Brain Death: Legal Obligations and the Courts

Abstract

Brain death, or death determined by neurologic criteria, has been legally adopted in all U.S. states for decades. Despite its long-established history, a lack of clear understanding has led to disputes requiring a legal forum for resolution. Recently, physicians and hospitals across the country have been impacted by a growing number of disputes about brain death. The authors offer clinicians a historical perspective on the evolution of brain death as a legal cause of death in the United States. They then review the more common legal categories of disputes encountered, including representative court cases for each. This overview provides physicians with a general legal perspective on brain death so they may better appreciate the pertinent issues if and when later confronted.

Keywords

brain death - legal - lawsuit - courts - religious accommodation

• References

• 1 Burkle CM, Sharp RR, Wijdicks EF. Why brain death is considered death and why there should be no confusion. Neurology 2014; 83 (16) 1464-1469
• 2 Pope TM. Legal briefing: brain death and total brain failure. J Clin Ethics 2014; 25 (3) 245-257
• 3 Smolensky KR. Defining life from the perspective of death: an introduction to the forced symmetry approach. U CHI LEGAL 2006; 41-84
• 4 Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. A definition of irreversible coma. JAMA 1968; 205 (6) 337-340
• 5 President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: Medical, Legal, and Ethical Issues in the Determination of Death. Washington, DC: Government Printing Office; 1981
• 6 The President's Council on Bioethics. Controversies in the Determination of Death. 2008 Bioethics Research Library at Georgetown University [online]. Available at: https://bioethicsarchive.georgetown.edu/pcbe/reports/death/Controversies%20in%20the%20Determination%20of%20Death%20for%20the%20Web%20(2).pdf . Accessed December 26, 2014
• 7 Uniform Law Commission, The National Conference of Commissiioners on Uniform State Laws. Legislative Fact Sheet - Determination of Death Act. Available at: http://www.uniformlaws.org/LegislativeFactSheet.aspx?title=Determination%20of%20Death%20Act . Accessed October 16, 2014
• 8 Association of Organ Procurement Organizations. State brain death laws. Available at: http://www.aopo.org/brain-death-a68 . Accessed October 16, 2014
• 9 Bernat JL. Controversies in defining and determining death in critical care. Nat Rev Neurol 2013; 9 (3) 164-173
• 10 Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58 (1) 20-25
• 11 Capron AM. Brain death—well settled yet still unresolved. N Engl J Med 2001; 344 (16) 1244-1246
• 12 Truog RD, Miller FG. Changing the conversation about brain death. Am J Bioeth 2014; 14 (8) 9-14
• 13 Shah SK, Truog RD, Miller FG. Death and legal fictions. J Med Ethics 2011; 37 (12) 719-722
• 14 Truog RD. Brain death - too flawed to endure, too ingrained to abandon. J Law Med Ethics 2007; 35 (2) 273-281
• 15 Gallups v. Cotter, 534 So. 2d 585 (Ala. 1988)
• 16 Berlinger N, Jennings B, Wolf SM. The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life. New York, NY: The Hastings Center; Oxford University Press; 2013: 105-110
• 17 Douglas v. Janssen Funeral Homes, No. 2KB-09–173CI, 2010 WL 9069780 (Alaska Super. Ct. 19 Nov. 2010) (citing 4 cases)
• 18 Miller RD. Problems in Health Care Law. 9th ed. Sudbury, MA: Jones & Bartlett; 2006: 765-775
• 19 Anderson JA, Vernaglia LW, Morrigan SP. Refusal of brain death diagnosis: the health lawyer's perspective. JONAS Health Law Ethics Regul 2007; 9 (3) 90-92
• 20 Clarke MJ, Remtema MS, Swetz KM. Beyond transplantation: considering brain death as a hard clinical endpoint. Am J Bioeth 2014; 14 (8) 43-45
• 21 Uniform Law Commission. Acts, Anatomical Gift Act. 2006. Available at: http://uniformlaws.org/Act.aspx?title=Anatomical+Gift+Act+(2006) . Accessed October 24, 2014
• 22 In re Motl Brody, No. 1:08-CV-01898 (HHK) (D.D.C. 2008)
