Defining Death

Robert M. Veatch, PhD, is professor of medical ethics emeritus at the Kennedy Institute of Ethics, Georgetown University. He has received the Lifetime Achievement Award from the American Society of Bioethics and the Humanities. The author of fifty books, he is coauthor of Transplantation Ethics, Second Edition, with Lainie F. Ross. He serves on the United Network for Organ Sharing Ethics Committee and the Board of Directors of the Washington Regional Transplant Community. Lainie F. Ross, MD, is the Carolyn and Matthew Bucksbaum Professor of Clinical Medical Ethics at the University of Chicago. She is the author of Children, Families and Health Care Decision-Making, Children in Medical Research: Access versus Protection, and coauthor of Transplantation Ethics, Second Edition, with Robert M. Veatch. She has served on the United Network for Organ Sharing Ethics Committee.

• 1. Defining Death: An IntroductionThe Emergence of the ControversyThree Groups of DefinitionsThe Emergence of a Uniform Brain-Oriented DefinitionIrreversible vs. Permanent Loss of FunctionDefining Death and Transplanting OrgansThe Structure of the Book 2. The Dead Donor Rule and the Concept of DeathThe Dead Donor RuleCandidates for a Concept of "Death"The Public Policy Question 3. The Whole-Brain Concept of DeathThe Case for the Whole-Brain ConceptCriteria for the Destruction of All Brain FunctionsProblems with the Whole-Brain DefinitionAlternatives to the Whole-Brain Definition 4. The Circulatory, or Somatic, Concept of DeathTwo Measurements of DeathCirculatory Death and Organ ProcurementThe DCD ProtocolsShewmon's Somatic ConceptThe Two Definitions of the US President's Council on Bioethics 5. The Higher-Brain Concept of DeathWhich Brain Functions Are Critical?Altered States of Consciousness: A ContinuumMeasuring the Loss of Higher-Brain FunctionAncillary TestsThe Legal Status of Death 6. The Conscience Clause: How Much Individual Choice Can Our Society Tolerate in Defining Death?The Present State of the LawConcepts, Criteria, and the Role of Value PluralismExplicit Patient Choice, Substituted Judgment, and Best InterestLimits on the Range of DiscretionThe Problem of Order: Objections to a Conscience ClauseImplementation of a Conscience ClauseConclusion 7. Crafting a New Definition-of-Death LawIncorporating the Higher-Brain-Function NotionThe Conscience ClauseClarification of the Concept of "Irreversibility"A Proposed New Definition of Death for Public Policy PurposesConclusion