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Brain	
  Death	
  Rejected:	
  	
  Expanding	
  
Clinicians'	
  Legal	
  Du:es	
  to	
  
Accommodate	
  Religious	
  Objec...
2	
  
End	
  	
  	
  
of	
  life	
  
4	
  
Pa:ent’s	
  
	
  	
  CBO	
  
5	
  
Roadmap	
  
6	
  
1.  Legal	
  status	
  of	
  
	
  	
  	
  brain	
  death	
  
	
  
2.	
  	
  	
  Religious	
  objec:ons	
  
	
  	
  	...
3.  DuMes	
  to	
  
accommodate	
  
objecMons	
  
	
  
4.	
  	
  Reasons	
  to	
  extend	
  
	
  accommodaMon	
  laws	
  
8	
  
Legal	
  status	
  
of	
  brain	
  
death	
  
All	
  56	
  US	
  
jurisdicMons	
  	
  
	
  
(narrow	
  excepMon	
  in	
  NJ)	
  
11	
  
UDDA	
  
An	
  individual	
  .	
  .	
  .	
  .	
  .	
  	
  is	
  dead	
  .	
  .	
  .	
  
who	
  has	
  sustained	
  either	
  	
  	
...
 
	
  total	
  
brain	
  
failure	
  
	
  
=	
  	
  death	
  
Legally	
  
seGled	
  	
  	
  
since	
  1980s	
  
Remains	
  	
  
seled	
  
(legally)	
  
“durable	
  
worldwide	
  
consensus”	
  
Bernat	
  	
  2013	
  
20	
  
Clinician	
  
du:es	
  aHer	
  
death	
  
“A_er	
  a	
  paMent	
  .	
  .	
  .	
  brain	
  
dead	
  .	
  .	
  .	
  medical	
  support	
  
should	
  be	
  discon:nued...
Consent	
  	
  not	
  
required	
  to	
  
stop	
  
physiological	
  
support	
  	
  
Not	
  a	
  
paMent	
  
Dead	
  
Not	
  a	
  
paMent	
  
No	
  
duty	
  
to	
  
treat	
  
27	
  
Religious	
  
objec:ons	
  
 
	
  total	
  
brain	
  
failure	
  
	
  
=	
  	
  death	
  
Not	
  dead	
  unMl	
  
heart	
  or	
  
breathing	
  stops	
  
Orthodox	
  Jews	
  
Japanese	
  Shinto	
  
NaMve	
  Americans	
  
Buddhists	
  
Muslim	
  (some)	
  
31	
  
Du:es	
  to	
  
accommodate	
  
objec:ons	
  
CA	
  	
  	
  	
  IL	
  	
  	
  	
  NY	
  
 “Each	
  hospital	
  shall	
  
establish	
  .	
  .	
  .	
  procedure	
  
for	
  the	
  reasonable	
  
accommoda:on	
  of	...
No	
  
duty	
  	
  
treat	
  
Dead	
  
No	
  
duty	
  	
  
treat	
  
Dead	
  
NY	
  CA	
  IL	
  change	
  this	
  
Imposes	
  duMes	
  
to	
  “treat”	
  	
  	
  	
  
aHer	
  DDNC	
  
Limited	
  
“reasonably	
  
brief	
  period”	
  
<24	
  	
  	
  x	
  x	
  x	
  x	
  
24	
   	
  	
  x	
  x	
  x	
  x	
  x	
  x	
  
36	
  
48	
  	
  	
  	
  x	
  
72	
  	
 ...
NJ	
  
Opposite	
  	
  
No	
  
duty	
  	
  
treat	
  
Dead	
  
NJ	
  changes	
  this	
  
Changes	
  
definiMon	
  
itself	
  
 “[D]eath	
  .	
  .	
  .	
  shall	
  not	
  	
  
be	
  declared	
  upon	
  the	
  
basis	
  of	
  neurological	
  
criteri...
No	
  
death	
  
by	
  BD	
  
Religious	
  
objecMon	
  
No	
  
death	
  
by	
  CP	
  
VenMlato
r	
  
Indefinite	
  
accommodaMon	
  
	
  
(unMl	
  death	
  by	
  CP	
  criteria)	
  
Narrow	
  excep:ons	
  	
  
	
  	
  in	
  4	
  states	
  
Accommoda:on	
  
denied	
  
elsewhere	
  
Motl Brody (DC)
52
Shahida	
  Virk	
  	
  (Mich.)	
  
