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October 10, 1977, Vol 238, No. 15 >
ARTICLE | October 10, 1977

Brain Death: Title and subTitle BreakI. A Status Report of Medical and Ethical Considerations FREE

Frank J. Veith, MD; Jack M. Fein, MD; Moses D. Tendler, PhD; Robert M. Veatch, PhD; Marc A. Kleiman, JD, LLM; George Kalkines, JD
[+] Author Affiliations

Reprint requests to Montefiore Hospital, 111 E 210 St, New York, NY 10467 (Dr Veith).


JAMA. 1977;238(15):1651-1655. doi:10.1001/jama.1977.03280160045026
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References

Use of neurologic criteria to pronounce death, although accepted by many, has caused controversy among physicians, lawyers, legislators, philosophers, and theologians. The present work attempts to resolve this by accomplishing four objectives. (1) It summarizes scientific information that establishes the ability to determine the state of brain death with certainty on the basis of presently available clinical and laboratory criteria. (2) It shows that the concept of brain death is in accord with secular philosophy and the three major Western religions. (3) It documents the need for legislative recognition that death may be pronounced on the basis of neurologic criteria. (4) It reviews the present status of judicial and statutory law relating to the determination of death in the United States.

(JAMA 238:1651-1655, 1977)

REFERENCES

1 +
High D:  Death: Its conceptual elusiveness . Soundings 55:438-458, 1972;.
2 +
Ramsey P: The Patient as Person: Explorations in Medical Ethics . New Haven, Conn, Yale University Press, 1970;, pp 101-112.
3 +
Haring B: Medical Ethics . Notre Dame, Ind, Fides Publishers Inc, 1973;.
4 +
Geelhoed GW:  Life and death: Who decides? The Pharos , (January) 1977;, pp 7-12.
5 +
Jonas H:  Against the stream: Comments on the definition and redefinition of death , in Jonas H (ed): Philosophical Essays: From Ancient Creed to Technological Man . Englewood Cliffs, NJ, Prentice Hall, 1974;, pp 132-140.
6 +
 Definition of death . JAMA 227:728, 1974;.
7 +
Tobin CJ:  Statement in behalf of the New York State Catholic Conference delivered at the public hearing related to death legislation held by the New York State Assembly Subcommittee on Health Care, Albany, New York, Nov 30, 1976 . Origins 6:413-415, 1976;.
8 +
 A definition of irreversible coma, Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death . JAMA 205:337-340, 1968;.
9 +
 Refinements in criteria for the determination of death: An appraisal, report by the Task Force on Death and Dying of the Institute of Society, Ethics and the Life Sciences . JAMA 221:48-53, 1972;.
10 +
Walker AE, Diamond EL, Moseley J:  The neuropathological findings in irreversible coma: A critique of the "respirator brain." J Neuropathol Exp Neurol 34:295-323, 1975;.
11 +
Korein J, Braunstein P, Kricheff I, et al:  Radioisotopic bolus technique as a test to detect circulatory deficit associated with cerebral death: 142 studies on 80 patients demonstrating the bedside use of an innocuous IV procedure as an adjunct in the diagnosis of cerebral death . Circulation 51:924-939, 1975;.
12 +
Crafoord C:  Cerebral death and the transplantation era . Dis Chest 55:141-145, 1969;.
13 +
Heiskanen O:  Cerebral circulatory arrest caused by acute increase of intracranial pressure: A clinical and roentgenological study of 25 cases . Acta Neurol Scand 40( (suppl 7) ):1-57, 1964;.
14 +
Bergquist E, Bergstrom K:  Angiography in cerebral death . Acta Radiol (Diagn) 12:283-288, 1972;.
15 +
Lofstedt S, von Reis G:  Diminution or obstruction of blood flow in the internal carotid artery . Opuscula Med 4:345-360, 1959;.
16 +
Greitz T, Gordon E, Kolmodin G, et al:  Aortocranial and carotid angiography in determination of brain death . Neuroradiology 5:13-19, 1973;.
17 +
Silverman D, Saunders MG, Schwab RS, et al:  Cerebral death and the electroencephalogram, Report of the Ad Hoc Committee of the American Electroencephalographic Society on EEG Criteria for Determination of Cerebral Death . JAMA 209:1505-1510, 1969;.
18 +
