Avoiding common pitfalls in the determination of death.

AuthorDuBois, James
PositionReprint

7 NAT'L CATH. BIOETHICS Q. 545 (2007).

According to legend, John Duns Scotus was buried alive, as evidenced by scratch marks found inside his casket when his body was later exhumed. He was allegedly comatose when buried and mistaken for dead. In earlier times, "inappropriate death diagnoses were not uncommon and included victims of lightening strikes, diabetic ketoacidosis, epilepsy, stroke, drowning, and even hysterical fainting."

In this age of advanced medicine, we once again find ourselves wrestling with fears that we may be mistaken for dead while still alive. It is precisely our technology that has given rise to such fears, specifically, our ability to transplant organs and our ability to make very early determinations of death. These two things go hand in hand: we cannot transplant organs that have begun to decompose or grow necrotic; thus, we must determine the death of the human being very quickly when organ donation is desired.

Doubts about death criteria in the context of organ transplantation are not the sole property of a paranoid few. A review of surveys conducted on attitudes toward organ donation and death criteria found that it is not unusual for adults to express doubts about death criteria, and that rates of consent to organ donation are negatively correlated with doubts about death. The author provides several conclusions resulting from his study of death and working in the field of transplantation as an ethicist, social psychologist, and observer.

First, focus on death as a state, not an event or process. Some recent medical ethicists argue that death is a slow process which includes macro events (such as cardiac arrest) and micro events (such as necrosis of individual organs). Those who focus on death as a process tend to view any set of criteria for determining death as arbitrary: there is no key event, no absolute line. The key question that should be asked before organ procurement is, "Is this body in a state of death?" If the body is in such a state, then the question of killing via organ procurement is moot, because killing involves causing someone to enter the state of death.

Second, rely on a description of the stare of death based on medical experience rather an a priori definition of death. All fifty states have adopted a variation of the Uniform Determination of Death Act (UDDA), which states: "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2)...

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