Cho Fook Cheng (Mass)
Extend	
  	
  
du:es	
  to	
  
accommodate	
  
1.	
  	
  BD	
  imposes	
  
on	
  profound	
  
beliefs	
  
2.	
  AccommodaMon	
  
has	
  worked	
  for	
  
decades	
  in	
  4	
  
populous	
  states	
  
 	
  No	
  complaints	
  
3.	
  DuMes	
  
are	
  limited	
  
Frequency	
  
Brain	
  death	
  	
  
<	
  1%	
  	
  
hospital	
  deaths	
  
0.3 	
  Japanese	
  Shinto	
  
0.3 	
  Orthodox	
  Jew	
  
0.3 	
  NaMve	
  American	
  
0.7 	
  Buddhist	
  
	
  
2%	
  of	
  1%	
  	
  =	
  	
  0.0002	
  
	
  
1	
  in	
  5000	
  deaths	
  
	
  
	
  
400	
  cases	
  	
  
naMonwide	
  annually	
  
	
  
Most	
  in	
  CA,	
  NY,	
  IL,	
  NJ	
  
	
  
Type	
  
“hospital	
  is	
  required	
  to	
  
conMnue	
  only	
  previously	
  
ordered	
  cardiopulmonary	
  
support.	
  No	
  o...
DuraMon	
  
69
24	
  h	
  
“in	
  determining	
  what	
  
is	
  reasonable,	
  a	
  
hospital	
  shall	
  
consider	
  .	
  .	
  .	
  needs	
  of	
  ...
4.	
  Brain	
  death	
  
conceptually	
  
flawed	
  
 
	
  total	
  
brain	
  
failure	
  
	
  Death	
  =	
  
Value	
  laden	
  judgment	
  
about	
  when	
  it	
  is	
  
worthwhile	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
 ...
uniformity	
  
Only	
  NJ	
  changes	
  who	
  is	
  
dead	
  
	
  
CA	
  –	
  IL	
  –	
  NY	
  
accommodaMon	
  does	
  	
  
not	
  thre...
79
Thaddeus	
  Mason	
  Pope	
  	
  
Director,	
  Health	
  Law	
  InsMtute	
  
Hamline	
  University	
  School	
  of	
  L...
80	
  
References	
  
Medical	
  Fu:lity	
  Blog	
  	
  
	
  
Since	
  July	
  2007,	
  I	
  have	
  been	
  blogging,	
  almost	
  daily,	
  
t...
Brain	
  Death	
  Rejected:	
  Expanding	
  Clinicians'	
  
Legal	
  DuMes	
  to	
  Accommodate	
  Religious	
  
ObjecMons...
Legal	
  Aspects	
  of	
  Brain	
  Death	
  DeterminaMon,	
  in	
  35	
  
SEMINARS	
  IN	
  CLINICAL	
  NEUROLOGY:	
  THE	...
Pregnant	
  and	
  Dead	
  in	
  Texas:	
  A	
  Bad	
  Law,	
  Badly	
  
Interpreted,	
  LOS	
  ANGELES	
  TIMES	
  (Jan.	...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
Thaddeus Mason Pope, "Brain Death Rejected:  Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Co...
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Thaddeus Mason Pope, "Brain Death Rejected: Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Continue Physiological Support"

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Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience.

This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation.

