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The Case for Choice
Robert M. Veatch and Lainie F. Ross
New technologies and medical treatments have complicated questions such as how to determine the moment when someone has died. The result is a failure to establish consensus on the definition of death and the criteria by which the moment of death is determined. This creates confusion and disagreement not only among medical, legal, and insurance professionals but also within families faced with difficult decisions concerning their loved ones.
Distinguished bioethicists Robert M. Veatch and Lainie F. Ross argue that the definition of death is not a scientific question but a social one rooted in religious, philosophical, and social beliefs. Drawing on history and recent court cases, the authors detail three potential definitions of death — the whole-brain concept; the circulatory, or somatic, concept; and the higher-brain concept. Because no one definition of death commands majority support, it creates a major public policy problem. The authors cede that society needs a default definition to proceed in certain cases, like those involving organ transplantation. But they also argue the decision-making process must give individuals the space to choose among plausible definitions of death according to personal beliefs.
Taken in part from the authors' latest edition of their groundbreaking work on transplantation ethics, Defining Death is an indispensable guide for professionals in medicine, law, insurance, public policy, theology, and philosophy as well as lay people trying to decide when they want to be treated as dead.
1. Defining Death: An Introduction
The Emergence of the Controversy
Three Groups of Definitions
The Emergence of a Uniform Brain-Oriented Definition
Irreversible vs. Permanent Loss of Function
Defining Death and Transplanting Organs
The Structure of the Book
2. The Dead Donor Rule and the Concept of Death
The Dead Donor Rule
Candidates for a Concept of “Death”
The Public Policy Question
3. The Whole-Brain Concept of Death
The Case for the Whole-Brain Concept
Criteria for the Destruction of All Brain Functions
Problems with the Whole-Brain Definition
Alternatives to the Whole-Brain Definition
4. The Circulatory, or Somatic, Concept of Death
Two Measurements of Death
Circulatory Death and Organ Procurement
The DCD Protocols
Shewmon’s Somatic Concept
The Two Definitions of the US President’s Council on Bioethics
5. The Higher-Brain Concept of Death
Which Brain Functions Are Critical?
Altered States of Consciousness: A Continuum
Measuring the Loss of Higher-Brain Function
The Legal Status of Death
6. The Conscience Clause: How Much Individual Choice Can Our Society Tolerate in Defining Death?
The Present State of the Law
Concepts, Criteria, and the Role of Value Pluralism
Explicit Patient Choice, Substituted Judgment, and Best Interest
Limits on the Range of Discretion
The Problem of Order: Objections to a Conscience Clause
Implementation of a Conscience Clause
7. Crafting a New Definition-of-Death Law
Incorporating the Higher-Brain-Function Notion
The Conscience Clause
Clarification of the Concept of “Irreversibility”
A Proposed New Definition of Death for Public Policy Purposes
"The authors, distinguished scholars of medical ethics, have proposed and defended a multiplex definition of death for death statutes. They argue that our liberal, pluralistic society should provide every citizen a personal choice in the definition of their death. Their provocative argument merits careful study by public policy experts."—James Bernat, Louis and Ruth Frank Professor of Neuroscience, Dartmouth-Hitchcock Medical Center
"Veatch and Ross compellingly endorse a public policy that allows some room for individual choice in how death is declared. They base their endorsement on a thorough understanding and explication of the clinical, legal, social and philosophical issues in play."—Stuart Youngner, Professor of Bioethics, Professor of Psychiatry, Case Western Reserve University
"Veatch and Ross take us on a journey to better understand what is significant to humans and what is at stake at the time of death. Readers will be fascinated by the evolution of the definition of death: from the well established heart-and lung-oriented concept to the still controversial whole-brain based definition and to the future hot topic concept of higher-brain death. By proposing individual choice among socially accepted definitions of death, the authors advocate for a fair, flexible approach to law and public policy in the pronouncement of death."—Ali Bagheri, Assistant Professor of Medicine and Medical Ethics, School of Medicine, Tehran University of Medical Sciences
"This excellent and concise volume offers a definitive account of the contemporary definition-of-death debate. Veatch and Ross adeptly integrate the clinical, philosophical, ethical and policy issues to craft a compelling argument for widespread adoption of a conscience clause in the determination of death."—Robert Olick, Associate Professor, Center for Bioethics and Humanities
"Veatch and Ross have provided a very readable and authoritative account of how medicine and society have struggled with the question of defining death in the era of organ transplantation. They offer a compelling approach to resolving this debate that deserves serious consideration by all with an interest in these critical issues."—Robert Truog, Professor and Director, Center for Bioethics, Harvard Medical School
Commended for the 2017 Catholic Press AssociationBook Award for Faith and Science of the Catholic Press Association
Robert M. Veatch, PhD, is professor of medical ethics emeritus at the Kennedy Institute of Ethics, Georgetown University. He has received the Lifetime Achievement Award from the American Society of Bioethics and the Humanities. The author of fifty books, he is coauthor of Transplantation Ethics, Second Edition, with Lainie F. Ross. He serves on the United Network for Organ Sharing Ethics Committee and the Board of Directors of the Washington Regional Transplant Community.
Lainie F. Ross, MD, is the Carolyn and Matthew Bucksbaum Professor of Clinical Medical Ethics at the University of Chicago. She is the author of Children, Families and Health Care Decision-Making, Children in Medical Research: Access versus Protection, and coauthor of Transplantation Ethics, Second Edition, with Robert M. Veatch. She has served on the United Network for Organ Sharing Ethics Committee.
168 pp., 5.5 x 8.5
168 pp., 5.5 x 8.5