Episode 149: Lainie Ross and Christos Lazaridis talk about defining death
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What is the Uniform Determination of Death Act (UDDA) and how does it define death?
Yeah, yeah.
Hello and welcome to Elucidations, an unexpected philosophy podcast. I'm Matt Teichman, and with me today are Laney Ross, Carolyn and Matthew Bucksbound Professor of Clinical Ethics at University of Chicago Medicine, and Christos Lazaritis, Associate Professor of Neurology at University of Chicago Medicine. And they are here to talk about defining death. Leni and Christos, welcome.
Thank you.
And welcome back to Christos. Thank you. So in uh kind of part one of this episode with just Christos, we talked about brain death. Um I wonder if maybe we could just get back into the headspace by doing quick little one on one on like what is brain death? What are we talking about?
Yes. Uh I was thinking Matt to just do a quick recap and talk about um how we determine death uh in the hospital. Uh so we follow the uh UDDA, which is the Uniform Determination of Death Act. So that's the law about how to determine death. And this can be done in two ways. There are two sets of criteria that uh diagnose or determine the same event which is death. Death. So it's either by the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the brain and the brainstem, the so-called whole brain concept.
Does one of those determine the other? Like if you lose circulation or respiration, doesn't that also cut off your Consciousness or are they not causally connected?
So it does and they are causally connected. However, this is not necessarily the rationale. Uh and we can talk about this later. But uh if anyone meets either set of criteria then they are determined to be dead.
So the topic of this episode is defining death and you might think we just did it. You might think, Well, that's the definition. We can all go home. But one of the things that you both have worked on is the fact that in many cases there seems to be l at least a little bit of wiggle room in exactly what criterion you're going to use to determine whether someone has undergone this process of death. What's the range of options there?
Under current law, under the current U D D. A, there are the two options. There is the option of being declared dead by permanent loss of circulatory and respiratory function and the permanent loss of the whole brain. There are other options that one can envision but under the law those are the only two.
So just to uh follow up on what Lainey said, there is a third approach or concept if you like called higher brain death, which by the way it's not in law in any jurisdiction, but it's more of a scholarly proposal. The idea that uh not the entire brain or the whole brain is necessary for someone to be determined dead. And I think that relates more to the death of a person or the cessation of personhood. So people have talked about the higher brain in the sense that that's where consciousness is housed. And so the higher brain translates to the permanent or irreversible. By the way, there is debate about permanence in reversible. reversibility, but let's say the permanent loss of the capacity of consciousness that equates to death.
That's the higher brain position.
And is that different from the what we just talked about with the UDDA? Or is that the same or is that just another way to think of Irreversible cessation of consciousness.
So this goes back to your question about whether does death by circulatory lead to death by neurologic or vice versa. And this third one. So the fact is is that there are two ways to determine death under the law. This third method would be not currently accepted under any law, neither in the United States or anywhere in the world, but it would because there are two different ways to determine it. We also have to acknowledge then that we haven't actually given a a pure definition of death.
How do physicians determine death using circulatory‑respiratory versus whole‑brain criteria?
And so the fact is that these two different ways to determine it are social constructs. They are criteria that have been determined by healthcare providers, there have been many other stakeholders involved, but in the end, they're social constructs.
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Chapters
8 chapters
1
What is the Uniform Determination of Death Act (UDDA) and how does it define death?
0:15–4:36
2
How do physicians determine death using circulatory‑respiratory versus whole‑brain criteria?
4:36–8:42
3
What is the ‘higher‑brain’ (or upper‑brain) proposal for defining death?
8:42–13:52
4
Why are clinicians questioning whether current brain‑death tests capture all brain functions?
13:52–18:19
5
How do organ‑donation protocols intersect with the choice of death criteria?
18:19–24:16
6
Should patients have the legal right to choose which death criteria apply to them?
24:16–29:43
7
What ethical dilemmas arise when a pregnant woman is declared brain‑dead but remains on life support?
29:43–35:38
8
How could expanding the New Jersey model give all Americans the ability to pick their death definition?
35:38–41:43
Speakers
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