1968

Report of Harvard Brain Death Committee, authored especially by anesthesiologist Henry Beecher and neurologist Robert Schwab: Death could be declared if three criteria were met: no movement or breathing; no reflexes; and flat EEG. Brain death justifies pronouncement of death for patient in irreversible coma. Report was not an attempt to expand transplantation, but rather a focusing on “The contingent balance of specific purposes, risks, and similarity to therapeutic ends in routine medical practice”; this was held to be “a better guide for an ethic of experimentation [i.e., transplantation] that protected persons (Belkin, 354). . . . “[Influenced by philosopher Joseph Fletcher] Beecher struggled with the morality of relationships, like between researcher and subject, based on the results of the particular way others were treated. He came to rely on a situation ethics in which the specific good at stake was critical for moral judgment. But means had to live up to their ends. The use of informed consent, although necessary, was unreliable as a guarantee for the protection of subjects from the vested interests of investigators or of society. . . . “Beecher described how this connection between his ethics of how to protect the individual and the need to set limits in uses of medical technology could be guided via a definition of brain death. He suggested that criteria developed by Schwab was the place to begin setting such limitations. Treatment of no value was ethically suspect as a waste of resources and an intrusion into the rights of the individual to the degree that it strayed from a compelling balance. At the core of his experimentation ethics was therapeutic purpose and appropriate means as judged within the context of the given situation, in this (355). . . .case, that of the irreversibly comatose. For Beecher, concerns about transplant, his call to limit treatment in the irreversibly comatose, and experimentation ethics were each a reflection of the larger problem of how to reconcile benefits of medical technology with personal dignity, with what he called ‘the right to be let alone’ (356). . . . Transplantation was ethically clarified as a subset of the primary problem of coma and hopelessness. . . Using intrusive techniques to support a hopelessly unconscious patient without brain function could neither summon itself as an appropriate end nor a valuable basis to evaluate means, except as an attempt to harvest organs for others. “Transplantation did not cause the Ad Hoc Committee’s pursuit of irreversible coma; it redeemed medical treatment in those cases” (357). . . . In the context of increasingly interventionist medical practice, irreversible coma offered a bottom-line standard for consensus that reliably indicated both the point at which treatment became ethically unacceptable, and at the same time framed when experimentation (transplant) could be considered” (358).