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LETTERS: Joan McClusky Tell public about brain death BMJ 2007; 334: 1179-b [Full text]

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Death still misunderstood

Andrew N Bamji   (11 June 2007)

Death by deception

Dr David J Hill   (14 June 2007)

Death still misunderstood 11 June 2007
Andrew N Bamji, Consultant Rheumatologist Queen Mary's Hospital, Sidcup, Kent DA14 6LT Send response to journal: Re: Death still misunderstood	I am surprised that you published two letters on brain death (Michael Potts & Joan McClusky) when both reiterate the misconceptions surrounding death that were so elegantly laid to rest by the late Chris Pallis - not least as his book was published by the BMJ (1). The book makes two points inter alia; first, it emphasises the difference between brain death and brain stem death (the latter resulting in an irrecoverable loss of the capacity to breathe); second, it firmly rebuts the suggestion repeated by McCluskey that a cardiopulmonary definition of death has primacy, pointing out that until the circulation was understood in the 17th century it was the cessation of respiration that was accepted as the point of death. "Brain dead" is a meaningless and useless term which, quite clearly, still serves to confuse - even though the arguments and explanations of what brain stem death is have been done to death (sic) for decades. There are no criteria of brain death that are used for deciding on death, so it's pointless to discuss them. (1) Pallis C, Harley DH. ABC of Brain Stem Death. BMJ Books, 1989 Competing interests: Contributor of material to the ABC of Brain Stem Death and regular writer on the subject
Death by deception 14 June 2007
Dr David J Hill, Emeritus Consultatnt Anaesthetist Addenbrooke's Hospital CB2 2QQ Send response to journal: Re: Death by deception	The ABC of Brain Stem Death(1) quoted by Andrew Bamji has been extensively criticised since its publication 18 years ago and the ex cathedra statements by Pallis et al. challenged on scientific, philosophical and ethical grounds(2). If a potential or actual donor does not know that organs will be removed "after my death" whilst he/she is still respiring with spontaneous heartbeat and circulation, with functioning vital organs (or they would not be of no use for transplantation), and with residual brain and central nervous system activity such that some form of anaesthesia is required to control responses to the surgery, then consent is by no means fully informed. Pallis's idiosyncratic concept of death may not be that of the donor. Presumed consent would, of course, by-pass these serious difficulties but risk further undermining public confidence in our profession. (1)Pallis C, Harley DH. The ABC of Brain Stem Death. BMJ Books 1989. (2) Finis Vitae - Is Brain Death Still Life?. Roberto de Mattei Ed. Rubbettino 2006. Competing interests: Author of papers critical of brain death