• 23 Stipulation re: Protocol for Possible Removal of Jahi McMath from Children's Hospital CASE NO. RP13707598: Submitted to the Superior Court of California, County of Alameda. Available at: http://www.thaddeuspope.com/images/2014-01-03_Stip.pdf . Accessed October 16, 2014
• 24 Armstrong PW, Olick RS. Innovative legislative initiatives: the New Jersey Declaration of Death and Advance Directives for Health Care Acts. Seton Hall Legis J 1992; 16 (1) 177-197
• 25 N. J. Rev Stat. 26:6A–3
• 26 Grodin MA. Religious exemptions: brain death and Jewish law. J Church State 1994; 36 (2) 357-372
• 27 N. J. Rev Stat. § 26:6A–5
• 28 People v. Eulo, 63 N.Y.2d 341 (N.Y. Ct. App. 1984)
• 29 10 N.Y.C.R.R. § 400.16 (1987)
• 30 New York State Department of Health and New York State Task Force on Life & the Law. Guidelines for Determining Brain Death. Nov. 2011. Available at: http://www.health.ny.gov/professionals/hospital_administrator/letters/2011/brain_death_guidelines.pdf . Accessed October 14, 2014
• 31 Alvarado v New York City Health & Hosp. Corp., 547 N.Y.S.2d 190 (N.Y. Sup. Ct. 1989); vacated 157 A.D.2d 604 (1990)
• 32 Burkle CM, Schipper AM, Wijdicks EF. Brain death and the courts. Neurology 2011; 76 (9) 837-841
• 33 In the Matter of Long Island Jewish Med. Center, 641 N.Y.S.2d 989 (N.Y. Sup. Ct. 1996)
• 34 Cal. Health & Safety Code §§ 7180–81
• 35 Cal. Health & Safety Code § 1254.4(a)
• 36 Cal. Health & Safety Code § 1254.4(b)
• 37 Cal. Health & Safety Code § 1254.4(c)
• 38 Pope TM. Involuntary passive euthanasia in US courts: reassessing the judicial treatment of medical futility cases. Marquette Elder's Advisor 2008; 2: 229-268
• 39 Ioffee K, DeBolt D. Jahi McMath being kept at New Jersey Hospital. Mercury News 2014. Available at: http://www.contracostatimes.com/news/ci_25992853/jahi-mcmath-being-kept-alive-at-new-jersey . Accessed February 15, 2015
• 40 Winkfield v. Children's Hospital, No. PR13–707598 (Writ of Error Corum Nobis and Memorandum Regarding Court's Jurisdiction to Hear Petition for Determination that Jahi McMath Is Not Brain Dead)
• 41 In re Issac Lopez, a Minor, No. 14-CI-354 (Jefferson Circuit Court, Kentucky 22 July 2014) (Order).
• 42 Ky. Rev. Stat. § 446.400(2)
• 43 Galofaro C. Brain-dead baby taken off life support. Courier Journal; 2014
• 44 Jacobs v. CORE, No. 1:09-CV-00048-SJM (W.D. Pa. 23 Aug. 2012) (trial brief)
• 45 Jacobs v. CORE, No. 1:09-CV-00048-SJM (W.D. Pa. 6 Nov. 2012) (Petition to Obtain Approval of Settlement)
• 46 O'Brien J, Moulder JJ. St. Joseph's ‘dead’ patient awake as doctors prepared to remove organs. Syracuse Post-Standard; 2013
• 47 Westhoff v. Children's Hospital and Research Center of Oakland, No. RG14721095 (Alameda County Sup. Court, Calif. 11 Apr. 2014) (Complaint)
• 48 Greene M, Wolfe LR . Pregnancy exclusions in state living will and medical proxy statutes. Available at: http://www.centerwomenpolicy.org/programs/health/statepolicy/documents/REPRO_PregnancyExclusionsinStateLivingWillandMedicalProxyStatutesMeganGreeneandLeslieR.Wolfe.pdf . Accessed July. 21, 2014
• 49 Munoz v. John Peter Smith Hospital. Plaintiff's original petition for declaratory judgment and application for unopposed expedited relief cause No. 017–270080–14. Available at: http://thaddeuspope.com/images/Munoz_v._JPS_Jan_2014_.pdf . Accessed July 21, 2014
• 50 Hellerman C, Morris J, Smith M . Brain-dead Texas woman taken off ventilator. Available at: http://www.cnn.com/2014/01/26/health/texas-pregnant-brain-dead-woman/index.html?iphoneemail . Accessed July 21, 2014. 2014
• 51 Chappell B . Judge tells hospital to take pregnant woman off life support. Available at: http://www.npr.org/blogs/thetwo-way/2014/01/24/265785603/judge-tells-hospital-to-take-pregnant-woman-off-life-support . Accessed July 21, 2014
• 52 Munoz v. John Peter Smith Hospital, Tarrant County, Texas District Court Order Cause No. 096–270080–14. Available at: http://thaddeuspope.com/images/MUNOZ_202053415-Judges-Order-on-Munoz-Matter.pdf . Accessed July 21, 2014