Accepting brain death.

death was determined by means of multiple independent neurologic examinations, including one ordered by a court. Her family refused to accept that she had died and went to court to prevent physicians at Children’s Hospital and Research Center in Oakland from discontinuing ventilator support. Per a court-supervised agreement, the body was given to the family 3 weeks after the initial determination. The family’s attorney stated that ventilatory support was continued and nutritional support added at an undisclosed location. In Fort Worth, Texas, Marlise Muñoz’s body was maintained on mechanical ventilation for 8 weeks after the medical and legal criteria for death were met, in an attempt to “rescue” her fetus. Muñoz was 14 weeks pregnant when she died from pulmonary embolism. Her family asserted that continuing ventilatory support was contrary to what the patient would have wanted, but John Peter Smith Hospital cited a state law requiring that support not be terminated if a patient is pregnant. A judge ultimately ordered that the hospital follow the medically and legally indicated steps of declaring the patient dead and removing ventilatory support. The McMath family’s attorney claimed that their constitutional rights were violated and their religious beliefs (both about when death occurs and about prognosticating a possibility of recovery) were not respected. In making this argument, proponents of allowing family members to determine death threaten to undermine decades of law, medicine, and ethics. The current U.S. approach to determining death was developed in response to the emergence of technologies that made the traditional standard of cardiopulmonary death problematic. In 1968, an ad hoc committee at Harvard Medical School published an influential article arguing for extending the concept of death to patients in an “irreversible coma.”1 The emerging neurologic criteria for death defined it in terms of loss of the functional activity of the brain stem and cerebral cortex. Although clinical criteria were developed in the 1960s, it took more than a decade for consenAccepting Brain Death