Death Determination and Clinicians’ Epistemic Authority

Rodríguez‐Arias, David; Pérez, Alberto Molina; Díaz-Cobacho, Gonzalo

doi:10.1080/15265161.2020.1754514

Cited by 16 publications

(8 citation statements)

References 9 publications

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“…Our analysis deepens previous insights into the role of relatives, which international colleagues have profoundly analyzed (Delgado et al 2019;Rodríguez-Arias, Molina-Pérez, and Díaz-Cobacho 2020;Shaw et al 2020). Based on their comparative analyses, we provide case studies, which give detailed insights that a lack of information about the role of the family 1 in the German organ donation system has unintended consequences for the relatives, as well as the medical staff involved.…”

Section: Introductionmentioning

confidence: 60%

Explorations about the Family’s Role in the German Transplantation System: Epistemic Opacity and Discursive Exclusion

Hilbrich

Hansen

2021

Social Epistemology

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With regard to organ donation, Germany is an 'opt-in' country, which requires explicit consent from donors. The relatives are either asked to decide on behalf of the donors' preferences, if these are unknown or if the potential donor has explicitly transferred the decision to them. At the core of this policy lies the sociocultural and moral premise of a rational, autonomous individual, whose rights require legal protection in order to guarantee a voluntary decision. In concrete transplantation practices, the family plays an even more important role. Potential donors and their families decide while being embedded in relations, a point which does still not gain full recognition. This particular discrepancy between policy and practice creates conflicts, which remain taboos of academic inquiry and public discourse. Our analysis shows a plurality of the family's role in the transplantation process, which reveals an inner tension of the organ donation system. This tension provokes epistemic opacity on the one hand and different collective strategies as responses to discursive exclusion on the other. In future deliberations about organ donation, it is important to create spaces for open discussion, but also practices of communicative engagement, which take care of the needs and emotions attached to taboos.

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Section: Introductionmentioning

confidence: 60%

Explorations about the Family’s Role in the German Transplantation System: Epistemic Opacity and Discursive Exclusion

Hilbrich

Hansen

2021

Social Epistemology

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“…The problems raised in this article correspond to the need to expand the scope of scientific research dealing with the borderline between human life and death. The research conducted so far shows that “though most clinicians know and personally endorse the legal criteria for declaring death, some may still feel uncomfortable with the concept of death and hesitant with the idea that brain death really equates to death” [ 22 ]. It must be stressed that even some neurologists do not have a consistent rationale for accepting brain death as death [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Attitudes of Polish Doctors towards Brain Death

Leśniewski

Antoszewska

Baczewska

2022

IJERPH

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Brain death has been one of the most controversial issues in the medical and bioethical debate globally for more than fifty years. There is no unanimous acceptance of the understanding of brain death, and a single set of neurological criteria for the determination of human death that is accepted worldwide has yet to be established. Physicians from different specialisations understand brain death differently. Therefore, research is needed to understand and typologically classify their points of views as regards brain death. In Poland, this research is particularly important, as the views of anaesthesiologists, neurologists and transplantologists, who fully accept and support brain death as being synonymous with biological human death, have dominated the scholarly debate on this issue. This study presents the opinions of Polish physicians with various medical specialisations in relation to brain death. Free-form interviews with 28 doctors were conducted. Participants expressed their personal views on brain death, while exhibiting at the same time various emotions. We discuss our findings in relation to the existing framework of knowledge and debate concerning brain death and the Polish legal regulation in force when the interviews were carried out. Although participants had different beliefs with regard to brain death, the research team managed to classify their statements and opinions into five attitudes, taking into account what for them were the most important, namely: the escapist–protective attitude, the scientistic–medical attitude, the accepting–critical attitude, the ignorant–agnostic attitude, and the ambiguous attitude.

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“…It is well known that conscientious objection can be formulated by an individual in an specific situation in which a conflict between a legal imperative and an ethical imperative is raised (that is, a conviction, be it religious or not). 42 Under the donation model, conscientious objection could be considered under three scenarios: the conscientious objection of the deceased, that is, the owner of the body that projects after death the conviction held while alive; the conscientious objection of the deceased’s family if granted any ownership right over the deceased’s body by the regulation (be it a domestic or a supranational regulation); or the conscientious objection of the medical staff that opposes to an automatic organ procurement itself, or refuses to conduct brain death certification as a prelude to and precondition of deceased organ donation, 43 pleading conscientious reasons. Nevertheless, only one of those scenarios could be contemplated under the AOPM: that of the medical staff, since the left scenarios (individual and family’s conscientious objection) could not be contemplated under an AOPM, because, by definition, this model withdraws any right for the individual or his family to make any decision over the destination of the organs of the deceased.…”

Section: Arguments Against An Automatic Organ Procurement Modelmentioning

confidence: 99%

Addressing organ shortage: An automatic organ procurement model as a proposal

et al. 2021

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Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals.

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Death Determination and Clinicians’ Epistemic Authority

Cited by 16 publications

References 9 publications

Explorations about the Family’s Role in the German Transplantation System: Epistemic Opacity and Discursive Exclusion

Explorations about the Family’s Role in the German Transplantation System: Epistemic Opacity and Discursive Exclusion

Attitudes of Polish Doctors towards Brain Death

Addressing organ shortage: An automatic organ procurement model as a proposal

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