Background Requirements for organ donation after cardiac or imminent death have been introduced to address the transplantable organs shortage in the United States. Organ procurement organizations (OPOs) increasingly use the Internet for organ donation consent. Methods An analysis of OPO Web sites available to the public for enrollment and consent for organ donation. The Web sites and consent forms were examined for the minimal information recommended by the United States Department of Health and Human Services for informed consent. Content scores (...) were calculated as percentages of data elements in four information categories: donor knowledge, donor consent reinforcement, donation promotion, and informed consent. Results There were 60 Web sites for organ donation enrollment serving the 52 states. The median percent (10 percentile-90 percentile) content scores of the Web sites for donor knowledge, donor consent reinforcement, and donation promotion were 33% (20–47), 79% (57–86), and 75% (50–100), respectively. The informed consent score was 0% (0–33). The content scores for donor knowledge and informed consent were significantly lower than donor consent reinforcement and donation promotion for all Web sites (P < .05). The content scores for the four categories were similar among the 11 regions of the United Network for Organ Sharing. Conclusion The Web sites and consent forms for public enrollment in organ donation do not fulfill the necessary requirements for informed consent. The Web sites predominantly provide positive reinforcement and promotional information rather than the transparent disclosure of organ donation process. Independent regulatory oversight is essential to ensure that Internet enrollment for organ donation complies with legal and ethical standards for informed consent. (shrink)

Islamic political thought has long been concerned with the abuses of tyranny. To contemporary Islamists, the tyrant is the ruler who adopts foreign ideas opposed to the original values of Islam. This sentiment is sometimes coupled with calls for revolutionary violence, a view popularized by the Egyptian Islamist Sayyid Qutb.1 While to some modern Islamists tyrannical rule signifies encroaching Western hegemony, its premodern use was less geographically specific. The Prophet Muhammad had simply stipulated that the "best struggle is a word (...) of truth [spoken] to a tyrannical [or unjust] ruler".2 This maxim alone does not describe the tyrant's cultural and religious... (shrink)

This study was carried out to investigate the roles of epistemic beliefs and writing self-efficacy in predicting second language writing anxiety among learners of English as a foreign language. To this end, three validated scales were distributed among 240 EFL students. They were asked to complete the questionnaires during their regular courses. A structural equation modeling approach was utilized to analyze the hypothesized SEM model and the causal paths among the constructs. The direct and indirect path analyses of the hypothesized (...) model indicated that EBs and WSE accounted for 43% of the variance in L2WA. Although both constructs had a significant effect on L2WA, EBs turned out to be a robust predictor of increasing L2WA. Notably, it was revealed that learners’ EBs directly and significantly influenced their L2WA. Besides, the results indicated that WSE had a unique effect in reducing L2WA. More precisely, students who had a higher level of EBs seemed to have a greater L2WA, and those who had a higher level of WSE experienced less L2WA. The findings of this explanatory study suggest that L2 teachers and material developers should pay serious attention to the Students’ cognitive and affective variables as they were known to be significant factors in influencing L2WA. (shrink)

This study investigates whether financial performance is affected by corporate violations of laws and regulations. In a sample of 128 publicly traded banks that were subject to enforcement actions by US regulatory authorities over a 20-year period, we observed a significant negative market reaction pursuant to the violations. However, the market reaction did not vary meaningfully in accordance with the severity or repetitiveness of the violation. The results of this study are in conformity with previous research on industries other than (...) banking, notably with regard to negative market reaction. This confirms that shareholders in the banking industry react in a manner considerably similar to their counterparts in other industries. (shrink)

Business Ethics, the Environment & Responsibility, Volume 31, Issue 2, Page 398-418, April 2022.

Islam and End-of-Life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences Content Type Journal Article Pages 175-205 DOI 10.1007/s10730-009-9095-8 Authors Mohamed Y. Rady, Mayo Clinic Hospital in Phoenix 5777 East Mayo Boulevard Phoenix Arizona USA 85054 Joseph L. Verheijde, Mayo Clinic College of Medicine 5777 East Mayo Boulevard Phoenix Arizona USA 85054 Muna S. Ali, Arizona State University Phoenix Arizona USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue (...) Volume 21, Number 2. (shrink)

