49 found
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  1. Inconsistency between the Circulatory and the Brain Criteria of Death in the Uniform Determination of Death Act.Alberto Molina-Pérez, James L. Bernat & Anne Dalle Ave - 2023 - Journal of Medicine and Philosophy 48 (5):422-433.
    The Uniform Determination of Death Act (UDDA) provides that “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.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions.” By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the (...)
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  2.  5
    The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols.James L. Bernat - 2024 - American Journal of Bioethics 24 (6):4-15.
    Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...)
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  3.  72
    A Defense of the Whole‐Brain Concept of Death.James L. Bernat - 1998 - Hastings Center Report 28 (2):14-23.
    The concept of whole‐brain death is under attack again. Scholars are arguing that the concept of brain death per se—regardless of the focus on “higher,” “stem” or “whole”—is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole‐brain death remains the standard for determining death in much of the Western world and its defenders (...)
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  4.  45
    The Organism as a Whole in an Analysis of Death.Andrew P. Huang & James L. Bernat - 2019 - Journal of Medicine and Philosophy 44 (6):712-731.
    Although death statutes permitting physicians to declare brain death are relatively uniform throughout the United States, academic debate persists over the equivalency of human death and brain death. Alan Shewmon showed that the formerly accepted integration rationale was conceptually incomplete by showing that brain-dead patients demonstrated a degree of integration. We provide a more complete rationale for the equivalency of human death and brain death by defending a deeper understanding of the organism as a whole and by using a novel (...)
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  5.  84
    How the Distinction between "Irreversible" and "Permanent" Illuminates Circulatory-Respiratory Death Determination.James L. Bernat - 2010 - Journal of Medicine and Philosophy 35 (3):242-255.
    The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory–respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted (...)
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  6.  52
    The ethical obligation of the dead donor rule.Anne L. Dalle Ave, Daniel P. Sulmasy & James L. Bernat - 2020 - Medicine, Health Care and Philosophy 23 (1):43-50.
    The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We (...)
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  7.  31
    The Whole-Brain Concept of Death Remains Optimum Public Policy.James L. Bernat - 2006 - Journal of Law, Medicine and Ethics 34 (1):35-43.
    The definition of death is one of the oldest and most enduring problems in biophilosophy and bioethics. Serious controversies over formally defining death began with the invention of the positive-pressure mechanical ventilator in the 1950s. For the first time, physicians could maintain ventilation and, hence, circulation on patients who had sustained what had been previously lethal brain damage. Prior to the development of mechanical ventilators, brain injuries severe enough to induce apnea quickly progressed to cardiac arrest from hypoxemia. Before the (...)
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  8. The Whole-Brain Concept of Death Remains Optimum Public Policy.James L. Bernat - 2006 - Journal of Law, Medicine and Ethics 34 (1):35-43.
    “Brain death,” the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: agreeing on the paradigm of death, a set of preconditions that frame the discussion; determining the definition of death by making explicit the consensual concept of death; determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; (...)
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  9.  31
    Aligning the Criterion and Tests for Brain Death.James L. Bernat & Anne L. Dalle Ave - 2019 - Cambridge Quarterly of Healthcare Ethics 28 (4):635-641.
    Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training (...)
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  10.  45
    On Noncongruence between the Concept and Determination of Death.James L. Bernat - 2013 - Hastings Center Report 43 (6):25-33.
    A combination of emerging life support technologies and entrenched organ donation practices are complicating the physician's task of determining death. On the one hand, technologies that support or replace ventilation and circulation may render the diagnosis of death ambiguous. On the other, transplantation of vital organs requires timely and accurate declaration of death of the donor to keep the organs as healthy as possible. These two factors have led to disagreements among physicians and scholars on the precise moment of death. (...)
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  11.  61
    Whither Brain Death?James L. Bernat - 2014 - American Journal of Bioethics 14 (8):3-8.
    The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human (...)
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  12. Neuroimaging and disorders of consciousness: Envisioning an ethical research agenda.Joseph J. Fins, Judy Illes, James L. Bernat, Joy Hirsch, Steven Laureys & Emily Murphy - 2008 - American Journal of Bioethics 8 (9):3 – 12.
    The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move (...)
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  13.  17
    Clarifying the DDR and DCD.James L. Bernat - 2023 - American Journal of Bioethics 23 (2):1-3.
    Over the past quarter century, organ donation after the circulatory determination of death (DCD) has grown in acceptance and prevalence throughout the world (Domínguez-Gil et al. 2021). Notwithstan...
