Uniform Determination Of Death Act Research Articles

Frequency of use of the religious exemption in New Jersey cases of determination of brain death

BackgroundThe 1981 Uniform Determination of Death Act (UDDA) established the validity of both cardio-respiratory and neurological criteria of death. However, many religious traditions including most forms of Haredi Judaism (ultra-orthodox) and many varieties of Buddhism strongly disagree with death by neurological criteria (DNC). Only one state in the U.S., New Jersey, allows for both religious exemptions to DNC and provides continuation of health insurance coverage when an exception is invoked in its 1991 Declaration of Death Act (NJDDA). There is yet no quantitative or qualitative data on the frequencies of religious exemptions in New Jersey. This study gathered information about the frequency of religious exemptions and policy in New Jersey that was created out of respect for religious beliefs.MethodsLiterature and internet searches on topics related to religious objections to DNC were conducted. Fifty-three chaplains and heads of bioethics committees in New Jersey hospitals were contacted by phone or email requesting a research interview. Respondents answered a set of questions about religious exemptions to DNC at the hospital where they worked that explored the frequency of such religious exemptions in the past five years, the religious tradition indicated, and whether any request for a religious exemption had been denied. This study was approved by the Northeastern University Institutional Review Board (IRB #: 16–03-15).ResultsEighteen chaplains and bioethics committee members participated in a full research interview. Of these, five reported instances of religious exemptions to DNC occurring at the hospital at which they worked for a total of approximately 30–36 known exemptions in the past five years. Families sought religious exemptions because of faith in an Orthodox Judaism tradition and nonreligious reasons. No failed attempts to obtain an exemption were reported.ConclusionsReligious exemptions to DNC in New Jersey do occur, although very infrequently. Prior to this study, there was no information on their frequency. Considering religious exemptions do occur, there is a need for national or state policies that addresses both religious objections to DNC and hospital resources. More information is needed to better understand the impact of granting religious exemptions before new policy can be established.

Ethical and Legal Concerns With Nevada's Brain Death Amendments.

In early 2017, Nevada amended its Uniform Determination of Death Act (UDDA), in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology's (AAN) guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. Neurologists have generally supported Nevada's amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person's entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges.

Hypothalamic–Pituitary Function in Brain Death

The Uniform Determination of Death Act (UDDA) states that an individual is dead when "all functions of the entire brain" have ceased irreversibly. However, it has been questioned whether some functions of the hypothalamus, particularly osmoregulation, can continue after the clinical diagnosis of brain death (BD). In order to learn whether parts of the hypothalamus can continue to function after the diagnosis of BD, we performed 2 separate systematic searches of the MEDLINE database, corresponding to the functions of the posterior and anterior pituitary. No meta-analysis is possible due to nonuniformity in the clinical literature. However, some modest generalizations can reasonably be drawn from a narrative review and from anatomic considerations that explain why these findings should be expected. We found evidence suggesting the preservation of hypothalamic function, including secretion of hypophysiotropic hormones, responsiveness to anterior pituitary stimulation, and osmoregulation, in a substantial proportion of patients declared dead by neurological criteria. We discuss several possible explanations for these findings. We conclude by suggesting that additional clinical research with strict inclusion criteria is necessary and further that a more nuanced and forthright public dialogue is needed, particularly since standard diagnostic practices and the UDDA may not be entirely in accord.

The lack of scientific evidence in clinical practice guideline in brain death determination: Implications for organ donation and transplantation.

Human death is universally understood to be a biological phenomenon, that is, the irreversible loss of the body's ability to mitigate entropy. Technological advances in transplantation medicine created the problem of optimally managing the supply of and demand for viable organs. We have previously outlined how irreversible apneic coma was introduced as a criterion of death and was approved by the US President's Commission in 1981.[1] The Uniform Determination of Death Act (UDDA) enacted two alternative methods in death determination: (1) Irreversible cessation of circulatory and respiratory functions; or (2) irreversible cessation of all functions of the entire brain, including the brainstem.[1] Other countries have adopted the brainstem definition of death. Most jurisdictions have followed the US legislation. Existing laws already disallow the act of procurement to be the proximate cause of the donor's death, reflecting a deontological moral premise that, in the context of organ donation, is referred to as the dead donor rule (DDR). Different cultures and religions do not object to organ donation if and only if vital organs are procured from cadavers and thus, in compliance with the DDR. The legal and moral legitimacy of procuring organs after determination of death with brain-based criteria, that is, brain death (BD) is centered on its equivalency with biological death. The concept of BD has serious shortcomings in this regard: (1) equivalency with biological death cannot be substantiated by contemporary neuroscience; (2) standard practice guideline for BD diagnosis is based only on weak scientific evidence, and (3) the biophilosophical explanation to equate BD and human death lacks logical coherence.

