Technical and clinical developments have raised challenging questions about the concept and practice of brain death, culminating in recent calls for revision of the Uniform Determination of Death Act (UDDA), which established a whole brain standard for neurologic death. Proposed changes range from abandoning the concept of brain death altogether to suggesting that current clinical practice simply should be codified as the legal standard for determining death by neurologic criteria (even while acknowledging that significant functions of the whole brain might persist). We propose a middle ground, clarifying why whole brain death is a conceptually sound standard for declaring death, and offering procedural suggestions for increasing certainty that this standard has been met. Our approach recognizes that whole brain death is a functional, not merely anatomic, determination, and incorporates an understanding of the difficulties inherent in making empirical judgments in medicine. We conclude that whole brain death is the most defensible standard for determining neurologic death—philosophically, biologically, and socially—and ought to be maintained.

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确定脑死亡的生物哲学方法

技术和临床的发展对脑死亡的概念和实践提出了具有挑战性的问题，最终导致最近呼吁修订《统一死亡判定法》(UDDA)，该法建立了神经性死亡的全脑标准。拟议的修改范围从完全放弃脑死亡的概念到建议当前的临床实践应该被编纂为通过神经学标准确定死亡的法律标准（即使承认整个大脑的重要功能可能持续存在）。我们提出了一个中间立场，阐明为什么全脑死亡在概念上是宣告死亡的合理标准，并提供程序建议以提高满足该标准的确定性。我们的方法认识到全脑死亡是一种功能性决定，而不仅仅是解剖学决定，并且结合了对医学经验判断固有困难的理解。我们的结论是，全脑死亡是确定神经系统死亡的最合理的标准——从哲学上、生物学上和社会上——并且应该得到维持。