Once irreversible coma (coma depassé) and its concomitant, the massive central necrosis of the brain, had been recognized as a clinicopathologic entity by Fischgold et al and Mollaret et al in Paris in 1959, the question of the significance of life without a brain had to be answered. But the first issue then to be considered was whether the clinical diagnosis could be made with complete certainty. This matter was addressed by the Harvard Ad Hoc Committee, who set forth what it conceived as the criteria for reliable diagnosis in 1968. Almost immediately, critical essays followed in the United States, France, West Germany, and Switzerland on the medical, ethical, and religious implications of redefining death in terms of pannecrosis of the brain rather than the traditional view of cardiac arrest.
Professor Walker, who served on the President's Committee to evaluate guidelines for the determination of death, presents in this small