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Thaddeus Mason Pope, "Brain Death Rejected: Expanding Clinicians' Legal Duties to Accommodate Religious Objections and Continue Physiological Support"

  1. 1. Brain  Death  Rejected:    Expanding   Clinicians'  Legal  Du:es  to   Accommodate  Religious  Objec:ons   and  Con:nue  Physiological  Support      Petrie-­‐Flom  Center  for  Health  Law  Policy,    Biotechnology,  and  Bioethics  at  Harvard  Law    School    ●  Annual  Conference:    Law,  Religion,            and  Health  in  America    ●    May  8,  2015                Thaddeus  Mason  Pope,  J.D.,  Ph.D.                          Hamline  University  Health  Law  InsMtute  
  2. 2. 2   End       of  life  
  3. 3. 4   Pa:ent’s      CBO  
  4. 4. 5   Roadmap  
  5. 5. 6   1.  Legal  status  of        brain  death     2.      Religious  objec:ons                to  brain  death  
  6. 6. 3.  DuMes  to   accommodate   objecMons     4.    Reasons  to  extend    accommodaMon  laws  
  7. 7. 8   Legal  status   of  brain   death  
  8. 8. All  56  US   jurisdicMons       (narrow  excepMon  in  NJ)  
  9. 9. 11   UDDA  
  10. 10. An  individual  .  .  .  .  .    is  dead  .  .  .   who  has  sustained  either       (1)  irreversible  cessaMon  of   circulatory  and  respiratory   funcMons,  or     (2)  irreversible  cessaMon  of  all   funcMons  of  the  enMre  brain  
  11. 11.    total   brain   failure     =    death  
  12. 12. Legally   seGled       since  1980s  
  13. 13. Remains     seled   (legally)  
  14. 14. “durable   worldwide   consensus”   Bernat    2013  
  15. 15. 20   Clinician   du:es  aHer   death  
  16. 16. “A_er  a  paMent  .  .  .  brain   dead  .  .  .  medical  support   should  be  discon:nued.”  
  17. 17. Consent    not   required  to   stop   physiological   support    
  18. 18. Not  a   paMent   Dead  
  19. 19. Not  a   paMent   No   duty   to   treat  
  20. 20. 27   Religious   objec:ons  
  21. 21.    total   brain   failure     =    death  
  22. 22. Not  dead  unMl   heart  or   breathing  stops  
  23. 23. Orthodox  Jews   Japanese  Shinto   NaMve  Americans   Buddhists   Muslim  (some)  
  24. 24. 31   Du:es  to   accommodate   objec:ons  
  25. 25. CA        IL        NY  
  26. 26.  “Each  hospital  shall   establish  .  .  .  procedure   for  the  reasonable   accommoda:on  of  the   individual's  religious  .  .  .   objecMon.  .  .  .”   10  N.Y.C.R.R.  §  400.16(e)(3)  
  27. 27. No   duty     treat   Dead  
  28. 28. No   duty     treat   Dead   NY  CA  IL  change  this  
  29. 29. Imposes  duMes   to  “treat”         aHer  DDNC  
  30. 30. Limited  
  31. 31. “reasonably   brief  period”  
  32. 32. <24      x  x  x  x   24      x  x  x  x  x  x   36   48        x   72        x  x  x  
  33. 33. NJ  
  34. 34. Opposite    
  35. 35. No   duty     treat   Dead   NJ  changes  this  
  36. 36. Changes   definiMon   itself  
  37. 37.  “[D]eath  .  .  .  shall  not     be  declared  upon  the   basis  of  neurological   criteria  .  .  .  when  .  .  .   violate  the  personal   religious  beliefs  .  .  .  .”  
  38. 38. No   death   by  BD   Religious   objecMon  
  39. 39. No   death   by  CP   VenMlato r  
  40. 40. Indefinite   accommodaMon     (unMl  death  by  CP  criteria)  
  41. 41. Narrow  excep:ons        in  4  states  
  42. 42. Accommoda:on   denied   elsewhere  
  43. 43. Motl Brody (DC)
  44. 44. 52 Shahida  Virk    (Mich.)  
  45. 45. Cho Fook Cheng (Mass)
