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In this episode, Matt sits down with Christos Lazaridis (University of Chicago Medicine) to chat about what brain death is and whether brain death should count as death, period. Click here to donwload episode 148 of Elucidations.

Modern life support technology really hit its stride in the 1960s, allowing doctors to buy themselves more time to save their patients by connecting them to machines that could assist with breathing, blood oxygenation and/or heart pumping. But the flipside to that incredible technological breakthrough was that the medical community now needed to get more precise about the moment at which a person goes from being alive to being dead. After all, what had previously been a quick window between the two was now, due to life support technology, happening in extreme slow motion. In addition, organ transplanation was becoming more and more commonplace, meaning that determining whether someone was dead was no longer as simple as e.g. checking that their heart had stopped.

By the early 80s, the United States had settled on a standard definition for when someone counts as dead, which states that a person is dead if they have either permanently lost consciousness or permanently lost the ability to breathe and pump blood with their heart. That criterion makes certain life-saving practices possible; for example, it legally feasible for organ transplantation to begin once a patient has fallen into an irreversible coma, provided they agreed to donate their organs in advance.

But should a person really count as dead just because they fell into an irreversible coma? We call that condition ‘brain death’, or sometimes the wordier ‘death by neurological criteria’, and we legally count it as a full death. Critics of the notion of brain death say that it should not count as death, because a person in this condition is still biologically alive. Their argument is that saying a person in this condition is dead is just a story we’re telling ourselves.

In this episode, Christos Lazaridis—who is a practicing neurointensivist—argues that even if that is a story we’re telling ourselves, that’s fine, because death by neurological criteria is a corner case in which it makes sense for the social/legal status of being dead to come apart from the biological status of being dead. Tune in to hear why he thinks this is the case!

Further Resources

If you’d like to read up on the debate amongs clinicians and medical ethicists about the legitimacy of the notion of brain death, a great starting point is our guest’s recent paper on the topic:

Christos Lazaridis,
Defining Death Behind the Veil of Ignorance

He also recommends the following pieces:

Andrew P Huang and James L Bernat,
The Organism as a Whole in an Analysis of Death

Ari R. Joffe, Gurpreet Khaira, and Allan R. de Caen,
The intractable problems with brain death and possible solutions

Omelianchuk, Bernat, Caplan, Greer, Lazaridis, Lewis, Pope, Ross, and Magnus,
Revise the Uniform Determination of Death Act to Align the Law With Practice Through Neurorespiratory Criteria

Happy reading!

Matt Teichman