Sunday, May 29, 2016

Defining Death: The Case for Choice

Distinguished bioethicists Robert M. Veatch and Lainie F. Ross have adapted the first several chapters of their fabulous Transplantation Ethics to be a separate volume from Georgetown University Press: Defining Death: The Case for Choice.



"New technologies and medical treatments have complicated questions such as how to determine the moment when someone has died. The result is a failure to establish consensus on the definition of death and the criteria by which the moment of death is determined. This creates confusion and disagreement not only among medical, legal, and insurance professionals but also within families faced with difficult decisions concerning their loved ones."



Veatch and Ross argue that the definition of death is not a scientific question but a social one rooted in religious, philosophical, or social beliefs. Drawing on history and recent court cases, the authors detail three potential definitions of death--the whole-brain concept; the circulatory, or somatic, concept; and the higher-brain concept. Because no one definition of death commands majority support, it creates a major public policy problem. The authors cede that society needs a default definition to proceed in certain cases, like those involving organ transplantation. But they also argue the decision-making process must give individuals the space to choose among plausible definitions of death according to personal beliefs.



1. Defining Death: An Introduction

The Emergence of the Controversy

Three Groups of Definitions

The Emergence of a Uniform Brain-oriented Definition

Irreversible vs. Permanent Loss of Function

Defining Death and Transplanting Organs

The Structure of the Book



2. The Dead Donor Rule and the Concept of Death

The Dead Donor Rule

Candidates for a Concept of "Death"

The Public Policy Question



3. The Whole-Brain Concept of Death

The Case for the Whole-Brain Concept

Criteria for the Destruction of All Brain Functions

Problems with the Whole-Brain Definition: Case Reports

Problems with the Whole-Brain Definition: The Alternatives



4. The Circulatory, or Somatic, Concept of Death

Two Measurements of Death

Circulatory Death and Organ Procurement

The DCD Protocols

Shewmon's Somatic Concept

The Two Definitions of the US President's Council on Bioethics



5. The Higher-Brain Concept of Death

Which Brain Functions Are Critical?

Altered States of Consciousness: A Continuum

Measuring Loss of Higher-brain Function

Ancillary Tests

The Legal Status of Death



6. The Conscience Clause: How Much Individual Choice Can Our Society Tolerate in Defining Death?

The Present State of the Law

Concepts, Criteria, and the Role of Value Pluralism

Explicit Patient Choice, Substituted Judgment, and Best Interest

Limits on the Range of Discretion

The Problem of Order: Objections to a Conscience Clause

Implementation of a Conscience Clause 



7. Crafting a New Definition of Death Law

Incorporating the Higher-brain Notion

The Conscience Clause

Clarification of the Concept of "Irreversibility"

A Proposed New Definition of Death for Public Policy Purposes


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