This document summarizes an academic presentation on ongoing legal attacks against the concept of brain death. It outlines 4 main attacks: 1) Requests for religious exemptions to brain death criteria. 2) Arguments that clinician consent is required for brain death testing. 3) Claims that accepted medical criteria do not fully determine death. 4) Assertions that brain dead individuals still exhibit biological functions. The presenter concludes there is a need to revise the Uniform Determination of Death Act to reduce variability and increase certainty and trust regarding brain death.

1. Brain Death
under Attack
Thaddeus Mason Pope, JD, PhD, HEC-C
ASBH 2020 (October 15, 2020)

2. 2
Nothing
to disclose

4. Nick Torres

7. 09/27/20

12. unique

14. “Doctors declared your loved
one brain dead and want to
withdraw life-sustaining
treatment against your will”
“We can help”

23. Not just
academic
debate

24. “critics and
skeptics have
not gained
much traction
with lawmakers”

25. Courts and legislatures are tackling

26. Roadmap

27. 27
Legal primer
brain death

28. 28
Legal
attacks

29. 29

30. All 56 US
jurisdictions

31. individual … dead ... either
(1) irreversible cessation of
circulatory and respiratory
functions, or
(2) irreversible cessation of all
functions of the entire brain

32. Brain death
Death

33. Dead
w/d OST

34. “brain dead . . . medical
support should be
discontinued.”

35. “all medical
interventions
should be
withdrawn.”

36. Legally settled
since 1980s

37. >40 years

38. Unraveled

39. 39
Attack 1

40. Want
religious
exemption

42. “[D]eath … shall not be
declared … neurological
… violate … personal
religious beliefs . . . .”

43. No
death
by BD
Religious
objection

44. Pt may
satisfy
BD criteria

45. 45

46. May not
declare
death

47. Until
death by
CP criteria

48. Rejected
everywhere
outside NJ

49. Still
asked for

51. Nick
Torres

52. September 17, 2020

54. • Pic stinson
• Pic others SF KY etc
• Click click click
Israel Stinson

55. Suing state
of California

56. “Plaintiffs are Christians
with firm religious
beliefs . . . heart is
beating . . . is alive.”

57. “remove CP support …
unconstitutional …
interferes …
first amendment …
freedom of religion”

58. CHOP had 2 cases summer 2018

59. Areen Chakrabarti

60. Jayden Auyeing

61. Motl Brody (DC)

62. 62
Shahida Virk (Mich.)

63. Cho Fook Cheng (Mass)

64. 64

66. Will see more
of these cases

68. 68
Attack 2

69. Must clinicians
get consent
for BD tests?

70. Some try to
prevent
BD diagnosis

72. 72
this strategy

73. Clinician
duties
after BD

75. No post-BD
treatment rights

76. 76

77. Focus on
pre-BD
rights

78. Apnea
test

79. Final
confirmatory test

83. More family
refusals

84. Almost all pediatric

85. Parental
refusals

87. No apnea test
No BD

88. Treatment duties
continue until CP
No BD

89. Practically, same
as NJ religious
exemption

90. Opt out
BD

91. Must clinicians
honor the
refusal?

92. Do clinicians
need consent
for apnea test?

93. split

95. Allen
Callaway

96. Billings, Montana

97. 6-year-old
“Drowned” July 22, 2016

100. Mom:
“no”

103. “request …
permitting … testing
… is denied”

104. “mother has sole authority
to make medical decisions .
. . including . . . brain
functionality examinations”

105. Do clinicians
need consent
for apnea test?

106. MT said
“yes”

107. KS also
“yes”

108. Brett Shively
2yo “drown”
Wichita, 2006

109. Forbid brain viability exam
TRO - 02/01/06
D/C home - 03/17/06

110. CA also
“yes”

111. Alex Pierce - drowned

113. Refuse apnea test

116. • Pic stinson
• Pic others SF KY etc
• Click click click
Israel
Stinson

117. Do clinicians
need consent
for apnea test?

118. MT, KS, CA
said “yes”

119. Plausible

120. Normally, may not
do things to patient
without consent

122. VA said
“no”

124. 124

127. YES NO
California
Kansas
Montana
Georgia
Nevada
New York
Texas
Virginia

128. Conflict
continues

130. McKinley Hawkins

132. Payton Summons

133. 133
Attack 3

134. What are accepted
medical criteria for
determining death?

135. 135

136. “must be made in
accordance with
accepted medical
standards”

137. 137

138. variability

139. 139
Trial court did not
consider whether
AAN are
“accepted medical
standards”

143. Supreme Court of Nevada

144. 144
Attack 4

145. AAN does not
measure what
UDDA requires

146. 146

147. irreversible cessation
all functions
entire brain

148. 148

149. 149
Brain dead
people
do stuff

150. Gestate
a fetus

151. Heal wounds
Fight infections
Stress response
Grow
Sexually mature
Regulate temp

152. AAN measures only
cessation
some functions
part of brain

153. UDDA requires:
“all functions”
“entire brain”

154. Medical
criteria Legal
standard

157. “neuroendocrine
function may be
present”

158. “not inconsistent
with the whole brain
standard of death.”

