Brain Death, Culture & Personhood Michel C.F. Shamy , Neurologist, The Ottawa Hospital, Ottawa, Ontario, Canada Mark Fedyk, Sackville, New Brunswick, Canada
Re: "B rain death declaration " Wahlster, et al., 84:18 18701879doi:10.1212/WNL.0000000000001540 Controversies surrounding brain death determinations, as presented by Wahlster et al., [1] are not unexpected, and assertions that "brain death is death" [2] are unlikely to resolve them. Rather, such controversies exemplify how the diagnosis of brain death signals two separate things: the physiological fact that certain neurological functions have ceased, and the moral fact that the body so diagnosed is no longer a person. This second fact is what permits the declaration of death, the removal of organs for the purpose of transplantation, etc. Brain death, thus, is a synthetic concept that blends medical, moral, and legal information. Consequently, it can be a locus of controversy when, for instance, local culture holds a different conception of personhood than that reflected in the legal statute or in professional guidelines. These conflicts may seem purely empirical: either there exists or does not exist clinical evidence of the necessary brain functions; but there is no direct inference from brain death to person death, at least not until the question of personhood is resolved. Until such time, we should explore the possibility of separating our conceptions of catastrophic brain injury and the absence of personhood. 1. Wahlster S, Wijdicks EFM, Patel PV, et al. Brain Death Declaration: Practices and Perceptions Worldwide. Neurology 2015;84:18701879. 2. Burkle CM, Sharp RR, Wijdicks EF. Why Brain Death is Considered Death and Why There Should Be No Confusion. Neurology 2014;83:14641469. For disclosures, please contact the editorial office at
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