Brain stem death: managing care when accepted medical guidelines and religious beliefs are in conflictConsideration and compromise are possibleCommentary: Delay in stopping treatment can become unreasonable and unfair

Opposition to Brain Death Criteria

11 April 2002

Dr. Levyman’s reply (April 7, 2002) to Dr. Coimbra states, referring to brain death criteria in the UK, that "when the clinical criteria are properly applied they are reliable in predicting death in asystole without neurological recovery, even when the patient are [sic] kept on a ventilator." But the prediction of death is not the same thing as death; even if brain death criteria were reliable as a prognosis of death, this does not mean that brain death is the same thing as death.

Opposition to brain death criteria is not the "isolated" position which Dr. Levyman suggests; even if it were, the popularity of a position does not guarantee its truth. The debate over brain death criteria is not settled. An anthology was published in 1999 regarding controversies concerning brain death [1]. An anthology of essays opposing brain death criteria was recently published [2]. A number of articles questioning brain death criteria by Dr. Alan Shewmon, Professor of Pediatric Neurology at the UCLA School of Medicine, have also been published [3, 4, 5]. An article in the prestigious bioethics journal, Hastings Center Report, asked if "it is time to abandon brain death?" [6]. A recent book by Margaret Lock [7] has pointed out that the changes in criteria for declaring death were primarily fueled by the pressure to transplant viable organs. The point in mentioning these sources is that there is a live debate which continues over brain death criteria. Some defenders of brain death criteria fail to acknowledge that such a debate exists. When they do notice their position attacked, they behave like individuals whose religious orthodoxy has been questioned, and merely repeat the position that "brain death is death," without presenting arguments for that position, or seriously addressing the arguments of their opponents. The repetition of a position does not somehow make it true; neither are mere claims, or attacks on the credibility of those who oppose one's position, substitutes for careful argumentation.

1 The definition of death: contemporary controversies. Eds. Youngner S, Arnold RM and Schapiro R. Johns Hopkins University Press, 1999, Baltimore.

2 Beyond brain death: the case against brain based criteria for human death. Eds. Potts M, Byrne PA, Nilges RG. Kluwer Academic Publishers, 2000, Dordrecht/Boston/London.

3 Shewmon DA. Recovery from brain death: a neurologist’s apologia. Linacre Quarterly 1997; 64:30-96.

4 Shewmon DA. ‘Brain stem death,’ ‘brain death,’ and death: a critical evaluation of the purported evidence. Issues Law Med 1998; 14:125-45.

5 Shewmon DA. Chronic ‘brain death’: meta-analysis and conceptual consequences. Neurology 1998; 51:1538-45.

6 Truog R. Is it time to abandon brain death? Hastings Center Report 1997; 27:29-37.

7 Lock M. Twice dead: organ transplants and the reinvention of death. University of California Press, 2001, Berkeley

Competing interests: None declared

Michael Potts, Head, Philosophy and Religion Department

Methodist College, Fayetteville, NC USA 28311

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