THE DEFINITION OF DEATH: CONTEMPORARY CONTROVERSIES.

Abstract

This book about brain death is as much to do with legal and philosophical considerations, public attitudes and public policy as with clinical aspects. It arose out of a conference in 1995, but is much more scholarly and coherent than a conference proceedings—with authors referring to each others' chapters and the Editors writing an introductory commentary to each group of chapters. Each chapter has its own reference list and all are well written, making the book as a whole a rewarding read. Its focus is on the US, but there are chapters on specific public policy problems in Denmark, Germany and Japan. The Editors' introduction to the whole book raises the possibility that the public consensus following the report of the President's Commission might be about to deconstruct. The threat is from debates about whole brain, higher brain and brainstem definitions, and when death occurs, although they acknowledge that there has been little public interest in these academic controversies. Reviewing the cultural context of the evolution of brain death, an historian details reactions to the 1968 Harvard criteria. A major aim was claimed to be the avoidance of prolonged futile life-support and promoting death with dignity, rather than to aid the harvesting of organs. But the media focused only on the transplant issue and there followed no fewer than 11 feature films on the theme of murders to provide donor organs. Initially, the AMA did not want doctors to be ruled by guidelines, and lawyers did not think doctors should decide on their own. However, the President's Commission in 1981 largely resolved these issues. Laws were passed recognizing brain death, but leaving doctors to devise and apply criteria. The concept was `sold' to the public on the basis of whole brain death, the President's Commission rejecting the alternative higher brain …