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  14.  14
    The Brain-as-a-Whole Criterion and the Uniform Determination of Death Act.James L. Bernat - 2023 - American Journal of Bioethics Neuroscience 14 (3):271-274.
    Nair-Collins and Joffe (2023) highlighted the noncongruence between the language of the Uniform Determination of Death Act (UDDA) and the accepted brain death bedside testing standard by showing th...
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  15. The biophilosophical basis of whole-brain death.James L. Bernat - 2002 - Soc Philos Policy 19 (2):324-42.
    Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole- brain death ” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple (...)
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  16.  16
    The Brainstem Criterion of Death and Accurate Syndromic Diagnosis.James L. Bernat - 2024 - American Journal of Bioethics 24 (1):100-103.
    Ariane Lewis provided an insightful review of several controversial cases of death by neurologic criteria (“brain death”) in the UK, focusing on Archie Battersbee, a boy whose tragic illness provok...
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  17.  38
    The biophilosophical basis of whole-brain death.James L. Bernat - 2002 - Social Philosophy and Policy 19 (2):324-342.
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  18.  56
    Are Organ Donors after Cardiac Death Really Dead?James L. Bernat - 2006 - Journal of Clinical Ethics 17 (2):122-132.
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  19.  80
    Chronic disorders of consciousness.James L. Bernat - 2006 - Lancet 367 (9517):1181-1192.
  20.  60
    How Much of the Brain Must Die in Brain Death?James L. Bernat - 1992 - Journal of Clinical Ethics 3 (1):21-26.
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  21.  29
    A Conceptual Justification for Brain Death.James L. Bernat - 2018 - Hastings Center Report 48 (S4):19-21.
    Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I first addressed it in 1981, a development that (...)
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  22.  47
    Defining Death in Theory and Practice.James L. Bernat, Charles M. Culver & Bernard Gert - 1982 - Hastings Center Report 12 (1):5-9.
  23. Medical Decision Making by Patients in the Locked-in Syndrome.James L. Bernat - 2018 - Neuroethics 13 (2):229-238.
    The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for simple (...)
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  24.  19
    Conceptual Issues in DCDD Donor Death Determination.James L. Bernat - 2018 - Hastings Center Report 48 (S4):26-28.
    Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long‐standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of respiration and circulation. Critics of this standard argue that while the cessation of respiration and circulation (...)
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  25.  46
    An analysis of heart donation after circulatory determination of death.Anne Laure Dalle Ave, David Shaw & James L. Bernat - 2016 - Journal of Medical Ethics 42 (5):312-317.
  26.  32
    Donation after brain circulation determination of death.Anne L. Dalle Ave & James L. Bernat - 2017 - BMC Medical Ethics 18 (1):15.
    The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD]. In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation (...)
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  27. Perspectives and Experience of Healthcare Professionals on Diagnosis, Prognosis, and End-of-Life Decision Making in Patients with Disorders of Consciousness.Catherine Rodrigue, Richard J. Riopelle, James L. Bernat & Eric Racine - 2011 - Neuroethics 6 (1):25-36.
    In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an (...)
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  28.  32
    The Debate over Death Determination in DCD.James L. Bernat - 2010 - Hastings Center Report 40 (3):3-3.
  29. The concept and practice of brain death.James L. Bernat - 2006 - In Steven Laureys (ed.), Boundaries of Consciousness. Elsevier.
  30.  24
    Distinguishing between Patients' Refusals and Requests.Bernard Gert, James L. Bernat & R. Peter Mogielnicki - 1994 - Hastings Center Report 24 (4):13-15.
    To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die.
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  31.  31
    Harmonizing Standards for Death Determination in DCDD.James L. Bernat - 2015 - American Journal of Bioethics 15 (8):10-12.
  32.  30
    On irreversibility as a prerequisite for brain death determination.James L. Bernat - 2004 - In C. Machado & D. E. Shewmon (eds.), Brain Death and Disorders of Consciousness. Plenum. pp. 161--167.
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  33. The biophilosophical basis of whole-brain death.James L. Bernat - 2009 - In John P. Lizza (ed.), Defining the beginning and end of life: readings on personal identity and bioethics. Baltimore, Md: Johns Hopkins University Press.
     
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  34.  18
    Determining Death in Uncontrolled DCDD Organ Donors.James L. Bernat - 2013 - Hastings Center Report 43 (1):30-33.
    The most controversial issue in organ donation after the circulatory determination of death is whether the donor was truly dead at the moment death is declared. My colleagues and I further analyzed this issue by showing the relevance of the distinction between the “permanent” and the “irreversible” loss of circulatory functions. Permanent cessation means that circulatory function will not return because it will not be restored spontaneously and medical attempts to restore it will not be conducted. By contrast, irreversible cessation (...)
