Does the Uniform Determination of Death Act Need to Be Revised?

Abstract

<jats:p> Prompted by concerns raised by the rise in litigations, which challenge the legal status of brain death (BD), Lewis and colleagues recently proposed a revision of the Uniform Determination of Death Act (UDDA). The revision consists of (i) narrowing down the definition of BD to the loss of specific brain functions, namely those functions that can be assessed on bedside neurological examination; (ii) requiring that the determination of BD must be in accordance with the specific guidelines designated in the revision; and (iii) eliminating the necessity for obtaining consent prior to performing the tests for BD determination. By analyzing Lewis and colleagues’ revision, this article shows that this revision is fraught with difficulties. Therefore, this article also proposes two approaches for an ethical revision of the UDDA; the first is in accordance with scientific realism and Christian anthropology, while the second is grounded in trust and respect for persons. If the UDDA is to be revised, then it should be based on sound ethical principles in order to resolve the ongoing BD controversies and rebuild public trust. </jats:p><jats:sec><jats:title>Summary:</jats:title><jats:p> This article critically examines the recent revision of the Uniform Determination of Death Act (UDDA) advanced by Lewis and colleagues. The revision only further reinforces the status quo of brain death without taking into account the root cause of the litigations and controversies about the declaration of death by neurological criteria. In view of this deficiency, this article offers two approaches to revising the UDDA, both of which are founded on sound moral principles. </jats:p></jats:sec>

A Framework for Revisiting Brain Death: Evaluating Awareness and Attitudes Toward the Neuroscientific and Ethical Debate Around the American Academy of Neurology Brain Death Criteria

“…Whether these criteria in fact succeed in demonstrating whole-brain death per UDDA, or even true brainstem death, is a matter of scientific and legal debate. 21 Although there is a definite lack of understanding for the scientific reasoning behind the AAN procedural criteria even on the part of MDs, at baseline there is a high degree of trust across training types that these criteria demonstrate loss of brain function that is irreversible. Even prior to the educational intervention that reviews scientific criticisms, there is remarkably less agreement, especially among MDs, that the AAN criteria determine complete loss of brain function.…”

“…20 On the other hand, critics urge caution and reconsideration of the current criteria and its underlying rationale, since erroneous declaration of death in medical practice has catastrophic consequences on patients and families. 21,22 This academic controversy is reflected in clinical practice. It is relatively common for neurologists to encounter families who object to discontinuation of organ support after brain death 23 and yet survey studies have shown that neurologists do not have a consistent rationale for accepting brain death as death, nor a clear understanding of diagnostic tests for brain death.…”

“…20 On the other hand, critics urge caution and reconsideration of the current criteria and its underlying rationale, since erroneous declaration of death in medical practice has catastrophic consequences on patients and families. 21,22…”

It is time to abandon apneic-oxygenation testing for brain death

“…Lewis and colleagues [34] propose that the defi nition of standing legal requirement of consent for testing [36,37]. While agreeing that the UDDA needs revision, Nguyen [35] maintains that the suggestions of Lewis and colleagues neither address the root cause of the litigations (harm caused by testing) nor the controversies about the neurological declaration of brain death.…”

Challenges to Brain Death in Revising the Uniform Determination of Death Act

“…Several of the observers have independently submitted their opinions on how the committee should rewrite the UDDA for publication in Neurology 22 and other journals. [23][24][25] To explain the context and content of these issues for practicing neurologists, Neurology Editor, José Merino commissioned a series of articles on the UDDA and brain death of which this is the first. Here I outline the history and critiques of the UDDA and try impartially to provide the context for the debates over how it should be revised.…”