Education And Debate Ethical debate

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

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1266

Opposition to Brain Death Criteria

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;

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: No competing interests

11 April 2002
Michael Potts
Head, Philosophy and Religion Department
Methodist College, Fayetteville, NC USA 28311