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  35.  7
    Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion.Adam Omelianchuk, Alexander Morgan Capron, Lainie Friedman Ross, Arthur R. Derse, James L. Bernat & David Magnus - forthcoming - Hastings Center Report.
    In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors (...)
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  36.  85
    Questions remaining about the minimally conscious state.James L. Bernat - 2002 - Neurology 58 (3):337-338.
  37.  31
    Declare Death or Attempt Experimental Resuscitation?James L. Bernat - 2017 - American Journal of Bioethics 17 (5):17-19.
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  38.  26
    Defining Death: Which Way?James L. Bernat, Charles M. Culver, Bernard Gert, Alexander M. Capron & Joanne Lynn - 1982 - Hastings Center Report 12 (2):43.
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  39.  24
    The Boundaries of the Persistent Vegetative State.James L. Bernat - 1992 - Journal of Clinical Ethics 3 (3):176-180.
  40.  28
    How Contextual and Relational Aspects Shape the Perspective of Healthcare Providers on Decision Making for Patients With Disorders of Consciousness: A Qualitative Interview Study.Catherine Rodrigue, Richard Riopelle, James L. Bernat & Eric Racine - 2013 - Narrative Inquiry in Bioethics 3 (3):261-273.
    Disorders of consciousness (DOC) are a family of related neurological syndromes characterized by deficits of varying degrees of wakefulness (e.g., sleep–wake cycles and arousal) or awareness (e.g., reacting to stimuli, interacting with the environment). Although coma rarely persists for more than a few weeks, some patients remain in a subsequent vegetative state or a minimally conscious state for months or years. Caring for patients with DOC raises ethical questions, but the perspectives of healthcare providers on these questions remain poorly documented. (...)
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  41. Death in the Clinic.David Barnard, Celia Berdes, James L. Bernat, Linda Emanuel, Robert Fogerty, Linda Ganzini, Elizabeth R. Goy, David J. Mayo, John Paris, Michael D. Schreiber, J. David Velleman & Mark R. Wicclair - 2005 - Rowman & Littlefield Publishers.
    Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!
     
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  42.  9
    Commentary: Further Considerations in Using Functional Neuroimaging in Patients with Disorders of Consciousness.James L. Bernat - 2019 - Cambridge Quarterly of Healthcare Ethics 28 (4):632-634.
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  43.  23
    Constitutes Human Death.James L. Bernat - 2014 - In Arthur L. Caplan & Robert Arp (eds.), Contemporary debates in bioethics. Malden, MA: Wiley-Blackwell. pp. 25--377.
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  44.  12
    Reply to Chiong.James L. Bernat - 2014 - In Arthur L. Caplan & Robert Arp (eds.), Contemporary debates in bioethics. Malden, MA: Wiley-Blackwell. pp. 25--397.
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  45.  16
    The Veterans Affairs National Center for Clinical Ethics.James L. Bernat - 1992 - Kennedy Institute of Ethics Journal 2 (4):385-388.
    In lieu of an abstract, here is a brief excerpt of the content:The Veterans Affairs National Center for Clinical EthicsJames L. Bernat (bio)The veterans health administration is the largest health care system in the United States and, indeed, is larger that the health care system of many foreign countries. In February 1991 the Department of Veterans Affairs (V.A.) in Washington, D.C. awarded a contract to the clinical ethics group at the Veterans Affairs Medical Center in White River Junction, Vermont to (...)
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  46.  16
    Refusals Involving Requests.Leigh C. Bishop, Robert D. Orr, Dennis de Leon, Bernard Gert, James L. Bernat & R. Peter Mogielnicki - 1995 - Hastings Center Report 25 (4):4.
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  47. Participants of the Working Meeting on Ethics, Neuroimaging and limited states of consciousness. Neuroimaging and disorders of consciousness: envisioning an ethical research agenda.Joseph J. Fins, Judy Illes, James L. Bernat, Joy Hirsch, Steven Laureys & Emily Murphy - 2008 - Am J Bioethics 8 (9):3-12.
     
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  48.  10
    Caring for patients with disorders of consciousness: Highlights from the perspectives of healthcare professionals on communication and end-of-life decision making.Catherine Rodrigue, Richard J. Riopelle, James L. Bernat & Eric Racine - 2011 - Res Cogitans 8 (1).
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  49. Voluntarily stopping eating and drinking.Emily Rubin & James L. Bernat - 2014 - In Timothy E. Quill & Franklin G. Miller (eds.), Palliative care and ethics. New York: Oxford University Press.
     
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