159. 159

160. Cessation of
“all functions”
“entire brain”

162. Medically dead
Legally dead

163. 163
Conclusion

164. Life Death

165. Life Death

166. 166

167. Add ULC

168. 168

169. Richard Bonnie (UVA Law) Ariane Lewis (NYU neuro)

171. Step 1
Study
committee

172. July 2021

173. Step 2
Drafting
committee

174. 174
1. Med-Leg “gap”
2. Accepted criteria
3. Consent required
4. Religious objections
5. Other

175. July 2022

176. Step 3
State
legislatures

177. Reduce
variability
Increase
certainty & trust

178. 178
Thaddeus Mason Pope, JD, PhD, HEC-C
Director, Health Law Institute
Mitchell Hamline School of Law
875 Summit Avenue
Saint Paul, Minnesota 55105
T 651-695-7661
C 310-270-3618
E Thaddeus.Pope@mitchellhamline.edu
W www.thaddeuspope.com
B medicalfutility.blogspot.com

179. 179
References

180. Materials from this
presentation are available
http://thaddeuspope.com/braindeath

181. Medical Futility Blog
Since July 2007, I have been blogging, almost daily, to
medicalfutility.blogspot.com. This blog focuses on
reporting and discussing legislative, judicial, regulatory,
medical, and other developments concerning medical
futility and end-of-life medical treatment conflicts. The
blog has received nearly 4 million direct visits. Plus, it
is distributed through RSS, email, Twitter, and re-
publishers like WestlawNext and Bioethics.net.
181

182. Is There a Right to Delay Determination of
Death by Neurologic Criteria? 77 JAMA
NEUROLOGY (August 3, 2020) (with Ariane
Lewis, and Richard J. Bonnie).
Determination of Brain Death / Death by
Neurologic Criteria - The World Brain Death
Project, 323 JAMA (August 3, 2020) (with
others).

183. Brain Death Testing: Time for National Uniformity,
20(6) AMERICAN JOURNAL OF BIOETHICS 1-3 (2020).
It's Time to Revise the Uniform Determination of Death
Act, 173(1) ANNALS OF INTERNAL MEDICINE 75-75
(2020).
Revising the Uniform Determination of Death Act:
Response to Miller and Nair-Collins, HASTINGS
BIOETHICS FORUM (January 29, 2020) (with Ariane
Lewis and Richard J. Bonnie).

184. It’s Time to Revise the Uniform Determination of
Death Act, 172(2) ANNALS OF INTERNAL MEDICINE
143-144 (2020) (with Ariane Lewis and Richard
Bonnie).
Determination of Death by Neurologic Criteria in the
United States: The Case for Revising the Uniform
Determination of Death Act, 47(4) (Supp.) JOURNAL OF
LAW, MEDICINE & ETHICS 9-24 (2019) (with Ariane
Lewis, et al.).

185. The 50-Year Legacy of the Harvard Report on
Brain Death, 320(4) JAMA 335-336 (2018)
(with Robert Truog & David Shumway Jones).
Brain Death and the Law – Hard Cases and
Legal Challenges, 48(5) HASTINGS CENTER
REPORT (Nov/Dec 2018).

186. Brain Death Rejected: Expanding Clinicians’ Legal
Duties to Accommodate Religious Objections and
Continue Physiological Support, in LAW, RELIGION,
AND AMERICAN HEALTHCARE (Cambridge Univ.
Press 2017).
Brain Death: Legal Status and Growing Conflict,
and Court Challenges, 37 JOURNAL OF LEGAL
MEDICINE 265-324 (2017).

187. Legal Standards for Brain Death, 13
JOURNAL OF BIOETHICAL INQUIRY 173-
178 (2016).
Brain Death: Legal Obligations and the
Courts, 35 SEMINARS IN NEUROLOGY
174-179 (2015) (with Christopher Burkle).

188. Brain Death: Legal Duties to
Accommodate Religious Objections 147
CHEST e69 (2015).
Legal Briefing: Brain Death and Total Brain
Failure, 25(3) JOURNAL OF CLINICAL
ETHICS 245-257 (2014).

189. Pregnant and Dead in Texas: A Bad Law,
Badly Interpreted, LOS ANGELES TIMES
(Jan. 16. 2014) (with Art Caplan).
Legal Briefing: Organ Donation, 21(3)
JOURNAL OF CLINICAL ETHICS 243-263
(2010).

190. 190
Thaddeus Mason Pope, JD, PhD, HEC-C
Director, Health Law Institute
Mitchell Hamline School of Law
875 Summit Avenue
Saint Paul, Minnesota 55105
T 651-695-7661
C 310-270-3618
E Thaddeus.Pope@mitchellhamline.edu
W www.thaddeuspope.com
B medicalfutility.blogspot.com