4 days ago
The Debate Over Defining Death
To the Editor:
Re 'We Need a New Definition of Death,' by Sandeep Jauhar, Snehal Patel and Deane Smith (Opinion guest essay, Aug. 1):
As a physician and a neuroethicist who has argued for the rights of people with a severe brain injury, I was appalled and confused by the proposal made by these authors to include patients they define as 'hopelessly comatose' in a new definition of death.
The phrase 'hopelessly comatose' — which the authors maintain was deleted from a 1968 Harvard Brain Death Report — is a medical oxymoron. Comas are by definition self-limited. Once comatose, you either die, wake up or move into a vegetative state.
Regarding 'hopelessly': In 2018 the 'permanent' vegetative state was redesignated as 'chronic' because as many as 20 percent of patients recovered consciousness.
The proposal becomes more alarming considering our 2024 New England Journal of Medicine paper demonstrating that 25 percent of patients in a coma or vegetative state had cognitive motor dissociation or covert consciousness. They weren't hopelessly comatose, though they appeared so. Finally, there are emerging drugs and therapeutics that promise to transform hopelessness into hope.
In 2012, I resigned from the board of an organ procurement organization because it viewed these patients as reservoirs to harvest organs. We should be beyond utilitarian redefinitions of death that violate the disability and civil rights of vulnerable patients. It will backfire and erode trust in organ procurement and decrease donations.
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