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At least 19 recordsLinked to original sources
PubMed1997

A change of heart and a change of mind? Technology and the redefinition of death in 1968.

In 1968, an ad hoc committee of Harvard faculty publicly redefined death as "brain death". What interests and issues compelled the redefinition of death, and formed the "spirit" of this precedent-setting policy? This paper reports on an historical study of the files of the Harvard ad hoc committee, the proceedings of an international conference on ethical issues in organ transplantation, and a review of the medical literature and media in the decades preceding the redefinition of death. This analysis of the technological and professional forces involved in the redefinition of death in 1968 questions two common theses: that technological "progress", primarily in the areas of life support and electroencephalography, literally created brain-dead bodies and dictated their defining features (respectively), and that Harvard's definition of brain death by committee constituted a net loss of autonomy for medicine. In fact, medical researchers through the 1960s disputed and negotiated many features of the brain death syndrome, and transplantation interests-perhaps more kidney than heart-played a particularly influential role in tailoring the final criteria put forth by Harvard in 1968. It is also doubtful whether Harvard's definition of brain death by multidisciplinary committee undermined medical privilege and autonomy. The Harvard Ad Hoc Committee may not have succeeded in establishing definitive, indisputable brain death criteria and ensuring their consistent application to all clinical cases of brain death. However, it did gain significant ground for transplant and other medical interests by (1) establishing brain death as a technical "fact" and the definition of brain death as an exercise for medical theorists, (2) involving non-medical ethics and humanities experts in supporting the technical redefinition of death, and, (3) successfully involving transplant surgeons in the redefinition of death and attempting (albeit unsuccessfully) not to exclude them from the actual diagnosis of death in individual cases.

Brain Death↗
PubMed2003

Brain death and the historical understanding of bioethics.

In a 1968 Report, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death promulgated influential criteria for the idea and practice known as "brain death." Before and since the Committee met, brain death has been a focal point of visions and nightmares of medical progress, purpose, and moral authority. Critics of the Committee felt it was deaf to apparently central moral considerations and focused on the self-serving purpose of expanding transplantation. Historical characterizations of the uses and meanings of brain death and the work of the Committee have tended to echo these themes, which means also generally repeating a widely held bioethical self-understanding of how the field appeared-that is, as a necessary antidote of moral expertise. This paper looks at the Committee and finds that historical depictions of it have been skewed by such a bioethical agenda. Entertaining different possibilities as to the motives and historical circumstances behind the Report it famously produced may point to not only different histories of the Committee, but also different perspectives on the historical legacy and role of bioethics as a discourse for addressing anxieties about medicine.

Bioethical Issues↗
PubMed2003

The neurologist and Harvard criteria for brain death.

The Harvard ad hoc committee to examine the definition of brain death, chaired by anesthesiologist Beecher, published their report in 1968. Throughout the years, the committee has been a target of criticism. However, the workings of the ad hoc committee have not been carefully evaluated, and could provide insight into the role of the neurologists and their interaction with contemporaries. Review of the original files and interviews with three surviving members-Adams, Potter, and Murray-revealed 1) a major role and original contributions of the neurologists Schwab and Adams in defining criteria, and 2) a swift and decisive working committee that formulated a document aimed at simplicity and accuracy, and without special interest.

Advisory Committees↗
PubMed1994

Brain-death as an anthropological or as a biological concept.

In 1968, when the Harvard Committee defined brain-death to characterize irreversible coma, the question of when a doctor might stop resuscitation remained unresolved: brain-death is a safe, but not a sufficient criterion. Furthermore, the committee defined brain-death to be the death of man without any more than pragmatic reasons. Philosophers tried to give anthropological reasons, as important human functions are located in the brain. But this is misleading, for instance to concepts of partial brain-death. Biologically, however, the death of the whole brain disintegrates the organism and can therefore be accepted as the criterion for death of man.

Anthropology↗
PubMed1992

Criteria for death: self-determination and public policy.

'Whole brain death' criteria have found support in Western cultures in regard to post-mortem organ donation and the termination of care for patients meeting these strict criteria. But they are of minimal use in Asian cultures and in the ethics of caring for the persistent vegetative patient. This paper introduces a formula for a global Uniform Determination of Death statute, based on the 'entire brain including brain stem' criteria as a default position, but allowing competent adults by means of advance directives to choose other criteria for determining death during the process of dying.

Bioethics↗