"New technologies and medical treatments have complicated questions such as how to determine the moment when someone has died. The result is a failure to establish consensus on the definition of death and the criteria by which the moment of death is determined. This creates confusion and disagreement not only among medical, legal, and insurance professionals but also within families faced with difficult decisions concerning their loved ones."
Veatch and Ross argue that the definition of death is not a scientific question but a social one rooted in religious, philosophical, or social beliefs. Drawing on history and recent court cases, the authors detail three potential definitions of death--the whole-brain concept; the circulatory, or somatic, concept; and the higher-brain concept. Because no one definition of death commands majority support, it creates a major public policy problem. The authors cede that society needs a default definition to proceed in certain cases, like those involving organ transplantation. But they also argue the decision-making process must give individuals the space to choose among plausible definitions of death according to personal beliefs.
1. Defining Death: An Introduction
The Emergence of the Controversy
Three 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
2. The Dead Donor Rule and the Concept of Death
The Dead Donor Rule
Candidates for a Concept of "Death"
The Public Policy Question
3. 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
4. The Circulatory, or Somatic, Concept of Death
Two 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
5. The Higher-Brain Concept of Death
Which Brain Functions Are Critical?
Altered States of Consciousness: A Continuum
Measuring Loss of Higher-brain Function
The Legal Status of Death
6. 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
7. 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