REVIEWED BY REV. DENNIS BRODEUR, PhD
Stuart J. Youngner, Robert M. Arnold, and Renie Schapiro, eds.
Johns Hopkins University Press, Baltimore, 1999, 346 pp., $54 (hardback)
These 20 essays, grouped in seven sections, address the clinical, scientific, sociological, ethical, and public policy implications of the determination of death. This book was born out of a conference held in Cleveland in November 1995, at which many scholars debated the issue. It attempts to address the historical and clinical framework of the definition of death, as well as the interdisciplinary questions involving philosophy, the law, clinical determinations of death, public attitudes about brain death, international perspectives, and the public policy and future considerations of the question.
One fascinating aspect of the book is the nuanced distinctions various authors give to the history of the legal attempt to define death and the reasons for its redefinition, most of which involve organ transplantation. The book also elucidates the various strategies and aspects of the definition of death as related to clinical concerns, public policy concerns, and the lack of public concern about the issue.
For example, Martin S. Pernick's chapter outlines the debate as it relates to the first heart transplant surgery in the 1960s and subsequent debates concerning the Harvard Criteria. In other essays Dan W. Brock and H. Tristram Engelhardt Jr. discuss the clinical and public perceptions of death in the 1990s. These three chapters could lead to different public policy adoptions of what brain death is and how it is clinically determined.
In addition to the interesting comments about the history of the definition of death, readers will find a thorough outline of the relationship between philosophy and clinical medicine concerning the definition of death, the approach to organ transplantation—particularly in the United States—and the legal ramifications of these questions. In addition, the section on the public policy considerations of how we define death raises some interesting issues on how public policy is developed and to what extent it makes a difference in the public's understanding of the nuances of the definitions of death.
Section IV deals with public attitudes about brain death in the United States. Laura A. Siminoff and Alexia Bloch outline ways in which the legal perception of death still hinges on a more ritualistic view of death by the family, while Courtney S. Campbell and Fred Rosner, in their essays, discuss the definition of death in the Christian and Jewish traditions, respectively.
The reader will also be treated to a thorough evaluation of the various approaches to the definition of death, upper brain death, and questions that are raised when people are permanently unconscious. These approaches highlight how death might be viewed in light of the increasing need for organs for transplantation. Underneath these issues are more technical clinical, ethical, and legal arguments, which vary from chapter to chapter. Like many books that are compilations of works from different authors, there is some unevenness between the chapters.
This is not a book to be enjoyed by the general public, but those seriously interested in understanding the definition of death, proposed changes in regulations concerning death to further organ transplantation, and the rationale for when death might be pronounced (and its practical clinical and ethical implications) will find this a worthwhile read.
Reviewed by Rev. Dennis Brodeur, PhD, Senior Vice President, Stewardship, SSM Health Care, St. Louis