Skip to main content

Legal Responses to Religious and Other Objections to Declaration of Death by Neurologic Criteria

  • Chapter
  • First Online:
Death Determination by Neurologic Criteria

Part of the book series: Advances in Neuroethics ((AIN))


The concept of death by neurologic criteria has achieved wide, but not universal, acceptance. Disputes arise in the legal context in the form of claims that consent is required for testing for determination of death by neurologic criteria, that these determinations are incorrect, that the tests are unable to satisfy the legal criteria, and that the right to freedom of religion requires that religious objectors be exempted or accommodated. In this chapter, I describe briefly how these challenges have been framed and received by the courts, with a focus on religious objection. Legislators have responded to religious and cultural objections in different ways, occasionally providing statutory exemptions and accommodations. The chapter offers a description of the analysis in McKitty v Hayani (2018), a recent Canadian case that raised a constitutional right to the accommodation of religious objections to death by neurologic criteria. The question remains to be settled legally in Canada.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  1. Gross SE, Lavi S, Boas H. Medicine, technology, and religion reconsidered: the case of brain death definition in Israel. Sci Technol Hum Values. 2019;44(2):186–208.

    Article  Google Scholar 

  2. Ad Hoc Committee Harvard Medical School. 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(6):337.

    Article  Google Scholar 

  3. Greer DM, Shemie SD, Lewis A, et al. Determination of brain death/death by neurologic criteria: the world brain death project. JAMA. 2020;324(11):1078.

    Google Scholar 

  4. Silvester W, Dawson R, Quayyum S, et al. Brain death—death by neurologic criteria and the law. Supplement 13 to Greer DM et al. Determination of brain death/death by neurologic criteria: the world brain death project. JAMA. 2020;324(11):1078.

    Google Scholar 

  5. McKitty v Hayani 2018 ONSC 4105 (Ontario Superior Court of Justice). Accessed 14 Jan 2022.

  6. McKitty v Hayani 2019 ONCA 805 (Ontario Court of Appeal). Accessed 14 Jan 2022.

  7. Chandler JA. Cultural neuroethics in practice – Human rights law and brain death. In: Farisco M, editor. Neuroethics and cultural diversity. London: ISTE-Wiley; 2022.

    Google Scholar 

  8. Brown TR. Medical futility and religious free exercise. First Amendment Law Rev. 2017;15:43–95.

    Google Scholar 

  9. Terunuma Y, Mathis BJ. Cultural sensitivity in brain death determination: a necessity in end-of-life decisions in Japan. BMC Med Ethics. 2021;22(1):58.

    Article  Google Scholar 

  10. Yang Q, Miller G. East–West differences in perception of brain death: review of history, current understandings, and directions for future research. J Bioeth Inq. 2015;12(2):211–25.

    Article  Google Scholar 

  11. Pope TM. Brain death forsaken: growing conflict and new legal challenges. J Legal Med. 2017;37(3–4):265–324.

    Article  Google Scholar 

  12. Morlani et al. v. Hadara 2021 ONSC 7288 (Ontario Superior Court of Justice). Accessed 14 Jan 2022.

  13. National Conference of Commissioners on Uniform State Laws (NCCUSL). Uniform Determination of Death Act 1980. Accessed 14 Jan 2022.

  14. In re guardianship of Hailu, 361 P.3d 524 (Nev. 2015).

    Google Scholar 

  15. Lewis A, Bonnie RJ, Pope T. It’s time to revise the uniform determination of death act. Ann Intern Med. 2019;172(2):143–5.

    Article  Google Scholar 

  16. Miller FG, Nair-Collins M. An incoherent proposal to revise the Uniform Determination of Death Act. Hastings Center Bioethics Forum, 23 January 2020. Accessed 14 Jan 2022.

  17. Lewis A. The uniform determination of death act is being revised. Neurocrit Care. 2022;

  18. Veatch RM. Controversies in defining death: a case for choice. Theor Med Bioeth. 2019;40:381–401.

    Google Scholar 

  19. Canadian Charter of Rights and Freedoms, Part 1 of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11.

    Google Scholar 

  20. McMath et al. v. State of California et al., Complaint for Declaratory and Injunctive Relief, Petition for Injunctive and Declaratory Relief. Dated 23 December 2015. Accessed 14 Jan 2022.

  21. Fonseca v. Kaiser Permanente et al. Complaint for Declaratory Relief and Request for Temporary Restraining Order and Injunctive Relief. Dated 28 April 2016. Accessed 14 Jan 2022.

