Management of seven stable levels of brain death.

We have presented the choices available in the management of seven representative kinds of brain death and partial death as well as their legal ramifications. Refinements of tests of brain functions and new methods of evaluating cerebral blood flow allow more and more accurate estimates of brain viability. Human qualities of life are directly related to how much and which parts of the brain are viable and are indistinguishable from life itself. The decision to end life support should at present remain with the attending physician. New statutes concerning brain death imply that irrefutable technical evidence is readily available to diagnose brain death, that brain death is as valid a sign of death as any former criteria, and that in certain situtations brain death must be used to pronounce death. From the medical practitioner's viewpoint, we believe that a brain death law would rarely be useful and that community and national customs concerning heroic efforts would be sufficient. We do support a simple acknowledgement by statute that brain death may be a cause for determining death. The legal need for determining a precise time of death is understandable, but premature and restrictive definitions based on a rapidly evolving technology will create many problems.