This paper engages Alex Dubilet’s The Self-Emptying Subject: Kenosis and Immanence, Medieval to Modern and his account of immanence and kenosis as exhibited in his reading of Hegel’s concept of Entäußerung [externalization]. Specifically, I focus on the “problematic of desubjectivation” that centers Dubilet’s critique of transcendence and its relationship to subjection and subjectivity. I reconsider the relationship made between this problematic, the ethics of kenosis, and the concept of immanence so as to demonstrate the ways in which Dubilet attempts to (...) depart from transcendence, subjectivity, and their concomitant ethics. In particular, I consider his reading of Hegel’s concept of Entäußerung and its similarities to the Young Hegelians’ understanding of this concept. My reading of Dubilet suggests that while he seeks to depart from transcendence, he reintroduces transcendence through the “problematic of desubjectivation” and its relationship to kenosis. In conclusion, I question the philosophical import of immanence in contemporary critical inquiry and why its conceptualization is often positioned in opposition to transcendence. (shrink)

The purpose of this study was to know the relationship between student perception towards mathematics teacher with mathematics academic performace. The population of the study were all students of class VIII SMPN 8 Cirebon in the academic year 2014/2015, with the number of students 287 people. The sampling technique used proportional random sampling, and the sample size was 56 students. Data collection techniques used: 1) Questionnaire of Perceptions towards Mathematics teacher, and 2) The results of student mathematics learning test. The (...) result of correlation analysis show no significant correlation between students perception towards teacher and academic performance (r= .155, p= .254). (shrink)

A number of advocates for TQM contend that firms who embrace TQM will automatically and naturally act in ethically sound ways (Roth, 1993; Pace, 1999; Steeples, 1994). This claim is a strong one. This paper assesses its truth. We consider the many ways in which quality initiatives, if undertaken in good faith, can foster sound ethics. We explore the various ways in which TQM presupposes, and thus cannot engender, ethical behavior. And, finally, we identify some of the ethical blind spots (...) in quality initiatives and TQM. We propose that if TQM is undertaken by thoughtful people who take steps to correct its ethical blind spots and who understand the need for an ethical underpinning, then TQM and ethics will prove mutually reinforcing. (shrink)

There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns in living and (...) end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process. (shrink)

This paper aims to provide insights into the Malaysian newspaper reports on apostasy cases in the country. Being a Muslim country with multi-religions, apostasy is highly sensitive hence any issues related to apostasy need to be carefully managed. Four keywords were used to identify newspaper reports for the analysis. Two newspaper reports met the selection criteria and were analysed using a discourse analysis approach focusing on Grammatical Analysis, Macrostructures, and Rhetorical Structures. The analysis reveals that the report in New Straits (...) Times, which is the right-wing newspaper, carries the voice of anti-apostate and disapproves the act of renouncing Islam. On the other hand, the report in The Malay Mail, which is the left-wing newspaper, carries the voice of pro-apostate. By deconstructing the newspaper reports, this paper contributes to the understanding of the agendas that have been subtly set in the news. This paper concludes that the two reports have been strategically constructed to serve the interests and promote the ideology of the two competing groups in the country, thus creating a balance in the multi-religious context. (shrink)

This study empirically examines the relationship between wide-ranging board diversity and the quality of corporate social responsibility disclosure variables in Malaysia. We extend prior literature covering broader dimensions of board diversity and their impact on CSR after controlling for board and audit committee characteristics. Using 200 listed firms in Bursa Malaysia during 2009–2013 and applying both OLS and 2SLS instrumental variables approaches, we document significant positive effect of board education level and board tenure diversity on the quality of CSR disclosure. (...) Further analysis using robust regression also shows positive association between gender diversity and CSR disclosure. Our findings also demonstrate that the quality of CSR disclosure is significantly negatively associated with board age and nationality diversity. These results remain consistent with using alternative measures for board diversity, and characteristics for board of director and audit committees as well as split samples between large and small firms. Additional tests exhibit complementary relationship of education level and nationality with gender, while substitutive relationship of age and tenure with gender in influencing CSR. These findings provide useful insights into the policy makers in setting regulations in respect of board diversity in Malaysia and other emerging economies in the Asian region. Our evidence is also useful for listed companies in setting the criteria to identify directors who can support their strategic decisions. (shrink)