  46. 46. Extend     du:es  to   accommodate  
  47. 47. 1.    BD  imposes   on  profound   beliefs  
  48. 48. 2.  AccommodaMon   has  worked  for   decades  in  4   populous  states  
  49. 49.    No  complaints  
  50. 50. 3.  DuMes   are  limited  
  51. 51. Frequency  
  52. 52. Brain  death     <  1%     hospital  deaths  
  53. 53. 0.3  Japanese  Shinto   0.3  Orthodox  Jew   0.3  NaMve  American   0.7  Buddhist    
  54. 54. 2%  of  1%    =    0.0002     1  in  5000  deaths      
  55. 55. 400  cases     naMonwide  annually     Most  in  CA,  NY,  IL,  NJ    
  56. 56. Type  
  57. 57. “hospital  is  required  to   conMnue  only  previously   ordered  cardiopulmonary   support.  No  other  medical   intervenMon  is  required.”  
  58. 58. DuraMon  
  59. 59. 69 24  h  
  60. 60. “in  determining  what   is  reasonable,  a   hospital  shall   consider  .  .  .  needs  of   other  pa:ents  .  .  .  .”  
  61. 61. 4.  Brain  death   conceptually   flawed  
  62. 62.    total   brain   failure    Death  =  
  63. 63. Value  laden  judgment   about  when  it  is   worthwhile                                 to  conMnue   physiological  support    
  64. 64. uniformity  
  65. 65. Only  NJ  changes  who  is   dead     CA  –  IL  –  NY   accommodaMon  does     not  threaten  uniformity  
  66. 66. 79 Thaddeus  Mason  Pope     Director,  Health  Law  InsMtute   Hamline  University  School  of  Law   1536  Hewi  Avenue     Saint  Paul,  Minnesota  55104   T    651-­‐523-­‐2519   F    901-­‐202-­‐7549   E    Tpope01@hamline.edu   W    www.thaddeuspope.com   B    medicalfuMlity.blogspot.com  
  67. 67. 80   References  
  68. 68. Medical  Fu:lity  Blog       Since  July  2007,  I  have  been  blogging,  almost  daily,   to  medicalfu:lity.blogspot.com.    This  blog  is   focused  on  reporMng  and  discussing  legislaMve,   judicial,  regulatory,  medical,  and  other   developments  concerning  medical  fuMlity  and  end-­‐ of-­‐life  medical  treatment  conflict.    The  blog  has   received  over  850,000  direct  visits.    Plus,  it  is   distributed  through  RSS,  email,  Twier,  and  re-­‐ publishers  like  Westlaw,  Bioethics.net,  Wellsphere,   and  Medpedia.     81
  69. 69. Brain  Death  Rejected:  Expanding  Clinicians'   Legal  DuMes  to  Accommodate  Religious   ObjecMons  and  ConMnue  Physiological  Support,   invited  manuscript  for  2015  Annual  Conference   Law,  Religion,  and  American  Healthcare,  PETRIE-­‐ FLOM  CENTER  FOR  HEALTH  POLICY,   BIOTECHNOLOGY,  AND  BIOETHICS,  HARVARD   LAW  SCHOOL  (May  2015).     Brain  Death:    Legal  DuMes  to  Accommodate   Religious  ObjecMons  147  CHEST  __  (2015).  
  70. 70. Legal  Aspects  of  Brain  Death  DeterminaMon,  in  35   SEMINARS  IN  CLINICAL  NEUROLOGY:  THE  CLINICAL   PRACTICE  OF  BRAIN  DEATH  DETERMINATION   (forthcoming  2015)  (with  Christopher  Burkle).     Review  of  Death  before  Dying:  History,  Medicine,   and  Brain  Death  (OUP  2014),  36  JOURNAL  OF  LEGAL   MEDICINE  (forthcoming  2015).     Legal  Briefing:  Brain  Death  and  Total  Brain  Failure,   25(3)  JOURNAL  OF  CLINICAL  ETHICS  245-­‐257  (2014).  
  71. 71. Pregnant  and  Dead  in  Texas:  A  Bad  Law,  Badly   Interpreted,  LOS  ANGELES  TIMES  (Jan.  16.  2014)   (with  Art  Caplan).     Legal  Briefing:  Organ  DonaMon,  21(3)  JOURNAL   OF  CLINICAL  ETHICS  243-­‐263  (2010).  

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