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Edited by Stuart Youngner, Robert Arnold and Renie Schapiro, Baltimore, The Johns Hopkins University Press, 1999, 346 pages, £45.
This is a book that can be highly recommended to all students of medical ethics. The editors have assembled a diverse group of contributors who are all highly respected in the field of death and brain death and whilst there is a distinct North American flavour to most of the articles, there are contributions from other countries including the UK. All forms of brain death (brain stem death, whole brain death and neocortical death) are discussed from a variety of viewpoints but there is an unfortunate tendency to link brain death with organ transplantation. This link is most obvious in the article by Rix about the problems with brain death in Denmark. Although much of the book concentrates on the definition of death (especially in the USA) there is an excellent section on the attitude towards brain death of a variety of mainstream religions, including fundamentalist Christianity. Such discussion is not commonly seen and is a welcome addition to the text.
For readers approaching the topic of brain death for the first time, much of this book seems daunting but a thorough reading will provide an excellent overall view of the debate that has been in progress for some time. The historical development of brain death is well discussed, as is the public attitude to the development of the concept, along with international perspectives covering the USA, Europe and Japan. It ends with a consideration of possible future developments.
Many of the fundamental questions associated with debates on brain death are covered—what constitutes the death of a person, are the tests for brain death appropriate and has brain death been irrevocably established. The single most important question, ie does brain death of any description actually constitute death or is it merely predictive of death, is also addressed. Answers to questions of this nature, of course, underlie both treatment decisions in a small group of patients and the uses to which the organs of the “deceased” patient may be put (transplantation). This book makes it obvious that there are no simple or easy answers to these questions and the differences of opinion between experts is well demonstrated in the earlier articles.
My only criticism of the book is that the concept of brain death is repeatedly linked with organ donation and transplantation without qualification. Failure to separate these two issues constitutes a fundamental flaw in the development of the concept of brain death. Whilst this link may represent historical actuality, there is no suggestion in any article that such a link should be broken and that the debate about the definition of death should proceed without any reference to organ transplantation.
That criticism apart, this book is an excellent compilation of articles stating the present position in relation to brain death and clearly demonstrates the ethical dilemmas surrounding the concept of death and its determination in practice. It can be wholeheartedly recommended to those interested in brain death from almost any perspective.