The neurology of death and what it does not mean

Brain death is a neurological condition on which much can be said and theorized. A recent book Death Before Dying —with its contradictio in terminis title—puts some of the disputes on what could be called ‘the neurology of death’ into historical perspective. Belkin is a psychiatrist from New York University Langone Medical Centre who has a PhD in the history of science. During his psychiatry residency more than 20 years ago, he personally dissected the ‘Beecher papers’: the collected correspondence and drafts from the Harvard Medical School Ad Hoc Committee set up to examine the definition of brain death. To gain a fuller perspective, he also interviewed many neurologists and other physicians, including members of the Harvard Committee (the ‘brain death architects’ as he calls them). In Death before Dying , Belkin provides a good insight into the deliberations of the Committee and, more speculatively, places the Harvard criteria of brain death and its prior deliberation into the early history of medical ethics.The book takes a broad sweep, has many asides and dense prose, particularly when Belkin posits that ‘the explosive growth of bioethics was a response to a loss of faith in the pragmatism of the medical point of view, of the thought style and structure of medical knowledge as a source of values’. It leans heavily on personal remembrances by neurologists of the day and, although this can sometimes give a skewed one-sided view, it also produces a plethora of anecdotes and sentiments. Ultimately, the book is about Henry Beecher, the Committee and the Law, but also on how coma became better understood and the aforementioned emerging role of bioethics. This work is an exploration of, in essence, a very simple neurological finding generating all sorts of vexed questions and sophistical arguments. Belkin does much right in …