BRAIN-STEM DEATH, BRAIN-DEATH AND DEATH - A CRITICAL REEVALUATION OF THE PURPORTED EQUIVALENCE

The author challenges brain-based diagnoses of death by re-examining t he concept of death, its definition, the anatomical criterion, and the clinical signs or tests. Dr. Shewmon challenges the fundamental assum ptions underlying brain death: (1) that the brain is the body's ''crit ical system''; and (2) that the body even has a localized ''critical s ystem.'' He does not redefine death, but shifts the anatomical criteri on from a single focus (the brain) to the entire body. The clinical te sts correspondingly shift from those implying loss of brain function t o those implying thermodynamically supracritical microstructural damag e diffusely throughout the body. He concludes that the notion of ''bra in death'' as bodily death is logically and physiologically incoherent , and that its replacement by something scientifically more credible w ould promote not only the sanctity of life, but ironically even transp lantation as well.