James L Bernat
Biographic Data
| ID | 4497421 |
|---|---|
| NAME | James L Bernat |
| GIVEN NAMES | James L |
| FAMILY NAME | Bernat |
| SIGNATURE | BERNAT J L |
| AFFILIATIONS | Dartmouth College |
| ORCID | 0000-0003-1128-0442 |
| VERIFIED | Yes |
| TOTAL WORKS | 20 |
| TOTAL CITATIONS | 0 |
| AUTHOR COUNT | 19 |
| EDITOR COUNT | 1 |
| FIRST PUBLICATION YEAR | 1982 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 0 |
The Ethics of Heart Donation After the Circulatory Determination of Death: Gaps in Knowledge and Research Opportunities
In 2023, the National Heart, Lung, and Blood Institute (NHLBI) organized a workshop to identify research gap areas in organ donation after circulatory determination of death (DCDD). We present the findings of the DCDD ethics working group. Heart DCDD, as all DCDD, may disrupt optimal end‐of‐life care. Irrespective of organ donation, research opportunities include identifying which processes of withdrawal of life‐sustaining therapy offer optimum p…
Adam Omelianchuk, Alexander Morgan Capron, Lainie Friedman Ross, Arthur R. Derse, James L. Bernat, and David Magnus reply
This letter responds to letters by Garson Leder and by Harrison Lee in the same issue, September‐October 2024, of the Hastings Center Report
Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion
In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. …
Death Determination by Neurologic Criteria: Areas of Consensus and Controversy
Death Determination by Neurologic Criteria: Areas of Consensus and Controversy
What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed
Mismatch between whole-brain death criteria embedded in statutes and accepted tests physicians use to diagnose brain death have clinical and ethical implications that could undermine public trust in death pronouncements. We consider merits and drawbacks of 4 ways to address this problem
A Conceptual Justification for Brain Death
Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I firs…
Conceptual Issues in DCDD Donor Death Determination
Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long‐standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of…
How Should Physicians Manage Organ Donation after the Circulatory Determination of Death in Patients with Extremely Poor Neurological Prognosis
Organ donation after the circulatory determination of death (DCDD) accounts for a growing percentage of deceased organ donations. Although hospital DCDD protocols stipulate donor death determination, some do not adhere to national guidelines that require mechanical, not electrical, asystole. Surrogate decisions to withdraw life-sustaining therapy should be separated from decisions to donate organs. Donor families should be given sufficient inform…
Should Dementia Be Accepted as a Disability to Help Restore Hope during Cognitive Decline
Dementia is a common condition that impacts the patient, the family, and society. Currently, a diagnosis of dementia evokes hopelessness in the afflicted, and society provides few resources or systematic support for caregivers or for demented patients. In this commentary, we discuss the origins of hopelessness in dementia, the World Health Organization's six-stage framework of dementia care, and barriers to "normalizing" the experience of dementi…
Determining Death in Uncontrolled DCDD Organ Donors
The most controversial issue in organ donation after the circulatory determination of death is whether the donor was truly dead at the moment death is declared. My colleagues and I further analyzed this issue by showing the relevance of the distinction between the “permanent” and the “irreversible” loss of circulatory functions. Permanent cessation means that circulatory function will not return because it will not be restored spontaneously and m…
On Noncongruence between the Concept and Determination of Death
A combination of emerging life support technologies and entrenched organ donation practices are complicating the physician's task of determining death. On the one hand, technologies that support or replace ventilation and circulation may render the diagnosis of death ambiguous. On the other, transplantation of vital organs requires timely and accurate declaration of death of the donor to keep the organs as healthy as possible. These two factors h…
The Ethics of Diagnosing Nonepileptic Seizures with Placebo Infusion
Case Ms. Lamonica was admitted for a neurological evaluation after experiencing 2 severe seizures. At 38, Ms. Lamonica was overweight, but otherwise in good health. All studies including electroencephalograms (EEG) were normal. Because her description of her seizures seemed to exclude epilepsy—she remained fully conscious during the events, for example, and experienced no confusion afterward—her team of neurologists led by Dr. Patel began to susp…
Death: Merely Biological
A Defense of the Whole-Brain Concept of Death
The concept of whole-brain death is under attack again. Scholars are arguing that the concept of brain death per se--regardless of the focus on "higher," "stem" or "whole"--is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole-brain death rem…
Refusals Involving Requests
Madam: In highlighting the difference between patient refusals and patient requests, Gert, Bernat, and Mogielnicki (HCRJuly-August 1994) have contributed to the ever-pressing task of clarifying those vague and ambiguous terms and concepts (such as choice) into which our moral rhetoric frequently retreats. In delineating these concepts, they help us to clarify the moral obligations of physicians for those situations in which hon
Distinguishing between Patients' Refusals and Requests
To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die
What It Means to Be Dead
Robert M. Veatch, James L. Bernat, Charles M. Culver, Bernard Gert, James LeRoy Smith, Alexander M. Capron, Joanne Lynn, What It Means to Be Dead, The Hastings Center Report, Vol. 12, No. 6 (Dec., 1982), pp. 45-46
Defining Death: Which Way
Defining Death in Theory and Practice
No prominent works on this page.
