. The established view was that the nervous system is fixed and neurons are unable to regenerate. However, this old dogma has been confounded by recent research in neuroscience. Studies have revealed that new neurons are continuously generated in the hippocampus and olfactory bulb, and adult hippocampal neurogenesis may even contribute to human brain function [2]. Modern technologies and research techniques enable scientists to study neurogenesis, which demonstrates the role that new scientific discoveries have in debunking long-standing views of neuroanatomy.
Image courtesy of WikiCommons.

Also, recent advancements in neuroimaging have enabled physicians to detect signs of awareness in patients diagnosed as being in a vegetative state, whereas traditional clinical assessments that attempt to elicit predictable behavioral responses fail to do so.

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.