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states’ department of motor vehicles to promote citizens’ willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states’ department of motor vehicles. The media campaigns include the use of multifaceted communication tools (...) and provide training to desk clerks in the use of scripted messages for the purpose of optimizing enrollment in organ-donor registries. Scripted messages are communicated to customers through mass audiovisual entertainment media, print materials and interpersonal interaction at the offices of departments of motor vehicles. These campaigns give rise to three serious concerns: (1) bias in communicating information with scripted messages without verification of the scientific accuracy of information, (2) the provision of misinformation to future donors that may result in them suffering unintended consequences from consenting to medical procedures before death (e.g, organ preservation and suitability for transplantation), and (3) the unmanaged conflict of interests for organizations charged with implementing these campaigns, (i.e, dual advocacy for transplant recipients and donors). We conclude the following: (1) media campaigns about healthcare should communicate accurate information to the general public and disclose factual materials with the least amount of bias; (2) conflicting interests in media campaigns should be managed with full public transparency; (3) media campaigns should disclose the practical implications of procurement as well as acknowledge the medical, legal, and religious controversies of determining death in organ donation; (4) organ-donor registration must satisfy the criteria of informed consent; (5) media campaigns should serve as a means of public education about organ donation and should not be a form of propaganda. (shrink)

This study linked background TV and socioeconomic status to minority children’s Persian vocabulary development. To this end, 80 Iranian preschool children from two minority groups of Arabs and Turks were selected using stratified random sampling. They were simultaneous bilinguals, i.e., their mother tongue was either Arabic or Azari and their first language was Persian. Language sample analysis was used to measure vocabulary development through a 15-min interview by language experts. The LSA measures included total number of utterances, total number of (...) words, total number of new words, and mean length of utterance. A series of independent-samples t test, paired-samples t test, and repeated measures MANOVA tests were ran to examine data. Results showed significant improvements in children’s vocabulary scores from pretest to posttest for all children. In addition, high-SES children scored higher on the vocabulary measures in pretest and posttest. Moreover, background TV was associated with higher means in the TNW and the NDW in groups. The researchers concluded that background TV may be related to higher vocabulary scores in low-SES families as it may compensate for some linguistics gaps in these families including lower amount of child-parent interaction, play, and parents’ level of literacy. (shrink)

The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain death with human death (...) may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago. (shrink)

This article examines ḥikma as it was practiced by Ṣadr al-Dīn Shīrāzī, or Mullā Ṣadrā (d. 1640), in explaining the connection between the divine names and the attributes of God. This is done via a translation of the fourth part of his al-Maẓāhir al-ilāhiyya fī asrār al-ʿulūm al-kamāliyya [The loci of divine manifestations in the secrets of the knowledge of perfection]. Ḥikma, philosophy, as it is defined here, is the combination of rational demonstrations and spiritual unveiling. Shīrāzī’s philosophy is a (...) synthesis of Ibn ʿArabī’s school of metaphysical unveiling, the Ishrāqī school led by Suhrawardī, and the rational school of the Peripatetics. The text is translated here for the first time, and includes annotations. (shrink)

ABSTRACT Malaysia’s 13th general election in 2013 was the final election where the longest-serving elected government in the world, Barisan Nasional, regained power, before it was ousted after over six decades of authoritarian rule in 2018. In a country that practises parliamentary democracy but simultaneously observed close cooperation between the then ruling coalition and the mainstream press, this paper shows the micro-politics of the driving force of the coalition, United Malays National Organisation – specifically, how anxiety regarding the maintenance of (...) their privileged and empowered Malay position dominated the national narrative during the GE13 campaign. Focusing on editorial journalistic genres in four paid-for Malay-language newspapers, I illustrate the typical politics of fear that characterises much of Malaysian right-wing rhetoric – the ways in which racial and religion issues are provoked. The in-depth representational analysis, via the Discourse-historical Approach’s nomination and predication strategies, also suggests the normalisation of nationalistic and racist rhetoric, which primarily works with ‘fear’: fear of change, of loss of privilege, of the future, of other races; in principle, almost anything can be constructed as a threat to ‘Us’, an imagined homogenous people inside a well-protected territory through the discursive construction of such in-groups and out-groups. (shrink)

