Table of Contents

Defining death : an introduction.
The emergence of the controversy.
Groups of definitions.
The emergence of a uniform brain-oriented definition.
Irreversible vs. permanent loss of function.
Defining death and transplanting organs.
The structure of the book.
The dead donor rule and the concept of death.
The dead donor rule.
Candidates for a concept of "death".
The public policy question.
The whole-brain concept of death.
The case for the whole-brain concept.
Criteria for the destruction of all brain functions.
Problems with the whole-brain definition : case reports.
Problems with the whole-brain definition : the alternatives.
The circulatory, or somatic, concept of death.
Measurements of death.
Circulatory death and organ procurement.
The DCD protocols.
Shewmon's somatic concept.
The two definitions of the US President's Council on Bioethics.
The higher-brain concept of death.
Which brain functions are critical?.
Altered states of consciousness : a continuum.
Measuring loss of higher-brain function.
Ancillary tests.
The legal status of death.
The conscience clause : how much individual choice can our society tolerate in defining death?.
The present state of the law.
Concepts, criteria, and the role of value pluralism.
Explicit patient choice, substituted judgment, and best interest.
Limits on the range of discretion.
The problem of order : objections to a conscience clause.
Implementation of a conscience clause.
Crafting a new definition of death law.
Incorporating the higher-brain notion.
The conscience clause.
Clarification of the concept of "irreversibility".
A proposed new definition of death for public policy purposes. For most of human history there was little question about whether someone was dead or alive--a heartbeat or a pulse, or a foggy mirror under the nostrils, provided sufficient evidence. But in the mid-20th century, with new technologies and medical interventions that prolonged the dying process, the questions around the precise moment of death became much more complicated. Today the global medical community recognizes three general definitions of death: whole-brain, circulatory or somatic, and higher-brain. But even in the United States alone no single concept of death has the support of the majority of its citizens. Despite attempts to create and establish a uniform definition of death, physicians and policymakers continue to disagree on criteria and standards--resulting in confusion and acrimony in medicine, law, and insurance, not to mention families gathered around the bedside of a dying loved one. In this brief introduction Veatch and Ross lay out the history of this contentious issue and describe the three major definitions of death in detail. They contend that choosing a particular definition of death reflects an individual's basic religious and philosophical beliefs about what is essential to human existence. So while they propose higher-brain death as a default policy, they argue for some degree of personal choice.