Amid all the other changes to biological classification we have been treated to under the Biden administration, one is proposed involving the definition of death that is now drawing concern.
The Uniform Determination of Death Act (UDDA) has been in guidance in place since 1981. The UDDA states:
An individual who has sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brainstem, is dead. A determination of death must be made in accordance with accepted medical standards.”
Late last year, a group of lawyers and “experts” met to discuss revisions to the UDDA.
A group of lawyers as well as observers including neurologists and philosophers met Friday and Saturday to discuss potential revisions to the determination. The group, part of the Uniform Law Commission, also addressed updating policies surrounding the notification of families about the process for determining death….Brain death is a legal designation in all 50 states. How brain death is determined, which tests are used and the type of physician qualified to make the determination can vary by state, said Thaddeus Mason Pope, a law professor at Mitchell Hamline School of Law in St. Paul, Minn.In recent years, families have objected to doctors conducting brain-death evaluations on their loved ones. Some have filed lawsuits challenging brain-death determinations. And some doctors and lawyers have said guidelines for determining brain death don’t require tests for the loss of function in every part of the brain, such as the hypothalamus, which regulates hormones. The gap between the legal determination of brain death, they said, and the way doctors interpret it could erode public trust.Prof. Pope and two colleagues in 2020 co-wrote an article in the Annals of Internal Medicine calling for revisions to the Uniform Determination of Death Act to address these and other challenges. .
We have been treated to three years of disastrous consequences when scientific “experts” and their legal supporters decided to implement policy without proper vetting of what they propose. Let’s take a look at the new definition to see if there is reason to worry.
An individual who has sustained either (a) permanent cessation of circulatory and respiratory functions or; (b) permanent coma, permanent cessation of spontaneous respiratory functions, and permanent loss of brainstem reflexes, is dead. A determination of death must be made in accordance with accepted medical standards.
Heidi Klessig, M.D. (a retired anesthesiologist and pain management specialist) and Christopher W. Bogosh (a psychiatric mental health registered nurse) are observers of the Uniform Law Commission on the RUDDA. They sounded the alarm about the proposed revision.
Notice that the new neurological standard under (b) does not use the term “irreversible,” nor does it include the loss of whole-brain function. The term “permanent” is being defined to mean that physicians do not intend to act to reverse the patient’s condition.Thus, people in a coma whose prognosis is death will be declared dead under this new standard. An unresponsive person with a beating heart on a ventilator is not well, but he is certainly not dead!…In addition, the AAN proposes that there be no requirement for informed consent before initiating brainstem-reflex testing. One of the tests is called the apnea test. During this exam, the patient is removed from the ventilator for 8–10 minutes, attempts to breathe are monitored, and carbon dioxide in the blood is measured.This test has absolutely no benefit for the patient. It can only cause harm, as rising levels of carbon dioxide in the bloodstream cause an increase in intracranial pressure, which is hugely detrimental for a brain-injured patient. The idea that there will be no informed consent requirement for this potentially harmful exam violates the ethical principles of autonomy, justice, beneficence, and non-maleficence.
There are concerns changes to the UDDA are focused on elements that would support the organ donation process and be detrimental to the rights of patients and their families.
The current guidance may not be perfect. But the current proposal’s direction is truly disturbing, though completely aligned with the destructive choices that our policymakers continue to make.
NOTE AND CORRECTION: The post has been updated and corrected to reflect the following the nature of the proposed changes:
The Uniform Declaration of Death Act was drafted in 1981 by a President’s Commission study on brain death. It was approved by both the American Medical Association (AMA) and the American Bar Association (ABA) shortly after its publication
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