The Future of Brain Death: Epistemic Equality Through Inclusive Policy

In 2021, in response to growing concerns and skepticism surrounding the legitimacy of death by neurological criteria, the Uniform Law Commission's Executive Committee voted to create a drafting committee to propose revisions to the Uniform Determination of Death Act (UDDA). To guide their work, the drafting committee was tasked with investigating five questions, including "How should objections to the use of neurologic criteria to declare death be handled?" Engaging this question, we argue that the concept of neurological "death" is not based in science or biology but is a value-centric and socially constructed conception derived from unshared metaphysical and epistemological frameworks. And, despite the diversity of perspectives on death, there remains a persistent objective to enforce a singular view of death that excludes diverse populations as stakeholders and discredits alternate views as inferior and misinformed. Moreover, we hold that current policies surrounding brain death, including unilateral extubation, continue to inflict unjustified harm and deepen epistemic injustice under the guise of legitimate force. To address these harms, we argue two main points. First, that epistemological equity, exercised through inclusive discourse and resulting in inclusive policies, is fundamental to understanding that conceptions of death are inextricably bound to particular worldviews. And second, by mobilizing force individuals and communities who object to death by neurologic criteria are being illegitimately forced to conform to a "consensus" that has not adequately accounted for their values or underlying worldviews.

Jenny McCurdy, PhD, RN, MH, HEC-C – Assistant Professor, Center for Bioethics and Social Justic, Michigan State University; Georgina Campelia, PhD, HEC-C – Assistant Professor, Bioethics and Humanities, UW Medicine