  22. Ezer T, Wright MS, Fins JJ. The neglect of persons with severe brain injury in the United States: an international human rights analysis. Health Hum Rights. 2020;22(1):265–78.

    Google Scholar 

  23. Young MJ, Bodien YG, Giacino JT, et al. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain. 2021;144(11):3291–310.

    Google Scholar 

  24. Akabayashi A. Bioethics across the globe. Singapore: Springer; 2020. p. 13–26.

    Google Scholar 

  25. Japan Organ Transplant Network (JOTN). The enactment of the organ transplantation law, and the revised organ transplant act [Internet]. Accessed 14 Jan 2022.

  26. Asai A, Kadooka S, Aizawa K. Arguments against promoting organ transplants from brain-dead donors, and views of contemporary Japanese on life and death. Bioethics. 2012;26(4):215–23.

    Article  Google Scholar 

  27. Natori Y. Legal determination of brain death. JMAJ. 2011;54(6):363–7.

    Google Scholar 

  28. Japan Organ Transplant Network (JOTN). Views on brain death [Internet]. Accessed 14 Jan 22.

  29. New Jersey Law Revision Commission. Final Report Relating to the New Jersey Declaration of Death Act. 18 January 2013. Accessed 14 Jan 2022.

  30. N.J. Rev. Stat. § 26:6A-5; N.J. Admin. Code § 13:35-6A.6.

    Google Scholar 

  31. N.J. Rev. Stat. § 26:6A-7.

    Google Scholar 

  32. Ashkenazi T, Steinberg A, Cohen J. A national survey of attitudes of the Zionist ultra-orthodox community in Israel to organ donation. Prog Transplant. 2019;29(1):43–7.

    Article  Google Scholar 

  33. Cohen J, Ashkenazi T, Katvan E, Singer P. Brain death determination in Israel: the first two years experience following changes to the brain death law-opportunities and challenges: brain death determination. Am J Transplant. 2012;12(9):2514–8.

    Article  CAS  Google Scholar 

  34. Israel, Cerebro-Respiratory Death Act, 2008. Translation available from the Halachic Organ Donation Society,; Accessed 14 Jan 2022.

  35. Ill Rev Stat Ch 110 § 302(b); 1981.

    Google Scholar 

  36. Clausing M. The acceptance of brain death as a legal definition of death in Illinois: In Re Haymer. DePaul Law Rev. 1983;33:207–23.

    Google Scholar 

  37. In re Haymer 115 Ill. App. 3d 349, 450 N.E.2d 940 (Ill. App. Ct 1983).

    Google Scholar 

  38. 210 Ill. Comp. Stat 85/6.23; 2012.

    Google Scholar 

  39. Cal Health & Safety Code § 1254.4(a).

    Google Scholar 

  40. 10 N.Y.C.R.R. § 400.16; 1987.

    Google Scholar 

  41. NY State Department of Health and NY State Task Force on Life & the Law. Guidelines for Determining Brain Death November 2011. Accessed 14 Jan 2022.

  42. Trinidad and Tobago. Human Tissue Transplant Act c. 28:07, Act 13 of 2000, and Human Tissue Transplant Regulations LN 314/2004. Accessed 14 Jan 2022.

  43. Durham WC, Evans C. Freedom of religion and religion-state relations. Chapter 19. In: Tushnet M, Fleiner T, Saunder C, editors. Routledge handbook of constitutional law. London/New York: Routledge; 2013.

    Google Scholar 

  44. Berger BL. Section 1, constitutional reasoning and cultural difference: assessing the impacts of Alberta v Hutterian Brethren of Wilson colony. Supreme Court Law Rev (2d). 2010;51:25–46.

    Google Scholar 

  45. Gilbert D. Faith and/in medicine: religious and conscientious objections to MAiD. Dalhousie Law J. 2020;32:657.

    Google Scholar 

  46. Alberta v. Hutterian Brethren of Wilson Colony 2009 SCC 37 (Supreme Court of Canada). Accessed 14 Jan 2022

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jennifer A. Chandler .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chandler, J.A. (2022). Legal Responses to Religious and Other Objections to Declaration of Death by Neurologic Criteria. In: Lewis, A., Bernat, J.L. (eds) Death Determination by Neurologic Criteria. Advances in Neuroethics. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-15946-6

  • Online ISBN: 978-3-031-15947-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics