And She's Not Only Merely Dead, She's Really Most Sincerely Dead (Letter to the Editor‪)‬

To the Editor: D. Alan Shewmon's work over the last decade has clearly awakened the bioethics community from its dogmatic slumbers. Easy acceptance of the "somatic integration" rationale for equating the condition known as total brain failure with death of the human being is, after Shewmon, a thing of the past. In "Brain Death: Can It Be Resuscitated?" (Mar-Apr 2009), he has made yet another valuable contribution to the debate, providing a close and critical reading of the President's Council's white paper, "Controversies in the Determination of Death." Shewmon asserts that the council's effort is "brave but flawed." Having been involved in the production of the white paper as lead staff researcher and writer, I believe that he is mistaken on a number of points. (All opinions expressed here are mine alone.) Shewmon's account of the historical foundations of this controversy is far too one-sided. He rightly points out that the initial equation of "irreversible coma" with human death was made without a developed philosophical defense and with an eye to practical consequences that would follow from a new standard. But a more balanced historical account would also note that the condition in question--also revealingly called "coma depasse," or "beyond coma"--was recognized by neurologists and others as a case apart from all other brain injuries discovered in ventilator-dependent patients. Eelco Wijdick's 2003 historical study of the Harvard Committee's work gives a more nuanced picture, pointing out that "neurologists in the committee knew too well that brain death represented a unique comatose state that could be clearly delineated from other neurologic states." Regardless of the practical context, the task of interpreting this unique state in a way that does justice to the permanent and profound degree of its sufferers' incapacitation had to be taken up.