Tell public about brain death
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39234.458762.3A (Published 07 June 2007) Cite this as: BMJ 2007;334:1179All rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests