President Calvin Coolidge (1923-1929) had such a reputation as a man of few words that upon hearing the news of his death, popular poet Dorothy Parker quipped "How can they tell?"
Now, the same problem is being asked, more seriously, with respect to tens of thousands of Americans. For many years, death has been legally defined in almost every state as either the irreversible cessation of cardio-pulmonary function or the irreversible cessation of function of the entire brain. Moreover, for several years, many have been pushing to expand the determination of death criteria to include the cessation of just higher brain function.
But this story in Sunday's Boston Globe shows that there is a push in the other direction, to constrain the definition of death. Bob Truog is right. We do "gerrymander" the criteria we use to call people dead to reach the results we want, especially with respect to organ donation. Not only is brain death not purely scientifically based but also there has been a deliberate effort to mask the value judgments at stake. That deception was certainly for a good cause. But perhaps it is time to expose those judgments and face some of our tragic choices.
Truog suggests that debate over the definition of death will abate once we can obtain organs from non-cadaver sources like pigs. But this, I think, is wrong because it assumes that the definition of death matters only because of its relationship to the determination when organs can be obtained. But the definition of death is important for another reason. It matters in the context of determining when LSMT can be stopped. Each year, there are hundreds of disputes across the country in which surrogates demand that providers continue treatment even after the patient has been declared dead. Several of these escalate to the trial and appellate courts. As "death" is a bright line status under which providers need not provide treatment, it has been and will continue to be used as a mask for inappropriate care determinations.