Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act

Ariane Lewis; Richard J Bonnie; Thaddeus Pope; Leon G Epstein; David M Greer; Matthew P Kirschen; Michael Rubin; James A Russell

doi:10.1177/1073110519898039

Determination of Death by Neurologic Criteria in the United States: The Case for Revising the Uniform Determination of Death Act

J Law Med Ethics. 2019 Dec;47(4_suppl):9-24. doi: 10.1177/1073110519898039.

Authors

Ariane Lewis¹, Richard J Bonnie¹, Thaddeus Pope¹, Leon G Epstein¹, David M Greer¹, Matthew P Kirschen¹, Michael Rubin¹, James A Russell¹

Affiliation

¹ Ariane Lewis, M.D., is an Associate Professor at NYU Langone Medical Center in the Departments of Neurology and Neurosurgery (Division of Neurocritical Care) and an affiliate of the Department of Population Health (Division of Bioethics). She is also a member of the American Academy of Neurology/American Neurological Association/Child Neurology Society Ethics, Law and Humanities Committee. Richard J. Bonnie, LL.B., is Harrison Foundation Professor of Law and Medicine in the School of Law, Professor of Psychiatry and Neurobehavioral Sciences and Professor of Public Health Sciences in the School of Medicine, Professor of Public Policy in the Frank Batten School of Leadership and Public Policy, and Director of the Institute of Law, Psychiatry and Public Policy, at the University of Virginia. He is also a member of the American Academy of Neurology/American Neurological Association/Child Neurology Society Ethics, Law and Humanities Committee. Thaddeus Pope, J.D., Ph.D., is Director of the Health Law Institute and Professor at Mitchell Hamline School of Law (Saint Paul, Minnesota). He is also an Adjunct Professor with the Australian Centre for Health Law Research at Queensland University of Technology (Brisbane, Australia) and Visiting Professor of Medical Jurisprudence at St. George's University (Grenada, West Indies). Leon G. Epstein, M.D., is the Derry A. & Donald L. Shoemaker Professor of Pediatric Neurology at the Ann & Robert H. Lurie Children's Hospital of Chicago and Professor of Pediatrics at the Northwestern University Feinberg School of Medicine. He is also the Chairman of the American Academy of Neurology/American Neurological Association/Child Neurology Society Ethics, Law and Humanities Committee. David M. Greer, M.D., M.A., is Professor and Chairman of Neurology at Boston University School of Medicine, and Chief of Neurology at Boston Medical Center. He is also Adjunct Research Professor at Yale University School of Medicine. Matthew P. Kirschen, M.D., Ph.D., is an Assistant Professor of Anesthesiology and Critical Care Medicine, Neurology, and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia. He is also the Vice Chairman of the American Academy of Neurology/American Neurological Association/Child Neurology Society Ethics, Law and Humanities Committee. Michael Rubin, M.D., M.A., is Associate Professor of Neurology and Neurotherapeutics at UT Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute. He is also a member of the American Academy of Neurology/American Neurological Association/Child Neurology Society Ethics, Law and Humanities Committee. James A. Russell, D.O., M.S., is a staff neurologist at Lahey Hospital and Medical Center (Burlington, MA) and Chairman of its Ethics Section, Clinical Professor of Neurology at Tufts University of Medicine, Director of the Curt and Shonda Schilling ALS Clinic at LHMC. He is also the immediate past Chairman of the American Academy of Neurology/American Neurological Association/Child Neurology Society Ethics, Law and Humanities Committee.

PMID: 31955689
DOI: 10.1177/1073110519898039

Abstract

Although death by neurologic criteria (brain death) is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: (1) the medical standards used to determine death by neurologic criteria, (2) management of family objections before determination of death by neurologic criteria, and (3) management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act (UDDA) and the rationale for these recommendations.

Publication types

Historical Article
Legal Case

MeSH terms

Brain Death / diagnosis
Brain Death / legislation & jurisprudence*
History, 20th Century
History, 21st Century
Humans
Life Support Care / legislation & jurisprudence
Neurologic Examination / ethics
Religion and Medicine
Societies, Medical
Third-Party Consent / legislation & jurisprudence
United States
Withholding Treatment / legislation & jurisprudence