History matters: Putting the brain back into a history of brain death

Gary S. BELKIN
Erich Lindemann Mental Health Center, Harvard University, Boston, Massachusetts 02114 USA

When death occurs remains an active area of controversy, debate and uncertainty, unresolved by the advent of the 1968 "Harvard Committee" report declaring irreversible coma as a preferred standard method for declaring death. Debates swirling around the brain death construct, from calls to restrict it to "higher" cortical functions, to those wishing to abandon it altogether, often rest upon certain historical narratives of the development of the idea in the first place. Similarly, the appearance of brain death and reaction to it was an early skirmish defining and giving impetus to the early bioethics movement in the 1960's. Histories of that now flourishing and influential movement have generally cast the Harvard accomplishment as a narrow, self-protective assertion of medical authority, thus reinforcing the movement's own claims to provide unique and legitimate scrutiny and insight.

These histories of brain death, however, generally fail to actually study the roots of this idea and practice. In this paper I will detail, through close readings of successive drafts of the Harvard report, and in particular the papers and central contributions of MGH neurologist and Committee member Robert Schwab, how the neuroscientific and clinical context shaped selection of the criteria. I examine the EEG-neurophysiological and clinical-neurological literatures and context during the decades prior and up to 1968 that were resources for his, and other's, efforts to explore relationships between coma, consciousness and death. By doing so, insights are made available to inform current debates about brain death, and bioethics emerges as a discipline requiring new historical and intellectual models of itself.


Session VIII -- Later 20th Century: Current Issues
Tuesday, 13 June 2000, 3:30 - 4:00 pm

Fifth Annual Meeting of the International Society for the History of the Neurosciences (ISHN)

Providence, Rhode Island, USA