The Case for Reasonable Accommodation of Conscientious Objections to Declarations of Brain Death

Abstract

Since its inception in 1968, the concept of whole-brain death has been contentious, and four decades on, controversy concerning the validity and coherence of whole-brain death continues unabated. Although whole-brain death is legally recognized and medically entrenched in the United States and elsewhere, there is reasonable disagreement among physicians, philosophers, and the public concerning whether brain death is really equivalent to death as it has been traditionally understood. A handful of states have acknowledged this plurality of viewpoints and enacted "conscience clauses" that require "reasonable accommodation" of religious and moral objections to the determination of death by neurological criteria. This paper argues for the universal adoption of "reasonable accommodation" policies using the New Jersey statute as a model, in light of both the ongoing controversy and the recent case of Jahi McMath, a child whose family raised religious objections to a declaration of brain death. Public policies that accommodate reasonable, divergent viewpoints concerning death provide a practical and compassionate way to resolve those conflicts that are the most urgent, painful, and difficult to reconcile.

A morte que salva vidas: complexidades do cuidado médico ao paciente com suspeita de morte encefálica

“…Quanto às controvérsias na definição da morte encefálica (Quadro 1), os entrevistados discorrem sobre as dificuldades que envolvem "uma função vital artificial" e levam à negação e incompreensão por profissionais e familiares. Embora a morte do cérebro seja clínica e legalmente reconhecida, há um desacordo do seu significado entre médicos, filósofos e outros atores diretamente envolvidos 16 . Estudos 16,35,36 consideram que, desde a sua criação, esse conceito expõe controvérsias acerca da sua validade e coerência, sobretudo sua equivalência à definição de morte tradicionalmente aceita, vinculada à parada cardiorrespiratória.…”

“…Na literatura internacional, estudos sobre o cuidado médico ao paciente em suspeita de morte encefálica focam no envolvimento da família neste processo, sobretudo durante a realização do protocolo de morte encefálica 12,13 ; nos desafios enfrentados pelos médicos durante a abordagem sobre a doação de órgãos 14,15 ; e nas próprias dificuldades destes profissionais referentes ao conceito de morte encefálica 16,17 .…”

Is there a place for CPR and sustained physiological support in brain-dead non-donors?

“…Many would not. Only one state, New Jersey, permits indefinite extensions of physiological support in individuals who hold religious objections to brain death, in part to accommodate its Orthodox Jewish population 23 25 26. Healthcare institutions in New Jersey have not reported burdensome consequences in the 25 years since these exemptions were first granted.…”

A Response to the Legitimacy of Brain Death in Islam

“…Jahi McMath was declared brain-dead in December 2013. Her parents objected based on religious grounds and transferred Jahi to a different medical facility for continued medical care (Johnson 2016 ). Jahi McMath has remained alive with mechanical ventilation and assisted nutrition.…”