Diagnosing Death

It was not always doctors who diagnosed death. Advances in resuscitation and fears of premature burial led to doctors having a duty to diagnose death in a safe and timely way. The birth of intensive care in the twentieth century demonstrated that it was possible for the heart to keep beating even after the brain had permanently ceased functioning. A worldwide, unifying, brain-based definition of death could be termed ‘permanent brain arrest’. The clinical characteristics of permanent brain arrest would be the permanent loss of capacity for consciousness and loss of all brainstem functions (including the capacity to breathe), which might arise from primary brain injury or secondary to circulatory arrest. Three sets of criteria are used by doctors to diagnose death, depending on the clinical circumstances: forensic, circulatory, and neurological. All three sets of criteria point to the same brain-based definition of death. While there is widespread consensus for these standards—in practice and in law—they are not without criticism.