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Renaissance of criticism on the concept of brain death—the role of legal medicine in the context of the interdisciplinary discussion

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Abstract

Background

In the practice of legal medicine in Germany, the assessment of brain death is of minor importance and attracts little attention. However, since several years, international criticism on the concept of brain death has culminated. By reviewing literature and the results of a questionnaire distributed among the participants of the 93rd Annual Congress of the Germany Society of Legal Medicine, the state of knowledge and the current views on brain death were evaluated.

Materials and methods

Literature search of recent publications regarding brain death was performed (PubMed database, references of legal medicine, Report of the President’s Council on Bioethics, USA 2008). A questionnaire was developed and distributed among the participants of the Congress.

Results

The assumption that individual and brain death are synonymous is criticized. Internationally, there are trends to harmonize the very different clinical criteria to assess brain death. The diagnostic advantage of novel techniques such as CT angiography is controversially discussed. It becomes apparent that procedures which record the blood flow and perfusion of the brain will be applied more in the future. Regrettably, these developments are not described in the literature of legal medicine. Moreover, among German forensic scientists, different views concerning brain death exist. The majority favors its equivalent treatment with individual death. The thanatological background can be improved concerning certain aspects of brain death as well as its legal implications.

Conclusion

Teaching and research in legal medicine should include the subject brain death. Expertise in forensic science may contribute to the interdisciplinary discussion on brain death. The transfer of actual knowledge, also on disputed ethical aspects of thanatology, to physicians of all disciplines is of great importance.

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Acknowledgments

The authors thank the participants of the 93rd Annual Congress of the Germany Society of Legal Medicine members who answered the questionnaire and Prof. Dr. D. Mebs for his assistance in translating this article.

Conflict of interest

All authors declare that they have no competing interests.

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Authors and Affiliations

  1. Institute of Legal Medicine, University Hospital, Goethe University of Frankfurt, Frankfurt, Germany

    L. Markert, M. A. Verhoff & M. Parzeller

  2. Institute of Legal Medicine, Ernst Moritz Arndt University of Greifswald, University Medicine Greifswald, Greifswald, Germany

    B. Bockholdt

  3. Institute of Legal Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany

    S. Heinze

  4. Department of Radiology, St. Marienkrankenhaus, Ludwigshafen am Rhein, Germany

    S. Heinze

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  1. L. Markert
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  2. B. Bockholdt
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  3. M. A. Verhoff
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  4. S. Heinze
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  5. M. Parzeller
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Correspondence to L. Markert or M. Parzeller.

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Markert, L., Bockholdt, B., Verhoff, M.A. et al. Renaissance of criticism on the concept of brain death—the role of legal medicine in the context of the interdisciplinary discussion. Int J Legal Med 130, 587–595 (2016). https://doi.org/10.1007/s00414-015-1224-0

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