Should death be defined in strictly biological terms -- as the body's failure to maintain integrated functioning of respiration, blood circulation, and neurological activity? Should death be declared on the basis of severe neurological injury even when biological functions remain intact? Or is it essentially a social construct that should be defined in different ways?
These are among the wide-ranging questions explored in a new special report, " Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death ," published with the current issue of the Hastings Center Report . The special report is a collaboration between The Hastings Center and the Center for Bioethics at Harvard Medical School. Editors are Robert D. Truog , the Frances Glessner Lee professor of medical ethics, anaesthesiology & pediatrics and director of the Center for Bioethics at Harvard Medical School; Nancy Berlinger , a research scholar at The Hastings Center; Rachel L. Zacharias, a student at the University of Pennsylvania Law School and a former project manager and research assistant at The Hastings Center; and Mildred Z. Solomon , president of The Hastings Center.
Until the mid-twentieth century, the definition of death was straightforward: a person was pronounced dead when found to be unresponsive and without a pulse or spontaneous breathing. Two developments prompted the need for a new concept of death, culminating in the definition of brain death proposed in the Harvard report published in 1968.
The first development was the invention of mechanical ventilation supported by intensive care, which made it possible to maintain breathing and blood circulation in the body of a person who would otherwise have died quickly from a brain injury that caused loss of these vital functions. The second development was organ transplantation, which "usually requires the availability of 'living' organs from bodies deemed to be 'dead'," as the introduction to the special report explains. "Patients determined to be dead by neurologic criteria and who have consented to organ donation . . . are the ideal source of such organs, since death is declared while the organs are being kept alive by a ventilator and a beating heart."
While the legal determination of death in all 50 states includes death by neurological criteria - the irreversible cessation of all functions of the entire brain - the concept of brain death remains contested, most recently by the case of Jahi McMath, who was declared dead by neurological criteria but continued to have unexpected biological development. In the new special report, leading experts in medicine, bioethics, and other fields discuss and debate areas of continuing and new controversy, including:
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The special report, funded by the Boger Initiative for the Wise Use of Emerging Technologies at The Hastings Center, originated from presentations given at a 2018 conference at the Center for Bioethics at Harvard Medical School. The full text of the report, Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death, can be found here .
For more information and to interview Nancy Berlinger or Mildred Z. Solomon, contact
Susan Gilbert, director of communications
The Hastings Center
845-424-4040 x244
gilberts@thehastingscenter.org
To interview Robert Truog, contact
Angela Alberti, communications manager
Center for Bioethics, Harvard Medical School
617-432-6778
angela_alberti@hms.harvard.edu
Hastings Center Report