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Death by definition

Historically, death was declared when a person’s heart and lungs stopped working permanently. This changed with the development of life-support technologies. Once such organs could be kept active artificially, it became evident that a second definition of death was needed.

In 1968, a panel of professionals at Harvard Medical School concluded that if the “entire brain,” including the brainstem, had irreversibly ceased to function, that also meant a person has died. This definition of death was especially important to the field of organ donation, as it permitted the timely transfer of well-functioning organs.

The Harvard “total brain death” definition has been widely adopted in medical and legal circles.

In recent years, though, the Harvard view has been challenged, especially by neurologist Daniel Alan Shewmon, who showed that patients who had been declared brain dead but were placed on life-support machines were able to grow through puberty, fight off illness and even give birth, Mr. Brugger said.

Thus, while no one is arguing that corpses are being kept alive, he said, there is continuing disagreement over these end-of-life issues — especially “the adequacy” of the Harvard neurological definition for death.

In December 2008, the President’s Council on Bioethics reviewed these issues and upheld Harvard’s neurological standard as valid. But a few council members said sufficient uncertainty remained about the brain-death standard to “warrant an alternative approach to the care of the ‘brain dead’ human being and the question of organ procurement.”

The Terri Schiavo Life & Hope Network warned that Jahi’s case was “representative of a very deep problem within the U.S. healthcare system — particularly those issues surrounding the deaths of patients within the confines of hospital corporations, which have a vested financial interest in discontinuing life.”

“Families and individuals must make themselves aware of what so-called ‘brain death’ is and what it is not,” said Bobby Schindler, Schiavo’s brother and executive director of the organization.

“Every person needs to understand that medical accidents happen every day. Families and individuals must be more aware of the issue of accountability and patient rights.”