Nair-Collins Michael, Miller Franklin G
Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA.
Medical Ethics in Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
J Intensive Care Med. 2022 Feb;37(2):153-156. doi: 10.1177/0885066620939037. Epub 2020 Jul 6.
The legal standard for the determination of death by neurologic criteria in the United States is laid out in the Uniform Determination of Death Act (UDDA), which requires the irreversible cessation of all functions of the entire brain. Most other nations endorse a "whole-brain" standard as well. However, current practice in the determination of death by neurologic criteria is not consistent with this legal standard, because some patients who are diagnosed as brain-dead, in fact retain some brain function, or retain the capacity for the return of some brain function. In response, the American Academy of Neurology published updated guidelines, which assert that hypothalamic function is consistent with the neurological standard enshrined in the UDDA. Others have suggested that it is an open question whether the hypothalamus and pituitary are part of "the entire brain," as delineated in the UDDA. While we agree that determination of death practices are worthy of continued dialogue and refinement in practice that dialogue must adhere to reasonable standards of logic and scientific accuracy.
美国通过神经学标准判定死亡的法律标准在《统一死亡判定法案》（UDDA）中有明确规定，该法案要求全脑所有功能不可逆地停止。大多数其他国家也认可“全脑”标准。然而，目前通过神经学标准判定死亡的实践与这一法律标准并不一致，因为一些被诊断为脑死亡的患者实际上仍保留一些脑功能，或者保留了某些脑功能恢复的能力。作为回应，美国神经病学学会发布了更新后的指南，该指南断言下丘脑功能符合UDDA中所确立的神经学标准。其他人则认为，下丘脑和垂体是否属于UDDA中所界定的“全脑”的一部分，这是一个尚无定论的问题。虽然我们认同死亡判定实践值得持续进行对话并在实践中加以完善，但这种对话必须遵循合理的逻辑标准和科学准确性。