What It Means to Be Dead
Robert M. Veatch, James L. Bernat, Charles M. Culver, Bernard Gert, James LeRoy Smith, Alexander M. Capron, Joanne Lynn, What It Means to Be Dead, The Hastings Center Report, Vol. 12, No. 6 (Dec., 1982), pp. 45-46
Defining Death: Which Way
Defining Death in Theory and Practice
Distinguishing between Patients' Refusals and Requests
To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die
Refusals Involving Requests
Madam: In highlighting the difference between patient refusals and patient requests, Gert, Bernat, and Mogielnicki (HCRJuly-August 1994) have contributed to the ever-pressing task of clarifying those vague and ambiguous terms and concepts (such as choice) into which our moral rhetoric frequently retreats. In delineating these concepts, they help us to clarify the moral obligations of physicians for those situations in which hon
A Defense of the Whole-Brain Concept of Death
The concept of whole-brain death is under attack again. Scholars are arguing that the concept of brain death per se--regardless of the focus on "higher," "stem" or "whole"--is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole-brain death rem…
Death: Merely Biological
The Ethics of Diagnosing Nonepileptic Seizures with Placebo Infusion
Case Ms. Lamonica was admitted for a neurological evaluation after experiencing 2 severe seizures. At 38, Ms. Lamonica was overweight, but otherwise in good health. All studies including electroencephalograms (EEG) were normal. Because her description of her seizures seemed to exclude epilepsy—she remained fully conscious during the events, for example, and experienced no confusion afterward—her team of neurologists led by Dr. Patel began to susp…
Determining Death in Uncontrolled DCDD Organ Donors
The most controversial issue in organ donation after the circulatory determination of death is whether the donor was truly dead at the moment death is declared. My colleagues and I further analyzed this issue by showing the relevance of the distinction between the “permanent” and the “irreversible” loss of circulatory functions. Permanent cessation means that circulatory function will not return because it will not be restored spontaneously and m…
On Noncongruence between the Concept and Determination of Death
A combination of emerging life support technologies and entrenched organ donation practices are complicating the physician's task of determining death. On the one hand, technologies that support or replace ventilation and circulation may render the diagnosis of death ambiguous. On the other, transplantation of vital organs requires timely and accurate declaration of death of the donor to keep the organs as healthy as possible. These two factors h…
Should Dementia Be Accepted as a Disability to Help Restore Hope during Cognitive Decline
Dementia is a common condition that impacts the patient, the family, and society. Currently, a diagnosis of dementia evokes hopelessness in the afflicted, and society provides few resources or systematic support for caregivers or for demented patients. In this commentary, we discuss the origins of hopelessness in dementia, the World Health Organization's six-stage framework of dementia care, and barriers to "normalizing" the experience of dementi…
A Conceptual Justification for Brain Death
Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I firs…
Conceptual Issues in DCDD Donor Death Determination
Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long‐standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of…
How Should Physicians Manage Organ Donation after the Circulatory Determination of Death in Patients with Extremely Poor Neurological Prognosis
Organ donation after the circulatory determination of death (DCDD) accounts for a growing percentage of deceased organ donations. Although hospital DCDD protocols stipulate donor death determination, some do not adhere to national guidelines that require mechanical, not electrical, asystole. Surrogate decisions to withdraw life-sustaining therapy should be separated from decisions to donate organs. Donor families should be given sufficient inform…
What Should We Do About the Mismatch Between Legal Criteria for Death and How Brain Death Is Diagnosed
Mismatch between whole-brain death criteria embedded in statutes and accepted tests physicians use to diagnose brain death have clinical and ethical implications that could undermine public trust in death pronouncements. We consider merits and drawbacks of 4 ways to address this problem
Death Determination by Neurologic Criteria: Areas of Consensus and Controversy
Death Determination by Neurologic Criteria: Areas of Consensus and Controversy
Adam Omelianchuk, Alexander Morgan Capron, Lainie Friedman Ross, Arthur R. Derse, James L. Bernat, and David Magnus reply
This letter responds to letters by Garson Leder and by Harrison Lee in the same issue, September‐October 2024, of the Hastings Center Report
Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion
In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. …
The Ethics of Heart Donation After the Circulatory Determination of Death: Gaps in Knowledge and Research Opportunities
In 2023, the National Heart, Lung, and Blood Institute (NHLBI) organized a workshop to identify research gap areas in organ donation after circulatory determination of death (DCDD). We present the findings of the DCDD ethics working group. Heart DCDD, as all DCDD, may disrupt optimal end‐of‐life care. Irrespective of organ donation, research opportunities include identifying which processes of withdrawal of life‐sustaining therapy offer optimum p…
Psychology (14 works) · Medicine (9 works) · Organ Donation and Transplantation (9 works) · Palliative Care and End-of-Life Issues (9 works) · Grief, Bereavement, and Mental Health (7 works) · Law (7 works) · Political science (5 works) · Intensive care medicine (4 works) · Organ donation (4 works) · Surgery (4 works)