GEOGRAPHY DETERMINES WHEN A DEATH CAN BE DECLARED

Apart from decision fatigue, there is the issue of decision confusion. An example is that it is possible for an individual to be pronounced dead in one state, but not dead in a neighboring jurisdiction. As described in an article appearing on December 24, 2019 in the Annals of Internal Medicine, this situation exists because only 36 states have incorporated the complete language of the Uniform Determination of Death Act (UDDA) into their respective definitions of death. An original goal was for all states to adopt the UDDA as the legal standard for death by neurologic criteria (DNC). Instead, there is ongoing confusion about DNC since medical standards of determination vary, public acceptance is inconsistent, and responses to family objections have ranged from continuation of organ support indefinitely to unilateral discontinuation. Unresolved problems pertain to: (1) lack of uniformity in the medical standards used to determine DNC, (2) uncertainty about whether “all functions of the entire brain, including the brainstem” entail hormonal functions, (3) the UDDA does not address whether consent is needed before a determination of DNC, and (4) the UDDA does not address religious objections to discontinuation of organ support after DNC.

In a related vein, a debate is underway in the field of Alzheimer’s disease (AD) research over the definition of the disease itself. As described in the December 11, 2019 issue of the journal Science Translational Medicine, a problem is that the terms dementia and AD have become interchangeable. Arguments in favor of using a biological versus a clinical diagnosis for AD are that: the latter is not specific for any etiology; a biological definition of AD will lead to a better understanding of the sequence of events that leads to cognitive impairment and dementia; biological markers will improve efficiency of clinical trials; and a biological definition of AD enables study of the disease from the preclinical stage through all symptomatic stages and of all disease phenotypes, not only the memory loss phenotype.

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