End-of-life organ donation is controversial in Islam. The controversy stems from: scientifically flawed medical criteria of death determination; invasive perimortem procedures for preserving transplantable organs; and incomplete disclosure of information to consenting donors and families. Data from a survey of Muslims residing in Western countries have shown that the interpretation of religious scriptures and advice of faith leaders were major barriers to willingness for organ donation. Transplant advocates have proposed corrective interventions: reinterpreting religious scriptures, reeducating faith leaders, and utilizing media (...) campaigns to overcome religious barriers in Muslim communities. This proposal disregards the intensifying scientific, legal, and ethical controversies in Western societies about the medical criteria of death determination in donors. It would also violate the dignity and inviolability of human life which are pertinent values incorporated in the Islamic moral code. Reinterpreting religious scriptures to serve the utilitarian objectives of a controversial end-of-life practice, perceived to be socially desirable, transgresses the Islamic moral code. It may also have deleterious practical consequences, as donors can suffer harm before death. The negative normative consequences of utilitarian secular moral reasoning reset the Islamic moral code upholding the sanctity and dignity of human life. (shrink)

Building on the modified theory of planned behavior (TPB), this study examined the underlying psychological motives for academic dishonesty in a sample of 250 undergraduates drawn from three selected Malaysian public universities. The results yielded additional supports for usefulness of modified TPB model in predicting academic misconduct. All components of the model exerted statistically significant effects on intention towards academic misconduct, and intention itself exerted a statistically significant impact on academic dishonesty. This suggests that students’ academic misconducts could be addressed (...) effectively if proper attention is given to the underpinning factors. Further, the findings revealed that the hypothesized relationships among variables of the modified model were all statistically significant. The uniqueness of this study lies in the large amount of variance (69 % and 75 %) explained by components of the model (in the prediction of intention and academic dishonesty respectively). These variances have rarely been accounted for in the previous studies. Implications of the findings are discussed and suggestions advanced for future studies. (shrink)

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death (...) based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A [2015] EWHC 443. Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: the tests of brainstem function were not properly undertaken in this case; the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and absent authentication of the clinical criteria of death, the code of practice wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society. (shrink)

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because patients in PDOC can (...) survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

We respond to Morgan and Feeley’s critique on our article “Mass Media in Organ Donation: Managing Conflicting Messages and Interests.” We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: “to educate the general public about organ donation process” and “help individuals make informed decisions” about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to “information from pilot work or focus groups” but should include evidence-based (...) facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley’s claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ requestors at the Department of Motor Vehicles offices. We conclude that organ donation is a medical procedure subject to all the ethical obligations that the medical profession must uphold including that of transparency and truthfulness. (shrink)

In addition to opening a fertile field for inquiry in analytical social epistemology, Miranda Fricker’s work has provided powerful conceptual tools that merge descriptive capacity and political potency. For this reason, over the last fifteen years, the conceptual repertoire introduced by the author has been well received in both academic and political arenas. At times, the concepts of both testimonial and hermeneutical injustice acquire excessive dimensions in the literature, and this undermines, on the one hand, their analytical precision and, on (...) the other, their usefulness. In this paper I argue against Fricker’s structural parallelism thesis and defend an independent treatment of each of these concepts. On this basis, to counteract the hyperinflation of the concept of hermeneutic injustice, I proceed with an exercise of conceptual precision. To this end, I identify the conditions that make hermeneutic injustice both unjust and hermeneutic. Finally, I present theoretical and practical reasons to encourage the rigorous use of these concepts. (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

In assisted dying, the end-of-life trajectory is shortened to relieve unbearable suffering. Unbearable suffering is defined broadly enough to include cognitive (early dementia), psychosocial or existential distress. It can include old-age afflictions that are neither life-threatening nor fatal in the “vulnerable elderly”. The voluntary refusal of food and fluids (VRFF) combined with continuous deep sedation (CDS) for assisted dying is legal. Scientific understanding of awareness of internal and external nociceptive stimuli under CDS is rudimentary. CDS may blunt the wakefulness component (...) of human consciousness without eradicating internal affective awareness of thirst and hunger. Patients may suffer because of the slow dying process following dehydration and starvation. The difficulty to adequately control distress, without bringing the dying process to a rapid conclusion by lethal pharmacological interventions, can cause feelings of guilt among hospice and medical staff. Furthermore, the double-effect principle is not applicable in these situations because the primary objective of VRFF is to hasten death. Legal and societal debate should focus on sharpening the boundaries between assisted dying and palliative care. This separation is necessary to: 1) uphold trust in the patient-phyician relationship, and 2) preserve integrity and ethics of the medical profession. (shrink)

Volume 20, Issue 6, June 2020, Page 22-24.

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death (...) based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A [2015] EWHC 443. Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: the tests of brainstem function were not properly undertaken in this case; the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and absent authentication of the clinical criteria of death, the code of practice wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society. (shrink)

In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. (...) Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)