Annals of Internal MedicineStandards and Ethics Issues in the Determination of Death: A Position Paper From the American College of Physicians

ACP Advocates for Ethical and Medical Clarity in Determining Death

The American College of Physicians (ACP) has released a comprehensive position paper that delves into the ethical, medical, and legal complexities surrounding the determination of death. The paper aims to provide clarity and guidance in an area fraught with controversies, especially in the wake of medical advancements and legal challenges.

HCN Medical Memo
The ACP’s position paper serves as a crucial guide in navigating the complex ethical and medical landscape surrounding the determination of death. It underscores the importance of aligning medical tests with existing standards and calls for educational efforts to improve communication skills, particularly in culturally sensitive contexts. This paper is not just a theoretical exercise; it has direct implications for your practice and the trust your patients place in you.

Key Points:

• Clarification to UDDA: The ACP supports revising the Uniform Determination of Death Act (UDDA) to replace the term “irreversible” with “permanent” for circulatory and respiratory functions but maintains “irreversible” for brain death.
• Independent Standards: The ACP advocates for maintaining the cardiorespiratory and neurologic standards as separate, independent criteria for determining death, aligning with current medical practice and respecting cultural and religious traditions.
• Whole Brain Standard: The paper opposes the adoption of “higher brain” function standards, arguing for a more biologically sound whole brain standard.
• Alignment of Medical Tests: The ACP emphasizes that medical tests should align with existing standards for determining death, rather than changing the standards to fit new or existing tests.
• Separation from Organ Transplantation: The paper reaffirms the importance of the “dead donor rule” and argues for the separation of the determination of death from issues related to organ transplantation.

One study estimated that almost 98% of in-hospital deaths are determined by circulatory criteria.

Additional Points:

• Educational Efforts: The ACP recommends additional education for healthcare professionals and the public to improve understanding and communication about the determination of death.
• Culturally Sensitive Communication: The paper highlights the need for culturally sensitive communication to address health disparities.

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