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14 Issues L. & Med. 125 (1998-1999)
Brainstem Death, Brain Death and Death: A Critical Re-Evaluation of the Purported Equivalence

handle is hein.journals/ilmed14 and id is 143 raw text is: Brainstem Death, Brain Death and Death: A Critical Re-Evaluation of the Purported Equivalence D. Alan Shewmon, M.D.* ABSTRACT: The author challenges brain-based diagnoses of death by re-examining the concept of death, its definition, the anatomical criterion, and the clinical signs or tests. Dr. Shewmon challenges the fundamental assumptions underlying brain death: (1) that the brain is the body's critical system; and (2) that the body even has a localized critical system. He does not redefine death, but shifts the anatomical criterion from a single focus (the brain) to the entire body. The clinical tests correspondingly shift from those implying loss of brain function to those implying thermodynamically supracritical microstructural damage diffusely throughout the body. He concludes that the notion of brain death as bodily death is logically and physiologically incoherent, and that its replacement by something scientifically more credible would promote not only the sanctity of life, but ironically even transplantation as well. *Professor of Pediatric Neurology, UCLA Medical School; B.A., Harvard College, 1971; M.D., New York University Medical School, 1975. This article was adapted from a debate-lecture, Disputed Question #1: Is it Reasonable to Use as a Basis for Diag- nosing Death the UK Protocol for the Clinical Diagnosis of 'Brain Stem Death'? presented at the Linacre Centre for Health Care Ethics 20'h Anniversary International Conference, July 28-31, 1997, Queen's College, Cambridge University. Published with permission of the Linacre Centre. Direct correspondence to: D. Alan Shewmon, M.D., Department of Pediatrics, Division of Neurology, UCLA Medical Center, MDCC 22-474, Box 951752, Los Angeles, CA 90095-1752; tel: (310) 825-6196; fax: (310) 825-5834; email: ashewmon@pediatrics.medsch.ucla.edu.

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