Silverman D, Masland RL, Saunders MG, et al:  Irreversible coma associated with electrocerebral silence . Neurology 20:525-533, 1970;.
19 +
Masland RL:  When is a person dead? Resident Staff Physician , (April 5) , 1975;, pp 49-52.
20 +
Korein J, Maccario M:  On the diagnosis of cerebral death: A prospective study on 55 patients to define irreversible coma . Clin Electroencephalogr 2:178-199, 1971;.
21 +
Mohandas A, Chou SN:  Brain death: A clinical and pathological study . J Neurosurg 35:211-218, 1971;.
22 +
Ingvar DH, Widen L:  Brain death—A summary of a symposium . Kakartidningen 69:3804-3814, 1972;.
23 +
Walker AE:  Cerebral death , in Tower DB (ed): The Nervous System: The Clinical Neurosciences . New York, Raven Press, 1975;, vol 2, pp 75-87.
24 +
Ueki K, Takeuchi K, Katsurada K:  Clinical study of brain death, presentation 286 . Read before the Fifth International Congress of Neurologic Surgery, Tokyo, Oct 7-13, 1973 .
25 +
Walker AE:  The neurosurgeon's responsibility for organ procurement . J Neurosurg 44:1-2, 1976;.
26 +
 An appraisal of the criteria of cerebral death: A summary statement, A collaborative study . JAMA 237:982-986, 1977;.
27 +
 Diagnosis of brain death: Summary of Conference of Royal Colleges and Faculties of the United Kingdom . Lancet 2:1069-1970, 1976;.
28 +
Molinari GF:  Death: The definition: III. Criteria for death . Encyclopedia of Bioethics , to be published.
29 +
Bolton CF, Brown JD, Cholod E, et al:  EEG and "brain life." Lancet 1:535, 1976;.
30 +
Bab Talmud Tractate Yoma 85A.
31 +
Bab Talmud Tractate Chullin 21A and Mishnah Oholoth 1:6.
32 +
Maimonides: Tumath Meth 1:15.
33 +
Code of Laws:  Who is considered as dead although yet living? Yoreh Deah :370:1.
34 +
Genesis 2:7.
35 +
Connery JR:  Comment on the proposed act to amend the public health law of the State of New York in relation to the determination of the occurrence of death . Read before the New York State Legislature, 1975-1976 session, March 25, 1975 .
36 +
McFadden CJ: The Dignity of Life: Moral Values in a Changing Society . Huntington, Ind, Our Sunday Visitor Inc, 1976;, p 202.
37 +
Pius XII, Acta Apostolicae Sedia 45, November 1957, pp 1027-1033.
38 +
Nelson J: Human Medicine: Ethical Perspective on New Medical Issues . Minneapolis, Augsburg, 1973;, pp 125-130.
39 +
Fletcher J:  Our shameful waste of human tissue: An ethical problem for the living and the dead , in Cutler DR (ed): Updating Life and Death: Essays in Ethics and Medicine . Boston, Beacon Press, 1969;, pp 1-30.
40 +
Fletcher J:  New definitions of death . Prism 2:13ff, (January) 1974;.
41 +
Vaux K: Biomedical Ethics . New York, Harper & Row, 1974;, pp 102-110.
42 +
Smith H: Ethics and the New Medicine . Nashville, Tenn, Abington, 1970;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
High D:  Death: Its conceptual elusiveness . Soundings 55:438-458, 1972;.
2 +
Ramsey P: The Patient as Person: Explorations in Medical Ethics . New Haven, Conn, Yale University Press, 1970;, pp 101-112.
3 +
Haring B: Medical Ethics . Notre Dame, Ind, Fides Publishers Inc, 1973;.
4 +
Geelhoed GW:  Life and death: Who decides? The Pharos , (January) 1977;, pp 7-12.
5 +
Jonas H:  Against the stream: Comments on the definition and redefinition of death , in Jonas H (ed): Philosophical Essays: From Ancient Creed to Technological Man . Englewood Cliffs, NJ, Prentice Hall, 1974;, pp 132-140.
6 +
 Definition of death . JAMA 227:728, 1974;.
7 +
Tobin CJ:  Statement in behalf of the New York State Catholic Conference delivered at the public hearing related to death legislation held by the New York State Assembly Subcommittee on Health Care, Albany, New York, Nov 30, 1976 . Origins 6:413-415, 1976;.
8 +
 A definition of irreversible coma, Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death . JAMA 205:337-340, 1968;.
9 +
 Refinements in criteria for the determination of death: An appraisal, report by the Task Force on Death and Dying of the Institute of Society, Ethics and the Life Sciences . JAMA 221:48-53, 1972;.
10 +
Walker AE, Diamond EL, Moseley J:  The neuropathological findings in irreversible coma: A critique of the "respirator brain." J Neuropathol Exp Neurol 34:295-323, 1975;.
