Beyond repeal--a Republican proposal for health care reform.

could conceivably draw the line somewhere else, such as loss of cognitive functioning, the reliability and social consensus that has emerged around brain death as death is reflected in the broad legal agreement under which brain death is recognized in every state. Medical and legal acceptance that the irreversible loss of brain functioning is death enables families to grieve the loss of their loved ones knowing that they were absolutely beyond recovery, as distinct from patients in a coma or a vegetative state. It errs on the side of certainty when organ procurement is requested. The determination of death is a highly significant social boundary. It determines who is recognized as a person with constitutional rights, who deserves legal entitlements and benefits, and when last wills and testaments become effective. Sound public policy requires bright lines backed up by agreed-on criteria, protocols, and tests when the issue is the determination of death. The law and ethics have long recognized that deferring to medical expertise regarding the diagnosis of brain death is the most reasonable way to manage the process of dying. Nothing in these two cases ought to change that stance.