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Dr. David Crippen Co-Edits a Twelve-Part Series on Brain Death in the Journal of Critical Care

Tue, 08/26/2014

Dr. David Crippen and Leslie Whetstine (Ph.D., Professor of Philosophy, Walsh University, North Canton, OH) are currently editing a twelve-part series of articles in the Journal of Critical Care entitled, "Death by neurologic criteria 1968 - 2014: changing interpretations."

Two recent American court cases have caused a renewed interest in the issues surrounding brain death, and the apparent disagreements between the medical and philosophical definitions. For most physicians, no controversy surrounding brain death exists. The same cannot be said for public understanding, however. “The response to these cases once again revealed the public’s confusion over the concept, practice, and legality of brain death,” writes James L. Bernat, MD, in the Foreword.

This misunderstanding among patients and their families could perhaps arise from a simple misconstruing of the definition of brain death. As Dr. Crippen notes, “The original definition of brain death was loosely based on the failure of the brain to integrate the rest of the organs.” But developments in technology have led to situations in which “the body can be fed artificially—the air going in and out and the blood going round and round—thereby maintaining stone dead bodies for months or years in a condition that appears to mimic life to their surrogates.” Therefore, as Dr. Crippen concludes, our current definition of brain death is flawed, requiring a thorough revision. This series assembles physicians, philosophers, and medical-legal consultants in an effort to clarify the issues surrounding the conversation.

The articles are released in groups of three in successive issues of the Journal of Critical Care, beginning in April 2014 and ending in December 2014. According to Dr. Crippen, “These articles will eventually become free to anyone wishing to download them, their content reaching interested physicians much faster than if they were put into textbook form.”

Dr. Crippen, Professor in the Departments of Critical Care Medicine and Neurological Surgery, contributed the eighth article in the series, “Rejection of death by neurological criteria by the public; rights and responsibilities of surrogates, health care systems.” Dr. Crippen is not the only contributor from the Department of Critical Care Medicine, however. Dr. Lori Shutter, Professor in the Departments of Critical Care Medicine and Neurology and Director of the Neurocritical Care Fellowship program, also contributed to the series with the third article, “Pathophysiology of brain death. What does the brain do and what is lost in brain death?”

Below is a list of the articles in the series, followed by the author’s credentials:

-Forward:  (Jim Bernat, MD)
-Article I. History of brain death as death: 1968 to the present. (Michael DeGeorgia, MD)
-Article 2:  "Understanding the Spectrum of Catastrophic Brain damage: Cerebral cessation, Brain stem cessation, persistent vegetative state and minimally conscious state (Javier Provencio, MD).
-Article 3:  Pathophysiology of brain death. What does the brain do and what is lost in brain death. (Lori Shutter, MD)
-Article 4: Biophilosophical justification for regarding brain death as death. The relationship between the brain as the heart/circulation in brain death determination. (Sam Shemie, MD)
-Article 5: Biophilosophical criticisms of regarding brain death as death (Leslie Whetstine, PhD
-Article 6: Analysis/critique on the understanding of brain death by lawyers, health care professionals and the public (Jack Kilculle, MD, JD)
-Article 7:  Religious objections to brain death (Eran Segal, MD)
-Article 8: Rejection of death by neurological criteria by the public. Rights and responsibilities of surrogates, health care systems. (Dave Crippen, MD)
-Article 9: Analysis of the reports of high-level commissions that have comprehensively reviewed US public policy on brain death (US President's Commission in 1981; Institute of Medicine in 1995; US President's Council in 2008) and discuss why they ruled as they did. (Andy Kofke, MD)
-Article 10: Where have we been? Where are we going? Initiatives to improve uniformity of policies, integrity of practice, and improve understanding of brain death within the global medical community and lay public. (Sam Shemie, MD)
-Article 11:  The future of death. (Brian Wowk, PhD)
-Afterword: (Dave Crippen and Leslie Whetstine, PhD)
David Crippen, MD, FCCM
Departments of Critical Care Medicine and Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA
Leslie M. Whetstine, PhD
Department of Philosophy
Walsh University
North Canton, Ohio
Lori Shutter, MD, FCCM, FNCS
Departments of Critical Care Medicine & Neurology
Director, Neurocritical Care fellowship
University of Pittsburgh School of Medicine
Pittsburgh, PA
Sam Shemie, MD
Director, Pediatric critical care 
Director of Extracorporeal Life Support
Montreal Children’s Hospital,
McGill University
Montreal, CANADA
J. Javier Provencio, MD, FCCM, FAAN, FNCS
Associate Professor
Lerner College of Medicine at CWRU 
Faculty - Neuroinflammation Research Center
Associate Director | Neurocritical Care Fellowship
9500 Euclid Ave NC30 
Cleveland, OH
James Bernat, MD
Professor of Neurology and Medicine
Louis and Ruth Frank Professor of Neuroscience
Geisel School of Medicine
Dartmouth Hitchcock Medical Center
Lebanon, NH
Andrew Kofke, MD
Departments of Anesthesiology and Neurosurgery
Director Neuroanesthesia
University of Pennsylvania
Philadelphia, PA
Michael DeGeorgia, MD
Departments of of Neurology and Neurosurgery
Maxeen Stone and John A. Flower Endowed Chair in Neurology
Director of the Reinberger Neuroscience Intensive Care Unit
University Hospitals Case Medical Center
Cleveland, Ohio
Eran Segal, MD
Director, General ICU
Sheba Medical Center
Tel-Hashomer Hospital
Tel Aviv, Israel
John Kilcullen, MD, JD
Attending Intensivist
Medical-Legal consultant
Pulmonary and Medical Associates of Northern Virginia, LTD.
Falls Church, VA
Brian Wowk, PhD
Medical physicist and cryobiologist
Senior physicist, 21st Century Medicine, Inc.
Fontana, CA