ULC

Why States Should Adopt UDDA

Is it possible to be dead in one state, and not in another? Common sense says no. So does the medical profession. But legally, the answer is less clear. All states do not recognize the same legal standards for medical determinations of death. It is possible that an individual could be declared dead in one state and not in another even though, by medical standards, he or she is just as dead in both places.

This situation is more than paradoxical. Serious problems arise for hospitals, families, policymakers and the courts, as a too-typical incident in one state illustrates:

A child was brought into a hospital emergency room in a coma with severe head injuries. A respirator was attached to the child in an effort to sustain his life. But the child didn't recover, and the attending physician, applying highly exacting criteria, determined that the child's entire brain had stopped functioning and would never function again.

By universally accepted medical standards, the child was dead. But the doctor did not make a death determination and remove the respirator that artificially supported the child's heart and lungs. Why?

Under the common law, death is a matter of heart and lung function. Before respirators and reliable techniques for determining brain death, the rule was simple: a person whose heart and lungs stopped was dead. Dead in New York, in California, in Florida everywhere.

Today the heart and lungs can be maintained artificially, even when the brain has been proven completely and unequivocally dead. Accordingly, a growing number of states make "brain death" a valid standard for determining death. Without a clear statutory authorization to declare brain death, an attending physician often waits until a patient's heart fails to declare death even though death has, in fact, already occurred. That is exactly what happened in this case, with possibly unjust results:

Authorities and hospital medical personnel suspected child abuse. The persons responsible for the child's injuries faced a possible murder charge. An immediate autopsy was essential to establish death by criminal means. But the doctor suspended the death determination until, a few weeks later, the child's heart failed completely. By that time, because of the normal process of decay, essential physical evidence of criminal injury had disappeared. No prosecution for any crime was possible.

Clearly, such a case poses legal and medical dilemmas. But they are not insurmountable. The solution is the Uniform Determination of Death (UDDA). The UDDA recognizes both the common law standard for determining death and accepted medical criteria for determining brain death. According to the act, a person who loses the total function of either the cardiorespiratory (basically, heart and lung) system, or of the entire brain, is legally dead.

ADVANTAGES OF THE UDDA

LESS CONFUSION: The UDDA gives physicians and hospitals the legal basis they need for making brain death determinations when a patient's heart and lungs are functioning under the artificial stimulus of a respirator. It eliminates unnecessary delays in declaring death, reducing needless confusion and expense for the patient's family.

UNIFORM STANDARDS: More than half of the states have enacted the UDDA, and uniform adoption elsewhere is essential. People don't necessarily decide where they will die. Their status as "alive" or "dead" should not depend on the capricious question of immediate locale.

ORGAN TRANSPLANTS: A state's adoption of the UDDA aids the medical profession in saving lives. Brain death determinations are important for organ transplantation, because once death occurs, viable organs begin to deteriorate. Brain death determinations make fresh organs more available to those who need them.

ACCURATE TIME-OF-DEATH DETERMINATIONS: An attending physician is required to establish the time of a patient's death. Time of death can have important legal consequences, and the UDDA will ensure that there is no uncertainty.

AVAILABILITY OF LIFE-SUPPORT APPARATUS: The UDDA will help assure the public that emergency equipment, such as respirators, will be available in crisis situations for patients whose lives can be saved.

FEWER COURT BATTLES: The UDDA discourages litigation over death determination questions. Litigation often follows confusion or disagreement over the standards to be used in a particular case. The UDDA makes the legal standards clear.