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To the Editor: The 1968 JAMA article¹ presenting criteria for brain death justly deserves to be considered a classic. However, while the article provided criteria for the diagnosis of irreversible coma, it did not offer a rationale for why these criteria should be diagnostic of the death of a human being.

The commentary by Dr Rosenberg² did not mention the controversy over the status of patients diagnosed as brain dead, which has intensified over the last 20 years. Reflecting this controversy, the President's Council on Bioethics recently issued a white paper, "Controversies in the Determination of Death."³ Patients with brain death maintained on mechanical ventilation retain an array of vital functioning that makes it very difficult to give a coherent account of why they are dead.⁴

Forty years after the publication of the classic article, the consensus that brain death constitutes death of a human being has eroded. Although the . . . [Full Text of this Article]

Franklin G. Miller, PhD
fmiller@nih.gov
Department of Bioethics
National Institutes of Health
Bethesda, Maryland

Robert D. Truog, MD
Harvard Medical School
Boston, Massachusetts

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