Ellen Grass Memorial Lecture: Brain Death: Useful Myth or Problem Waiting to Happen?

In this paper, I will argue that in an intensive care environment, the exact moment of death is neither a scientific nor philosophical "fact." Rather, it is a socially constructed notion used to maximize organ procurement while avoiding responsibility for killing patients by removing their organs-the so-called dead donor rule. I will first review the tremendous importance of the declaration of death in all societies and point out how it once was and now has again become problematic. Next, I will review the importance of distinguishing among definitions, criteria, and tests. I will conclude that the current protocols for taking organs from brain-dead patients do so by maintaining several legal and clinical fictions. They are fictions because they are conceptually and clinically suspect and have been created primarily to avoid controversy. This has allowed removal of organs that save and improve many thousands of lives. I will argue that while brain-dead patients are not certainly dead, they are certainly beyond harm. In this sense, they are as good as dead as long as they and their families have agreed to organ procurement. Whether the current fictions about brain death are durable remains to be seen.