This is Professor Thaddeus Pope's presentation on brain death at the University of Chicago Neubauer Collegium for Culture and Society on March 24-25, 2021. https://neubauercollegium.uchicago.edu

1. 1
Should the UDDA
be Modified?
Thaddeus Mason Pope, JD, PhD, HEC-C
Neubauer Collegium • March 25, 2021

4. “No statutory
change in law
… necessary”

5. 5

6. 6
Risk averse - want
certainty & clarity

9. 9

10. 1970s
Variability

12. Dead state 1
but not state 2

13. Add ULC

14. “status as alive or dead
should not depend on
the capricious question
of immediate locale”

15. Tolerate
Encourage

16. MAID

17. 17

18. Death is
different

19. Death is more
consequential

21. Treatment
Organ D&T

23. Insurance
Health insurance stop
Life insurance start
Property
inheritance, estate tax, probate

24. Criminal
murder v. battery
Tort
wrongful death v. med mal

26. When
to grieve
to bury

27. Uniformity
Clarity
Certainty

28. 28

29. 29

30. There are
2 ways
to determine death

31. “irreversible cessation of
circulatory & respiratory
functions”

33. “irreversible cessation
of all functions of
the entire brain”

34. 2nd newer
prong
focus on this

35. Brain death
Death

36. Total brain failure
Death

38. 1970s variability
Eliminate

39. 39

40. 1979

42. =
State 1
State 2

43. =
Hospital 1
Hospital 2

44. =
MD 1
MD 2

45. =
Law
Practice

46. 46
Uncertainty
Confusion
manifests

48. Roadmap

49. 49
parts

50. 50
Legal
attacks

51. 51

52. 52
Attack 1

53. Most authoritative criteria

54. AAN does not
measure what
UDDA requires

56. 56

57. irreversible cessation
all functions
entire brain

58. 58

59. 59
Brain dead
people
do stuff

60. Gestate
a fetus

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

62. AAN measures only
cessation
some functions
part of brain

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

64. Medical
criteria Legal
standard

67. Patient can
satisfy BD
guidelines

69. 69
...

70. “neuro-endocrine
function may be
present”

71. Okay to declare dead
despite functions of
pituitary gland &
hypothalamus

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

73. 73

78. < 1/3 200 Mayo clinicians agree

79. Legal & public
trust problem

80. 80
requires

81. irreversible
cessation of

82. “all functions”
of the
“entire brain”

84. Medically dead
Legally dead

85. Medical criteria
do not require
cessation of
all functions

86. Require cessation
of critical functions

88. Lack authority
to do that

90. Measure satisfaction
Standard, not invent

91. Attack 1
Mismatch
Med – Leg

92. 92
Attack 2

93. Which guidelines
should clinicians use
to determine BD?

94. 94

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

96. 96

97. variability

98. 98
Trial court did not
consider whether
AAN are
“accepted medical
standards”

102. Reno
pic
Reno, Nevada

103. Aden
Hailu

104. 104
brain injury
during
exploratory
laparotomy

105. 105
Met AAN criteria
for brain death

106. Dad: “she
is not dead”

108. 108
Dad
loses

109. 109
Trial court
AAN criteria met
 Aden is dead

110. Dad
appeals
Nevada
Supreme
Court

111. 111
Dad
wins

112. Supreme Court of Nevada

113. 113
Irrelevant if Aden
meets AAN criteria
NOT the
“right” criteria

114. Unclear they are
“accepted medical
standards”
as UDDA requires

115. Nevada
A.B. 424 (2017)

116. New
Jersey
A.B. 3586 (2014)

117. H.B. 1896
(2021)

118. Attack 2
Which medical
standards

119. 119
Attack 3

120. Want
religious
exemption

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

123. No
death
by BD
Religious
objection

124. Pt may
satisfy
BD criteria

125. 125

126. May not
declare
death

127. Until
death by
CP criteria

128. 1991

132. Rejected
everywhere
outside NJ

133. asked for
still

134. Nick
Torres

135. H.B. 4329

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

138. September 17, 2020

139. Suing state
of California

140. “firm religious beliefs
… heart is beating …
is alive.”

141. “remove CP support …
unconstitutional …
interferes …
freedom of religion”

142. CHOP had 2 cases summer 2018

143. Areen Chakrabarti

144. Jayden Auyeing

145. Motl Brody (DC)

146. 146
Shahida Virk (Mich.)

147. Cho Fook Cheng (Mass)

148. 148

151. Will see more
of these cases

153. Attack 3
Religious
exemption

154. 154
Attack 4

155. Must clinicians
get consent
for BD tests?

156. Some try to
prevent
BD diagnosis

157. 157
this strategy

158. Clinician
duties
after BD

160. No post-BD
treatment rights

161. 161

162. Focus on
pre-BD
rights

163. Apnea
test

164. Final
confirmatory test

168. More family
refusals

169. Almost all pediatric

170. Parental
refusals

172. No apnea test
No BD

173. Treatment duties
continue until CP
No BD

174. Opt out
BD

175. Practically, same
as NJ religious
exemption

176. Determine
Declare
NJ

177. Determine
Declare
Here

178. Must clinicians
honor the
refusal?

179. Do clinicians
need consent
for apnea test?

180. split

182. Billings, Montana

183. Allen Callaway
6-year-old
“Drowned” July 22, 2016

186. Mom:
“no”

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

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

191. Do clinicians
need consent
for apnea test?

192. MT said
“yes”

193. KS also
“yes”

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

195. CA also
“yes”

196. Alex Pierce - drowned

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

198. Do clinicians
need consent
for apnea test?

199. MT, KS, CA
said “yes”

200. Plausible

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

204. VA said
“no”

206. 206

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

210. Conflict
continues

211. Attack 4
Consent for
BD testing

212. 212

213. 4 attacks 
Variability
Uncertainty

214. 214

215. 215
Response

216. Add ULC

218. Step 1
Appoint study
committee

219. July 2020

220. Step 2
Study committee
deliberates

221. Ongoing
now

222. Step 3
Study committee
recommendation

223. July 2021

224. Step 4
Appoint drafting
committee

225. Step 5
Drafting committee
deliberates

226. 226
1. Med-Leg “gap”
2. Accepted criteria
3. Consent required
4. Religious objections
5. Other

227. Step 6
Drafting committee
submits draft

228. July 2022

229. Step 7
State
legislatures

230. Reduce
variability
Increase
certainty & trust

231. Nevada
A.B. 424 (2017)

232. H.B. 1896
(2021)

233. 233
Conclusion

234. medical standards
Variability

235. legal criteria to
medical standards
Mismatch

236. More conflict
& litigation

237. Public
trust

240. “No statutory
change in law
… necessary”

241. qualified

244. Life Death

245. Life Death

247. 247
Thaddeus Mason Pope, JD, PhD, HEC-C
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

248. 248
References

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

250. 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.
250

251. 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).

252. Why Should We See Brain Death as
Socially Situated? 22(12) AMA JOURNAL
OF ETHICS E983-985 (December 2020)
(guest editor of issue with Ariane Lewis).
Brain Death Testing: Time for National
Uniformity, 20(6) AMERICAN JOURNAL OF
BIOETHICS 1-3 (2020).

253. 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).

254. 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.).

255. 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).

256. 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).

257. 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).

258. 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).

259. 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).

260. 260
Thaddeus Mason Pope, JD, PhD, HEC-C
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