CHEST Guidelines-Brain-Death

Brain-Death_chest

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In response to an article by Luce in the journal CHEST, Thaddeus Mason Pope addresses legal and ethical issues surrounding the determination of death by neurologic criteria (DDNC), commonly referred to as "brain death." Pope seeks to correct and clarify Luce's discussion about state laws accommodating religious or moral objections to DDNC.<br /><br />Firstly, Pope contests Luce's statement regarding New York's policies. While New York considered legislation in 1986 that would allow families to reject DDNC on religious grounds, this legislation did not pass. Instead, New York mandates "reasonable accommodation" for religious or moral objections, requiring hospitals to provide limited physiologic support for 24 to 72 hours after DDNC, unlike New Jersey, where an objection can change a person's death status.<br /><br />Secondly, Pope notes that Illinois also mandates that hospitals reasonably accommodate religious objections, a point Luce overlooks. Similar to California and New York, Illinois requires hospitals to consider a patient's religious beliefs in documenting the time of death.<br /><br />Lastly, Pope argues against a New Jersey-style law that entirely exempts religious objectors from DDNC, suggesting that "reasonable accommodation" laws in states like California, Illinois, and New York strike a better balance. These laws are not deemed burdensome, and most hospitals currently offer such accommodations. As such, expanding this mandate to other states would align with existing practices and provide clarity.<br /><br />Pope highlights that the US population with religious objections to DDNC is small, making related disputes rare. Thus, he advocates for codifying "reasonable accommodation" as the standard of care nationwide, reinforcing the existing informal practices of American hospitals.

Keywords

brain death

determination of death

neurologic criteria

religious objections

legal issues

ethical issues

reasonable accommodation

state laws

Thaddeus Mason Pope

New York policies