Death, Brain Death, and the Limits of Science: Why the Whole-Brain Concept of Death is a Flawed Public Policy

Legally defining "death" in terms of brain death unacceptably obscures a value judgment that not all reasonable people would accept. This is disingenuous, and it results in serious moral flaws in the medical practices surrounding organ donation. Public policy that relies on the whole-brain concept of death is therefore morally flawed and in need of revision.

Seeking to reconcile end-of-life organ procurement for transplantation with the uniform determination of death act

Seeking to reconcile end-of-life organ procurement for transplantation with the uniform determination of death act

Seeking to reconcile end-of-life organ procurement for transplantation with the uniform determination of death act

Seeking to reconcile end-of-life organ procurement for transplantation with the uniform determination of death act

Brain Death: Can It Be Resuscitated?

Why is a patient with a destroyed considered dead rather than moribund and irreversibly comatose? The world has been grappling with this question for the past four decades with little success. The recently released white paper of the President's Council on Bioethics is in many respects a refreshing, thoughtful, and comprehensive reexamination of this complex topic. (1) It offers a very helpful analysis of the major positions on the determination of death, and it proffers a creative new solution of its own. Unfortunately, the new solution does not put the problem to rest, but the humility with which the council discusses its own position and the honesty with which it confronts the consequences of being wrong alone make this report a very commendable document. Historical Backdrop What is refreshing about the white paper emerges best when it is put in historical perspective. In 1968, the Harvard Committee catalyzed a monumental socio-medico-legal revolution: the reformulation of in terms of function. (2) The only rationale given by the committee for why the irreversible cessation of all functions should be equated with was legal utility: it would free up beds in intensive care units and facilitate organ transplantation. The Harvard report ushered in a brief era of wild transplantation. (3) In a domino effect beginning in 1970, state after state revised its statutory definition of death, despite the absence not just of official diagnostic criteria for irreversible cessation of all functions, but also of any generally accepted philosophical rationale for why irreversible nonfunction of the should constitute death. By 1978, over thirty different diagnostic criteria had been published, none of them validated; neither had any consensus on the conceptual basis emerged. (4) The next milestone in the history of brain death was the 1981 President's Commission. (5) Its comprehensive report included a proposed Uniform Determination of Death Act (UDDA), which served as the model for the remaining twenty-three states that had not yet revised their statutes to include a brain-based criterion. Its medical consultants proposed a set of diagnostic criteria that instantly became the standard for the United States. And most importantly, it articulated a then-plausible rationale for equating irreversible cessation of all function with death--namely, the loss of integrative unity of the organism. It argued that the is the body's central integrator, without which the body necessarily and imminently literally dis-integrates and succumbs to asystole despite all technological interventions. The President's Commission also maintained that brain death and ordinary are physiologically identical states, only in the former case the equivalence is masked by artificial ventilation and circulatory support. That same year, James Bernat, Charles Culver, and Bernard Gert published an influential paper promoting even more forcefully the integrative unity rationale, which quickly became the mainstream conceptual justification for in the United States and many other countries. (6) Over the next two decades, however, new clinical data made it increasingly clear that patients with total failure were not physiologically identical to non-heart-beating corpses, and they did not necessarily dis-integrate despite all technological support. Moreover, the rare longer-surviving ones exhibited holistic properties such as homeostasis, proportional growth (of a child), teleological repair, and general ability to survive outside a hospital setting with relatively little support (ventilator, tube feedings, and nursing care-much less than many sick patients in intensive care units require, who are nevertheless clearly living organisms). Such properties are difficult to reconcile with the mainstream assumption that these bodies were nothing but bags of partially interacting subsystems. …

Donation After Cardiac Death: Perceptions Versus Reality

The paper by Rady et al 1 criticizes donation after cardiac death (DCD) on 3 levels: (1) it defies the spirit if not the letter of the dead donor rule; (2) asserts some manipulations of the DCD patient may inappropriately hasten death in patients technically still alive by brain death criteria, and (3) claims DCD is a threat to public trust in the organ donation system. These criticisms should stimulate further debate on these issues. The authors suggest that DCD evolved to access more viable organs from the potential pool. However, some have stated the primary reason was a utilitarian argument to allow families of severely brain injured (but not technically brain dead) patients to circumvent the dead donor rule to donate. If the dead donor rule interfered with the altruistic desire to donate organs from a patient who would die anyway, the dead donor rule was perceived as impedimentia. So there was incentive to circumvent it by creative interpretation. This is a shaky argument. It does not matter if there is an intent to resuscitate or not. Neither the patient nor his or her family can consent to any procedure that will result in death, nor can the family consent to the patient’s being dead in a predetermined number of hours or minutes. Consenting to either of these options is tantamount to consenting to euthanasia. The most fundamental criticism of DCD involves ambiguity in the rules created to determine whether a potential donor’s organs are alive enough to donate but the whole patient is dead enough to avoid vivisection. What ethicists call “irreversible cessation of the integrated functioning of the organism as a whole” (not the whole organism). The rules seem clear. In 1968, the Harvard Criteria objectified the progression of disease, thereby making it possible for clinicians to predict inevitable death, but the Uniform Determination of Death Act (UDDA) of 1980 made brain death an objective criterion for death. The UDDA specifically required that death be irreversible. This act states that 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 brain stem, is dead and that a death certificate may then be filled out. However, the UDDA does not elucidate how these 2 differing standards reflect the same phenomenon, opening the interpretation that there are actually 2 kinds of death: brain and cardiac. This ambiguity made the issue of determining death amenable to a creative interpretation. Pronouncement of death could make brain function irrelevant if the heart stops. A problem with this interpretation is the inability to establish precisely when death transitions from a reversible process to an irreversible event. Brain death is an actual diagnosis of death and is clearly defined in terms of irreversibility. Cardiac standstill is a prognosis of death. When the heart stops, the brain will die in time, but its progress is unknown and unmeasured. Because the point of irreversibility is not known at the time death is declared, the exact time of death cannot be determined. Technically, the From the Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

EMG artifact in brain death electroencephalogram, is it a cry of “ medullary death”?

The Uniform Determination of Death Act (UDDA) defines death as irreversible cessation of the functions of the entire brain including the brainstem. Many individuals meeting the clinical criteria of brain death can be documented to have some residual sub-cortical and brainstem function on careful testing. Determination of brain death still remains a persistently unresolved issue in health law and bioethics. The determination of brain death is clinical and involves testing for the integrity of brainstem functions. Documentation of irreversible cessation of brainstem functions when the cause of coma is established is usually sufficient to make a diagnosis of brain death. Confirmatory tests like four-vessel angiogram and electroencephalogram (EEG) are required in cases where the clinical testing is inconclusive or unreliable. EEG criteria for electrocerebral silence (ECS) is absence of any detectable cortical activity above 2 μV in a study performed as per the guidelines developed by the American Electroencephalographic Society. EEG studies carried out for ECS are at times contaminated by electromyographic (EMG) artifacts reflecting scalp motor unit activity. A secure EEG diagnosis of ECS cannot be made in such cases. What exactly is the relevance of scalp EMG activity in these clinically brain dead patients? What is the mechanism of generation of this spontaneous scalp EMG activity and how can the diagnosis of brain death be secured in these patients? These issues are explored in this article by highlighting a case.

Avoiding Common Pitfalls in the Determination of Death

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) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards. On the one hand, it is useful to test out data and intuitions against a theoretical definition that appears sound. …

Brain death and the anencephalic newborn.

We will set the stage for our analysis by reviewing selected medical aspects of anencephaly, outlining the history of the use of anencephalics as organ sources, and summarising the results of an important study recently completed at Loma Linda University. We will then employ some of the arguments and justifications underlying the Uniform Determination of Death Act (UDDA) to claim that anencephaly is morally equivalent to brain death, i.e., the reasons for considering brain-dead patients to be dead also apply to anencephalics. Finally, we will critique our proposal and discuss its implications.

Uniform determination of death act: implications for nursing practice.

Uniform determination of death act: implications for nursing practice.