Neurocritical Care

, Volume 26, Issue 3, pp 446–449 | Cite as

Physician Power to Declare Death by Neurologic Criteria Threatened

  • Ariane LewisEmail author
  • Thaddeus Mason Pope
Ethical Matters



Three recent lawsuits that address declaration of brain death (BD) garnered significant media attention and threaten to limit physician power to declare BD.


We discuss these cases and their consequences including: the right to refuse an apnea test, accepted medical standards for declaration of BD, and the irreversibility of BD.


These cases warrant discussion because they threaten to: limit physicians’ power to determine death; incite families to seek injunctions to continue organ support after BD; and force hospitals to dispense valuable resources to dead patients in lieu of patients with reparable illnesses or injuries.


Physicians, philosophers, religious officials, ethicists, and lawyers must work together to address these issues and educate both the public and medical community about BD.


Brain death Death by neurologic criteria Medicolegal UDDA 


Author's Contribution

Ariane Lewis was responsible for conception and design, drafting the manuscript, and final approval of the manuscript. Thaddeus Pope was responsible for conception and design, supervision, critical revision of the manuscript and final approval of the manuscript.

Compliance with Ethical Standards

Conflict of interest

Ariane Lewis and Thaddeus Pope have no conflicts of interest.


  1. 1.
    A definition of irreversible coma. Report of the Ad Hoc committee of the harvard medical school to examine the definition of brain death. JAMA. 1968;205:337–340.Google Scholar
  2. 2.
    Defining death: medical, legal and ethical issues in the determination of death. Washington D.C. 1981.Google Scholar
  3. 3.
    Wijdicks EFM. Determining brain death in adults. Neurology. 1995;45:1003–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Shemie SD, Hornby L, Baker A, et al. International guideline development for the determination of death. Intensive Care Med. 2014;40:788–97.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sprung CL, Truog RD, Curtis JR, et al. Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study. Am J Respir Crit Care Med. 2014;190:855–66.CrossRefPubMedGoogle Scholar
  7. 7.
    Bernat JL. Controversies in defining and determining death in critical care. Nat Rev Neurol. 2013;9:164–73.CrossRefPubMedGoogle Scholar
  8. 8.
    Lewis A, Varelas P, Greer D. Prolonging support after brain death: when families ask for more. Neurocrit Care. 2016;24:481–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Pope TM. Brain death: legal duties to accommodate religious objections. Chest. 2015;148:e69.CrossRefPubMedGoogle Scholar
  10. 10.
    Lewis A, Adams N, Varelas P, Greer D, Caplan A. Organ support after death by neurologic criteria: results of a survey of US neurologists. Neurology. 2016;87:827–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Shah SK, Kasper K, Miller FG. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy. J Med Ethics. 2015;41:291–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethics J. 2004;14:217–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Lewis A, Weaver J, Caplan A. Portrayal of Brain Death in Film and Television. Am J Transplant. 2016 (Epub ahead of print).Google Scholar
  14. 14.
    Lewis A, Lord AS, Czeisler BM, Caplan A. Public education and misinformation on brain death in mainstream media. Clin Transplant. 2016;30:1082–9.CrossRefPubMedGoogle Scholar
  15. 15.
    In Re: Mirranda Grace Lawson. 2016. CL16-2358, City of Richmond Circuit Court.Google Scholar
  16. 16.
    In Re: Guardianship of Hailu. 2015. 361 P.3d 5.Google Scholar
  17. 17.
    McMath vs. California. 2015. No. 3:15-06042, N.D. Cal.Google Scholar
  18. 18.
    Supreme Court of Virginia Apellate Case Management System. SCV Record Number 161321. [cited 2016 Dec 30].Google Scholar
  19. 19.
    Richer AD. Mirranda Grace Lawson dies; was focus of fight over brain death test [Internet]. Culpeper Star Expon. [cited 2016 Dec 30].
  20. 20.
    In Re: Allen Callaway. 2016. DG-16-08.Google Scholar
  21. 21.
    Datar S, Fugate J, Rabinstein A, Couillard P, Wijdicks EFM. Completing the apnea test: decline in complications. Neurocrit Care. 2014;21:392–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Burkle CM, Benson JJ. End-of-life care decisions: importance of reviewing systems and limitations after 2 recent North American cases. Mayo Clin Proc. 2012;87:1098–105.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Choong KA, Rady MY. Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society? HEC Forum. 2016 (Epub ahead of print).Google Scholar
  24. 24.
    Flamm AL, Smith ML, Mayer PA. Family members’ requests to extend physiologic support after declaration of brain death: a case series analysis and proposed guidelines for clinical management. J Clin Ethics. 2014;25:222–37.PubMedGoogle Scholar
  25. 25.
    Liao S, Ito S. Brain death: ethical challenges to palliative care concepts of family care. J Pain Symptom Manage. 2010;40:309–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Khandelwal N, Benkeser D, Coe NB, Engelberg RA, Teno JM, Curtis JR. Patterns of cost for patients dying in the intensive care unit and implications for cost savings of palliative care interventions. J Palliat Med. 2016;19:1171–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Smith ML, Flamm AL. Accommodating religious beliefs in the ICU: a narrative account of a disputed death. Narrat Inq Bioeth. 2011;1:55–64.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Division of Neurocritical Care, Departments of Neurology and NeurosurgeryNYU Langone Medical CenterNew YorkUSA
  2. 2.Mitchell Hamline School of LawSaint PaulUSA

Personalised recommendations