Science

By CHRISTOPHER CLAMPITT

death, (deth), n. [M.E. delh, deeth; A.S. death, death.]

1. the act or fact of dying; permanent cessation of life in a person, animal or plant, in which all vital functions cease permanently.
Webster's New Twentieth Century Dictionary, Unabridged

BUT WHAT is a vital function? And when has it ceased?

Traditionally, death has been defined as the loss of heart and lung function. Before the advent of the respirator, the loss of function in either of these organs spelled death. With activity of the heart and lungs easily observable, even to nonmedical personnel, questions were unlikely on the pronouncement of death, and there was little need for a statutory definition. Illinois statutes, like those of many other states, contain numerous references to death, but no single definition.

With the development of artificial respirators in recent decades, the situation has been made more complicated. While a respirator is in use, the presence of breathing or a heartbeat is no longer sufficient proof that the person, or body, is still alive. (The distinction between person and body is one better made by philosophers and theologians than by physicians or other scientists.) What this means is that another standard is needed for determining death.

The standard which has been most widely suggested is that of brain function. Brain activity can be easily monitored with an electroencephalograph (EEG), a device which measures and records the brain's weak electrical output. Some people have argued that loss of higher brain functions constitutes loss of "personhood," and therefore death. However, the medical and legal communities have taken a narrower view and held that death has occurred only with the loss of total brain function.

Of the 24 states which have adopted broad definitions of death, all have used brain-based criteria as at least part of the definition. Some make no reference to the traditional heart and lung standard, and others mention it only in passing.

Illinois currently has two narrow definitions of death, each covering a specific situation. In 1961, the Illinois General Assembly passed the first of these as part of the Vital Records Act. This act refers to fetal death as: "Death prior to the complete expulsion or extraction from its mother of a product of human conception." The act also lists a few signs of life, such as breathing, heartbeat and voluntary muscle activity.

The second definition of death was enacted in 1975 as an amendment to the Uniform Anatomical Gifts Act. The act now provides that "'Death' means, for the purposes of the Act, the irreversible cessation of total brain function, according to usual and customary medical practice." Two things should be noted about this definition. First, it only applies to cases where organs are to be taken from the body for purposes of transplantation. Second, while death is typically pronounced on the basis of loss of cardiopulmonary function, the act requires the use of a brain-based standard.

In January 1982, Senator John D'Arco (D., Chicago) introduced Senate Bill 1279, which would enact the Illinois Uniform Brain Death Act. This bill would define death "for legal and medical purposes" as "the irreversible cessation of all functioning of an individual's brain, including the brain stem." This definition would also replace the two existing statutory definitions of death. No cardiopulmonary standards are included in the bill.

But now another problem has arisen — a surplus of definitions. The American Bar Association (ABA), the American Medical Association (AMA) and several other groups have all made statutory proposals. At present, there are more brain-death standards than there are states which have enacted them. While the intent of the different laws may be identical, the different wordings could cause problems in cases where two or more states are involved.

Last year, some progress was made in clarifying the situation. In July, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published a report on its study of brain-based definitions of death. The report included a proposed statute which was recommended for adoption by all 50 states. This proposed law recognizes equally the traditional heart and lung definition of death and a brain-based definition: "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead." This model statute is thorouggh and straightforward. It also avoids the restrictions included in some brain death statutes, such as "for medical and legal purposes," which add nothing but confusion and the potential for legal challenge.

The ABA, AMA and other organizations which had proposed their own statutes quickly adopted this new wording. Since then, Idaho has adopted it, and Colorado enacted a very similar law.

As things stand now, 27 states include brain-based definitions of death in their statutes. Three states, including Illinois, have adopted such definitions only in their anatomical gifts statutes; the other 24 have enacted general brain death acts. With the introduction of S.B. 1279, the Illinois General Assembly has the opportunity debate this issue and bring state law in line with contemporary medical practice in defining death. □

Christopher Clampitt is an intern with the Illinois Legislative Council's science unit.

30/April 1982/Illinois Issues