Yanke Greg, Rady Mohamed Y, Verheijde Joseph L
School of Historical, Philosophical, and Religious Studies, Arizona State University, 975 S Myrtle Ave, Tempe, AZ, 85287, USA.
Department of Critical Care, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
J Bioeth Inq. 2018 Jun;15(2):193-198. doi: 10.1007/s11673-018-9852-y. Epub 2018 Apr 17.
In early 2017, Nevada amended its Uniform Determination of Death Act (UDDA), 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 (AAN) 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.
2017年初，内华达州修订了其《统一死亡判定法案》（UDDA），以明确死亡判定的神经学标准。修正案规定，死亡判定是一项临床决定，无需家属同意，且判定神经学死亡的适当标准是美国神经病学学会（AAN）的指南。一旦医生做出这样的死亡判定，内华达州修正案要求在24小时内撤除维持生命的治疗，但有有限的例外情况。神经学家普遍支持内华达州的修正案，认为其明确了诊断标准并限制了家庭成员对此提出质疑的能力。然而，更应担忧地看待内华达州的修正案。尽管《统一死亡判定法案》的主要目的是确保一个人整个大脑的所有功能都已停止，但美国神经病学学会的指南并未准确评估这一点。此外，内华达州立法机构将死亡判定仅仅描述为一项临床决定，不当忽视了知情同意原则，以及拒绝脑死亡的特定信仰和文化的观念。内华达州的修正案非但没有解决关于脑死亡判定的争议，反而可能引发众多宪法挑战。
