ACP addresses ethical issues in determining death
A new position paper from ACP supports a clarification to terminology in the Uniform Determination of Death Act but otherwise reaffirms it and its underlying ethical principles.
ACP has issued a new position paper addressing current controversies about the standards for determining death, supporting a clarification to the Uniform Determination of Death Act (UDDA) but otherwise reaffirming the current UDDA and the ethical principles that are its foundation. The paper was developed by ACP's Ethics, Professionalism and Human Rights Committee and was published Sept. 5 by Annals of Internal Medicine.
ACP believes physicians should advocate for policies and practices on the determination of death that are consistent with the medical profession's fundamental commitment to individual patients and to the public. The College supports:
- revising the Uniform Determination of Death Act to replace the word “irreversible” with “permanent” in clarifying the permanent cessation of circulatory and respiratory functions, but retaining the word irreversible in describing brain death (the “irreversible cessation of all functions of the entire brain…”);
- maintaining circulatory and whole brain (neurologic) standards for determining death as separate, independent standards, consistent with current medical practice and with respect for established standards as well as for those cultures and religious traditions that accept only the circulatory determination of death;
- retaining the whole brain standard for determining death according to neurologic criteria and opposing “higher brain” function standards;
- aligning medical tests used for determining death with legal standards, not the other way around, asserting that medical criteria or tests should not be specified in the UDDA as they do not define death but rather, indicate whether death has occurred;
- acknowledging that determination of death is a distinct issue from organ transplantation and that the criteria for determining death should not be governed by the need to procure organs for transplantation; and
- calling for additional education for physicians, other clinicians, and the public about how death is determined and improving communication about the determination of death and dying process.