Discrepancies between the Uniform Determination of Death Act (UDDA) and the adult and pediatric diagnostic guidelines for brain death (BD) (the “Guidelines”) have motivated proposals to revise the UDDA. A revision proposed by Lewis, Bonnie and Pope (the RUDDA), has received particular attention, the three novelties of which would be: (1) to specify the Guidelines as the legally recognized “medical standard,” (2) to exclude hypothalamic function from the category of “brain function,” and (3) to authorize physicians to conduct an apnea test without consent and even over a proxy’s objection. One hundred seven experts in medicine, bioethics, philosophy, and law, spanning a wide variety of perspectives, have come together in agreement that while the UDDA needs revision, the RUDDA is not the way to do it. Specifically, (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD in a non-BD patient, provides no benefit to the patient, does not reliably accomplish its intended purpose, and is not even absolutely necessary for diagnosing BD according to the internal logic of the Guidelines; it should at the very least require informed consent, as do many procedures that are much more beneficial and less risky. Finally, objections to a neurologic criterion of death are not based only on religious belief or ignorance. People have a right to not have a concept of death that experts vigorously debate imposed upon them against their judgment and conscience; any revision of the UDDA should therefore contain an opt-out clause for those who accept only a circulatory-respiratory criterion.

中文翻译：

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支持修订《统一死亡判定法》并反对拟议修订的声明


《统一死亡判定法》(UDDA) 与成人和儿童脑死亡 (BD) 诊断指南（“指南”）之间的差异促使人们提出修订 UDDA 的建议。 Lewis、Bonnie 和 Pope（RUDDA）提出的修订受到了特别关注，其三个新颖之处是：（1）将指南明确为法律认可的“医学标准”，（2）排除下丘脑功能(3) 授权医生在未经同意甚至代理人反对的情况下进行呼吸暂停测试。一百七名来自医学、生物伦理学、哲学和法律领域的专家，他们的观点各异，他们一致认为，虽然 UDDA 需要修订，但 RUDDA 并不是这样做的方法。具体来说，(1) 该指南存在不可忽视的假阳性错误风险，(2) 下丘脑功能与整个有机体的相关性比任何脑干反射更相关，(3) 呼吸暂停测试存在引发非 BD 患者出现 BD，对患者没有任何益处，不能可靠地实现其预期目的，甚至根据指南的内在逻辑，对于诊断 BD 来说并不是绝对必要的；它至少应该需要知情同意，就像许多更有益且风险更小的程序一样。最后，对死亡的神经学标准的反对不仅仅基于宗教信仰或无知。人们有权不接受专家们激烈争论的违背他们的判断和良心强加给他们的死亡概念；因此，UDDA 的任何修订都应包含针对那些仅接受循环呼吸标准的人的选择退出条款。