Statement in Support of Revising the Uniform Determination of Death Act and in Opposition to a Proposed Revision

Abstract

Discrepancies between the Uniform Determination of Death Act (UDDA) and the adult and pediatric diagnostic guidelines for brain death (BD) (the “Guidelines”) have motivated proposals to revise the UDDA. A revision proposed by Lewis, Bonnie and Pope (the RUDDA), has received particular attention, the three novelties of which would be: (1) to specify the Guidelines as the legally recognized “medical standard,” (2) to exclude hypothalamic function from the category of “brain function,” and (3) to authorize physicians to conduct an apnea test without consent and even over a proxy’s objection. One hundred seven experts in medicine, bioethics, philosophy, and law, spanning a wide variety of perspectives, have come together in agreement that while the UDDA needs revision, the RUDDA is not the way to do it. Specifically, (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD in a non-BD patient, provides no benefit to the patient, does not reliably accomplish its intended purpose, and is not even absolutely necessary for diagnosing BD according to the internal logic of the Guidelines; it should at the very least require informed consent, as do many procedures that are much more beneficial and less risky. Finally, objections to a neurologic criterion of death are not based only on religious belief or ignorance. People have a right to not have a concept of death that experts vigorously debate imposed upon them against their judgment and conscience; any revision of the UDDA should therefore contain an opt-out clause for those who accept only a circulatory-respiratory criterion.

Revise the Uniform Determination of Death Act to Align the Law With Practice Through Neurorespiratory Criteria

“…Although it has served as a model statute for 40 years, and has been embraced in whole or in part throughout the United States, 2 there is a growing recognition that the UDDA must be updated. 3 - 5 The Uniform Law Commission recently approved a Study Committee's recommendation to form a Drafting Committee that should submit its proposed UDDA revisions by July 2023. Meanwhile, Nevada, Oklahoma, and Texas have already moved to amend their own UDDA statutes (NV.…”

Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death

“…Despite its widespread adoption, there remains active debate on whether the UDDA is an appropriate statutory definition of death. [17][18][19] Medical students tend to have a poor knowledge of the criteria of brain death diagnosis, 5,6,8 yet little investigation has gone into students' attitudes toward different conceptions of death.…”

POINT: Whether Informed Consent Should Be Obtained for Apnea Testing in the Determination of Death by Neurologic Criteria? Yes

“…Another serious risk has received little attention: causing further brain damage and even precipitating BD. 4,5,[7][8][9] Management guidelines for patients who are braininjured warn that hypercarbia and acidosis (and with hypoxic-ischemic cause, possibly also hyperoxia) can exacerbate brain damage. Therefore, basic principles of neurointensive care include maintaining normocarbia, neutral pH, and normoxia.…”