Reevaluation of the U.S. Death Act: Leading Brain Injury Specialist Calls for Comprehensive Reform

Dr. Ariane Lewis, a renowned expert in brain injuries, is urging a reformulation of the legal definition of death in the United States. This call for change follows a study involving 41 different organizations, including medical, advocacy, and organ transplantation entities. Lewis argues for synchronizing the law with prevailing medical standards, particularly questioning the existing legal emphasis on the loss of hormone function as a determining factor in declaring death. While the majority of surveyed organizations are in favor of changes, there is divergence of opinion regarding how to best implement such reforms, notably between medical establishments and patient rights groups.

After collating the perspectives of 41 organizations on the Uniform Determination of Death Act (UDDA), Dr. Lewis is advocating for essential changes to the way death is legally defined in the country. She expresses disappointment over the recent temporary halt in the revision process initiated by the Uniform Law Commission but underscores that this should not deter the much-needed rectifications to the longstanding issues surrounding the Act.

Dr. Ariane Lewis, a professor and neurocritical care specialist affiliated with the NYU Grossman School of Medicine’s Departments of Neurology and Neurosurgery, contends that legal definitions concerning death should be in accordance with established medical criteria. Specifically, she notes that current medical guidelines do not necessitate considering loss of hormone function when declaring an individual as brain dead. Moreover, Lewis contends that the Act needs to be updated to provide healthcare providers with legal directives for handling instances where families resist the discontinuation of mechanical ventilation for a brain-dead relative.

Diverse Opinions Revealed Through Survey

The results of Lewis’s survey indicate that 83% of the 41 organizations (comprising 34 entities) favor revising the UDDA. However, Lewis concedes that opinions on how to execute these revisions vary widely. Certain religious organizations and patient advocacy groups resist the loss of brain function as criteria for declaring death, advocating instead for the traditional definition that death occurs post-cardiac arrest.

Dr. Lewis, who also serves as the director of neurocritical care at NYU Langone Health, has shared her findings and viewpoints with the Uniform Law Commission, whose revisionary efforts were recently put on hold. Lewis has been an observer in the commission’s three-year effort to amend the UDDA.

Recently published in the journal Neurocritical Care, Lewis’s study conducted a meticulous review of opinions submitted to the commission between January and July 2023 from 41 organizations influenced by the UDDA.

Historical Context and Ongoing Challenges

Historically, death was legally determined when an individual’s heart ceased beating, and they could no longer breathe independently. Advances in mechanical ventilation technology led to the 1981 creation of the U.S. Uniform Determination of Death Act, which established death as either the irreversible end of all brain or cardiopulmonary functions. This has been the standard across all states. However, the Act falls short in specifying which medical tests should be conducted to confirm death, leading to legal complications, especially when families object on religious grounds. Several lawsuits have emerged where families wish to keep their brain-dead relatives on life support indefinitely.

Pressing Need for More Explicit Guidelines

Dr. Lewis stresses the necessity for the commission to accept international and national medical benchmarks for determining death based on neurological factors. She refers to guidelines issued by reputable organizations such as the American Academy of Neurology, Society of Critical Care Medicine, American Academy of Pediatrics, and Child Neurology Society, which do not consider the loss of hormone function when determining brain death.

Lewis questions the Act’s current stipulation that includes the cessation of “all functions of the entire brain,” which could theoretically include hormone secretion, as impractical. She underscores that there are no medical standards for measuring the stoppage of hormone secretion from the brain. Hence, she recommends that the Act be revised to specify which brain functions should be absent to declare someone legally dead.

Lewis’s study also discovered that while medical organizations oppose requiring family consent before discontinuing mechanical ventilation after death, patient advocacy groups favor such provisions.

According to Lewis, despite general agreement on the need for revisions to the UDDA, deep divisions exist between medical organizations and patient advocacy groups regarding the appropriate strategy for these changes. With the commission’s activities currently in suspension and prospects for a collective agreement slim, Lewis concludes that a lack of updates to the law leaves both physicians and the general public without clear legal guidance on the tests required for brain death declarations and how to address family objections to such declarations.

Reference: “Perspectives of Medical Organizations, Organ Procurement Organizations, and Advocacy Organizations About Revising the Uniform Determination of Death Act (UDDA)” by Ariane Lewis, Neurocritical Care, 26 October 2023, DOI: 10.1007/s12028-023-01872-5.

Frequently Asked Questions (FAQs) about Uniform Determination of Death Act

More about Uniform Determination of Death Act

• Uniform Determination of Death Act: An Overview
• Medical Standards for Declaring Brain Death
• Dr. Ariane Lewis’ Professional Profile
• The Uniform Law Commission and Legal Reforms
• Neurocritical Care Journal
• American Academy of Neurology Guidelines
• Society of Critical Care Medicine Standards
• Ethical Concerns in End-of-Life Decisions
• Legal Challenges Surrounding the UDDA
• Hormone Function in Neurological Context