11 +
Korein J, Braunstein P, Kricheff I, et al:  Radioisotopic bolus technique as a test to detect circulatory deficit associated with cerebral death: 142 studies on 80 patients demonstrating the bedside use of an innocuous IV procedure as an adjunct in the diagnosis of cerebral death . Circulation 51:924-939, 1975;.
12 +
Crafoord C:  Cerebral death and the transplantation era . Dis Chest 55:141-145, 1969;.
13 +
Heiskanen O:  Cerebral circulatory arrest caused by acute increase of intracranial pressure: A clinical and roentgenological study of 25 cases . Acta Neurol Scand 40( (suppl 7) ):1-57, 1964;.
14 +
Bergquist E, Bergstrom K:  Angiography in cerebral death . Acta Radiol (Diagn) 12:283-288, 1972;.
15 +
Lofstedt S, von Reis G:  Diminution or obstruction of blood flow in the internal carotid artery . Opuscula Med 4:345-360, 1959;.
16 +
Greitz T, Gordon E, Kolmodin G, et al:  Aortocranial and carotid angiography in determination of brain death . Neuroradiology 5:13-19, 1973;.
17 +
Silverman D, Saunders MG, Schwab RS, et al:  Cerebral death and the electroencephalogram, Report of the Ad Hoc Committee of the American Electroencephalographic Society on EEG Criteria for Determination of Cerebral Death . JAMA 209:1505-1510, 1969;.
18 +
Silverman D, Masland RL, Saunders MG, et al:  Irreversible coma associated with electrocerebral silence . Neurology 20:525-533, 1970;.
19 +
Masland RL:  When is a person dead? Resident Staff Physician , (April 5) , 1975;, pp 49-52.
20 +
Korein J, Maccario M:  On the diagnosis of cerebral death: A prospective study on 55 patients to define irreversible coma . Clin Electroencephalogr 2:178-199, 1971;.
21 +
Mohandas A, Chou SN:  Brain death: A clinical and pathological study . J Neurosurg 35:211-218, 1971;.
22 +
Ingvar DH, Widen L:  Brain death—A summary of a symposium . Kakartidningen 69:3804-3814, 1972;.
23 +
Walker AE:  Cerebral death , in Tower DB (ed): The Nervous System: The Clinical Neurosciences . New York, Raven Press, 1975;, vol 2, pp 75-87.
24 +
Ueki K, Takeuchi K, Katsurada K:  Clinical study of brain death, presentation 286 . Read before the Fifth International Congress of Neurologic Surgery, Tokyo, Oct 7-13, 1973 .
25 +
Walker AE:  The neurosurgeon's responsibility for organ procurement . J Neurosurg 44:1-2, 1976;.
26 +
 An appraisal of the criteria of cerebral death: A summary statement, A collaborative study . JAMA 237:982-986, 1977;.
27 +
 Diagnosis of brain death: Summary of Conference of Royal Colleges and Faculties of the United Kingdom . Lancet 2:1069-1970, 1976;.
28 +
Molinari GF:  Death: The definition: III. Criteria for death . Encyclopedia of Bioethics , to be published.
29 +
Bolton CF, Brown JD, Cholod E, et al:  EEG and "brain life." Lancet 1:535, 1976;.
30 +
Bab Talmud Tractate Yoma 85A.
31 +
Bab Talmud Tractate Chullin 21A and Mishnah Oholoth 1:6.
32 +
Maimonides: Tumath Meth 1:15.
33 +
Code of Laws:  Who is considered as dead although yet living? Yoreh Deah :370:1.
34 +
Genesis 2:7.
35 +
Connery JR:  Comment on the proposed act to amend the public health law of the State of New York in relation to the determination of the occurrence of death . Read before the New York State Legislature, 1975-1976 session, March 25, 1975 .
36 +
McFadden CJ: The Dignity of Life: Moral Values in a Changing Society . Huntington, Ind, Our Sunday Visitor Inc, 1976;, p 202.
37 +
Pius XII, Acta Apostolicae Sedia 45, November 1957, pp 1027-1033.
38 +
Nelson J: Human Medicine: Ethical Perspective on New Medical Issues . Minneapolis, Augsburg, 1973;, pp 125-130.
39 +
Fletcher J:  Our shameful waste of human tissue: An ethical problem for the living and the dead , in Cutler DR (ed): Updating Life and Death: Essays in Ethics and Medicine . Boston, Beacon Press, 1969;, pp 1-30.
40 +
Fletcher J:  New definitions of death . Prism 2:13ff, (January) 1974;.
41 +
Vaux K: Biomedical Ethics . New York, Harper & Row, 1974;, pp 102-110.
42 +
Smith H: Ethics and the New Medicine . Nashville, Tenn, Abington, 1970;.

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